Premium invoice

Correction of premium imbalances pursuant to Articles 106 and 106a of the Swiss Health Insurance Act (KVG)

On 21 March 2014, the Federal Parliament voted to address the problem of cantonal imbalances in basic health insurance premiums that had emerged in the period between 1996 and 2013.

  1. Premium structure
  2. Basis of calculation
  3. What does this mean for you (Art. 106 KVG) ?
  4. Information on premium calculation for insured persons belonging to canton group 1 (AI, FR, GE, GR, TG, TI, VD, ZG, ZH)
  5. Information on premium calculation for insured persons belonging to canton group 3 (AG, BS, NE, SG, SZ, VS)
  6. What happens if there is a change of residence in 2016?
  7. Premium surcharge for 2016 in accordance with Article 106a KVG
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Premium structure

The imbalances came about because, in some cantons, insured persons were paying more towards the cost of basic insurance – relative to the cost of the benefits – than in others, even though the premiums had been approved by the relevant authorities. Over the years, health insurers have always abided by the laws governing premiums and their structure.

The process of adjusting historic premium payments will take place between 2015 and 2017 and the decision will be final.

Totalling some CHF 800 million, the compensation amount will be funded as follows:

• ⅓ via redistribution of premiums among insured persons in the cantons

• ⅓ from federal tax revenues

• ⅓ from the free reserves of health insurers

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Basis of calculation

The Federal Office of Public Health (FOPH) is responsible for calculating the premium adjustments. The FOPH figures are identical for all health insurers and are binding. For their part, the health insurers are responsible for implementing the changes passed by parliament.

The premium adjustment is determined by your official place of residence on 1 January 2016. Where you lived before that date is irrelevant in terms of the redistribution of premiums.

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What does this mean for you (Art. 106 KVG) ?

Depending on where you live on 1 January 2016, you fall into one of the following groups of cantons.

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Information on premium calculation for insured persons belonging to canton group 1 (AI, FR, GE, GR, TG, TI, VD, ZG, ZH)

If your official place of residence is in one of the above cantons on 1 January 2016, you will receive a one-off premium credit in June 2016 (consisting of a premium rebate and a premium refund). You will not receive a credit if you relocate to a canton in canton group 2 or 3 before the above qualifying date. The amount of the credit will be offset or paid out.

Canton Amount per person
ZH CHF 37.00
ZG CHF 13.35
FR CHF 16.25
AI CHF 20.75
GR CHF 0.45
TG CHF 48.10
TI CHF 60.75
VD CHF 86.05
GE CHF 57.30

Information on premium calculation for insured persons belonging to canton group 2 (AR, BE, BL, GL, JU, LU, NW, OW, SH, SO, UR)

If your official place of residence is in one of the above cantons on 1 January 2016, you will have to pay a monthly premium surcharge. The Federal Office of Public Health (FOPH) calculated the premium surcharge for 2016 as follows: Residents of the cantons AR, BE, BL, GL, JU, NW, OW, SH, SO, UR pay CHF 4 per month. Residents of the canton LU pay CHF 1.50 per month. The premium surcharge will be offset against your compulsory basic insurance premium and shown separately in your policy documents. The surcharge is the same for every insured person in the canton.

This adjustment will be shown as follows in an additional line on every KVG policy: "Premium surcharge pursuant to Art. 106 KVG"

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Information on premium calculation for insured persons belonging to canton group 3 (AG, BS, NE, SG, SZ, VS)

If your official place of residence is in one of these cantons on 1 January 2016, you will not be affected at all by the premium adjustment. You will receive the standard refund from the environmental levies. The standard refund is stated in your KVG policy documents.

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What happens if there is a change of residence in 2016?

Your premium adjustment is determined by your official place of residence on 1 January 2016. Where you lived previously or live subsequently will not be taken into account in the redistribution.

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Premium surcharge for 2016 in accordance with Article 106a KVG

Avanex has been requested by the supervisory authority, the Federal Office of Public Health (FOPH), to charge each insured person a total of CHF 33, solely for the year 2016, in order to compensate for imbalances in premiums. Where premiums are paid monthly the supplement will be CHF 2.75 per month. This supplement is listed on your insurance certificate. Avanex fought this charge as long as it could and would have preferred to pay the entire amount out of its reserves. However, the FOPH rejected our request.