17.11.2021 – 11:36
Swiss Insurance Association ASA
Berne (ots)
From 2022, new rules will apply to complementary hospital insurance, for the sake of transparency and clarity. With the sectoral guidelines for supplementary health insurers, the benefits payable by supplementary hospital insurance must be clearly indicated. This is the start of a transitional phase during which the old conventions will have to be adapted to the new directives.
The year 2022 is an important date for the reinforcement of transparency and readability in supplementary hospital insurance. In the future, new conventions will have to meet the eleven principles of the sector guidelines developed by complementary health insurers under the aegis of the Swiss Insurance Association ASA and adopted in June this year with binding effect. The new rules involve the overhaul of nearly a thousand existing agreements and must be applied before the end of 2024. From now on, it is the “principle of the additional service” which applies. Benefits exceeding the basic insurance must be clearly defined and evaluated. This change of model is consistent with the expectations of the supervisory authority in terms of transparency and readability.
In addition to the guidelines and their eleven principles, the requirements for supplementary medical services are specified in a addendum. This concerns in particular the services provided by independent hospital doctors who are not employed by the hospital but operate there in parallel with the activity which they exercise in their own practice.
Conditions for the tariff models formulated
Additional medical services must be defined and evaluated on a precise price basis. For the purpose of verifying their compliance with sectoral guidelines, supplementary health insurers have therefore formulated criteria with which the pricing models for supplementary medical services must comply. At present, none of the existing pricing models for complementary hospitalization meet the requirements of sector guidelines. Contractual partners – service providers and supplementary health insurers – must be given the opportunity to adapt their models before the end of 2023 so that they comply with sector guidelines. Urs Arbter, Deputy Director of ASA, says: “It is up to the contractual partners to show through what actions and intermediate steps they intend to achieve this goal.”
The sector guidelines “Additional benefits according to the VVG” of Swiss supplementary health insurers also form the basis on which service providers and insurers can rely when drawing up their supplementary service agreements. As regards the settlement of supplementary benefits according to the LCA, the agreements must comply with the principles of the sector guidelines. These conditions can easily be fulfilled by concentrating on an agreement between the complementary health insurer and the hospital providing the services as well as on framework agreements with the hospital and subsidiary agreements with independent hospital doctors. During the transitional period, the contractual partners are required to find an appropriate way to achieve the final objective.
Transition period for existing contracts until the end of 2024
In addition, supplementary health insurers have specified their minimum billing requirements. The aim is to strengthen transparency and improve readability for clients, but also for the insurance department responsible for checking invoices. Appropriate pricing models and agreements between the different parties involved are the foundation.
As supplementary health insurers announced in June 2021, from January 2022, only agreements that comply with sectoral guidelines will be concluded. A transitional period is granted to existing agreements until the end of 2024 at the latest.
Supplementary hospital insurance in private and semi-private wards are very popular in Switzerland
Almost 2.4 million people domiciled in Switzerland have taken out supplementary hospitalization insurance in a private or semi-private ward. They are fully aware of the added value of complementary hospital insurance for their health and thus invest knowingly – and voluntarily – in a cover exceeding that of the compulsory health insurance. People with additional hospitalization insurance are offered additional possibilities, such as the free choice of doctor, the intervention of other doctors, more comfort or faster and more flexible access to services. They also benefit from individualized therapies as well as innovative products and services. These customer needs are covered by supplementary insurance, which is governed by the Federal Law on Insurance Contracts (LCA).
Contact:
Swiss Insurance Association ASA
Andrea Hohendahl, press officer
Telephone: +41 44 208 28 21
email: [email protected]
Operational center telephone: +41 44 208 28 28
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