You have a problem with your supplementary health insurer

Health insurance is regulated by two separate bodies. FINMA is only responsible for supplementary health insurance which falls under the Insurance Contract Act. Here you can find answers to frequently asked questions and information on how to deal with problems with your supplementary health insurer. FINMA will review your tip-offs regarding possible irregularities. Where there is concrete evidence that the Insurance Contract Act has been violated, FINMA carries out further investigations and imposes measures on the supervised institution if necessary.

Have you already talked to the insurance company?

Lots of problems can be resolved by talking directly to your insurer – but we recommend going straight to management.

What role does FINMA play in regulating health insurance?

Health insurance is regulated by two separate bodies. The Federal Office of Public Health (FOPH) is responsible for compulsory health insurance and for the optional insurance that provides daily benefits under the Federal Act on Health Insurance. FINMA is only responsible for optional health insurance which falls under the Insurance Contract Act, widely known as supplementary health insurance.

Must I purchase my supplementary insurance from the same company as my basic health insurance?

No. These are distinct insurance contracts, and so they can be taken out independently.

What are the pros and cons of holding basic and supplementary health insurance with different providers?

The downside to having two providers is that policyholders need to think about who will settle which claim. The freedom to switch your basic insurance to a cheaper provider may be a financial advantage.

Does FINMA publish the premiums for supplementary insurance?

No. They are part of the provider’s business plan, which means they are treated as a trade secret. FINMA is bound by professional secrecy not to reveal data like this. Companies can decide for themselves how much of this information they want to publish.

Can my supplementary health insurer increase my premium if I take out basic health insurance with a different company?

Yes, it can. Some providers will only offer a discount on your supplementary insurance if you also hold your basic health insurance with them. They are also allowed to charge an administration fee or a minimum premium if they no longer provide your basic insurance. That is because the administrative costs for managing the rest of your insurance will be proportionally higher. To be on the safe side, ask your supplementary insurer before signing up.

Can my supplementary insurer increase the premium before my policy expires?

Yes, as long as the general policy conditions provide for this eventuality, which they usually do. Any adjustment to premiums must be reviewed by FINMA before it takes effect. FINMA will approve or reject the change, depending how solvent the product is.

As the tariffs for supplementary health insurance are often based on age categories, your premium might increase when you move up a category. If this happens, you are entitled to cancel your policy.

Policyholders must be told in good time that their tariff is going to change. If you do not agree to it, you can cancel your policy. If you do not make use of this right, the company will assume that you have accepted the change.

Can my insurer cancel my supplementary insurance if I cancel my basic health insurance with them and switch to a different provider?

No. The law explicitly states that supplementary health insurance may not be terminated on such grounds.

Can my insurer cancel my supplementary health insurance if I make a claim?

Nearly all insurers state in their terms and conditions that they will not make use of this option, although by law both parties to a contract have the right to terminate it. The general policy conditions are decisive. Policyholders can always cancel after a claim, as long as they do so by the date of settlement.

Can an insurer modify the cover provided by the policy?

Basically no, because in the private insurance sector any contractual changes require the explicit consent of both parties. An insurance company can, however, state in its general policy conditions that specific details (such as recognised therapists, recognised treatments, etc.) will be set out in a separate list. This list can be altered unilaterally by the insurer, notably to take on board recent medical research or to update its record of practising therapists. This does not entitle the policyholder to cancel the contract.

The general policy conditions may also state that the insurer is allowed to modify the terms to reflect changes in the health service, in particular if the statutory benefits provided by basic health insurance are redefined. As with premium adjustments, the policyholder has a right to cancel if this happens.

FINMA monitors premiums to ensure they are always justified by the benefits they offer. Adjustments must not be used to alter the tariff structure.