Reimbursement from environmental taxes

The most important questions and answers on the correction of premium imbalances pursuant to Articles 106 and 106a of the Sand answers on the correction of premium imbalances pursuant to Art. 106 of the Swiss Health Insurance Act (KVG).

  1. Why does this law (Art. 106 KVG) exist?
  2. Why were premiums deemed to be "too high" charged in certain cantons?
  3. Why is it always the insured persons who lose out when health insurers make mistakes?
  4. Will there be additional adjustments in the future?
  5. I live in the canton of XY; will I receive a credit or will I incur additional charges?
  6. I have moved home. What happens now?
  7. Whom should I inform? What do I need to do?
  8. How will the payment be made?
  9. How much will the credit amount to?
  10. What is the maximum amount that I will incur as a surcharge?
  11. How much is the credit for my child born in February 2016?
  12. The insured person died in February. Will the full amount be paid out?
  13. The social security office was responsible until the end of January 2016. Will the insured person receive a credit for this month?
  14. What happens if there is a change of health insurer during the year? Who pays out the credit?
  15. As a cross-border commuter working in Switzerland or a Swiss citizen abroad, am I affected by the premium adjustment?
  16. Will there be any changes for people who receive disability insurance benefits, additional benefits or premium subsidies?
  17. What does the premium surcharge in accordance with Art. 106a KVG mean?
  18. What does the fact that Avanex has no excess reserves mean?
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Why does this law (Art. 106 KVG) exist?

The background to this law is the alleged imbalance between premium incomes and healthcare costs for basic health insurance at cantonal level. At the request of individual cantons, the Federal Office of Public Health (FOPH) drafted a bill on premium adjustment (Art. 106 KVG) in February 2012. An amended version was adopted by the Federal Parliament in spring 2014. In September 2014, the FOPH introduced an ordinance governing its implementation.

An overall amount of CHF 800 million will be redistributed as a result of the premium correction. This will be financed 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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Why were premiums deemed to be "too high" charged in certain cantons?

At the end of July each year, health insurers submit their premiums for each canton for the following year to the Federal Office of Public Health (FOPH). These are based on the anticipated costs per canton. The FOPH checks whether the submitted premiums are proportionate to the costs.

The premium calculation always involves a certain level of uncertainty due to the multitude of unknown factors (e.g. future cost trends). This is why insurers build up provisions and reserves. Since health insurers are not permitted to make a profit from basic health insurance, the money always remains in the system and is only used for the payment of benefits. However, as the reserves are not calculated on a cantonal basis, there are minimal differences between the premium incomes and the health costs for each canton. The cantons have now demanded that these differences should be balanced out, and the politicians have acted on their request.

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Why is it always the insured persons who lose out when health insurers make mistakes?

Health insurers have calculated and submitted their premiums in accordance with the current law. Premiums have always been checked and approved by the Federal Office of Public Health (FOPH). The agreed premium adjustment was the result of a political decision and does not mean that the insurers made a mistake when calculating their premiums, but that the regulations have been changed in retrospect at a political level.

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Will there be additional adjustments in the future?

Insurers will implement the adjustments for 1996-2013 on behalf of the Federal Office of Public Health (FOPH) over the next two years. The FOPH does not expect there to be any further adjustments.

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I live in the canton of XY; will I receive a credit or will I incur additional charges?

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

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). The amount of the credit is the same for all insured persons in the canton. You will not receive a credit if you relocate to a canton in canton group 2 or 3 before the above qualifying date.

We will notify you of the amount of the premium credit in summer 2016.

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. This surcharge will be no higher than the amount you can claim back as a refund from the environmental levies. 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"

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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I have moved home. What happens now?

The qualifying date is 1 January 2016. A change of canton after this date will not be taken into account.

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Whom should I inform? What do I need to do?

Insured persons do not need to take any action. The surcharge and the credit are applied automatically. Any premium surcharge will be indicated on your policy. Any premium credit that you receive between 2015 and 2017 will be automatically credited in June.

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How will the payment be made?

Payment will be made on an annual basis from 2015 to 2017 in June in the form of a credit.

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How much will the credit amount to?

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
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What is the maximum amount that I will incur as a surcharge?

The premium surcharge corresponds to the maximum reimbursement of the VOC* levy. The credit from the environmental levy will total CHF 62.40 in 2016, i.e. CHF 5.20 per month.

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How much is the credit for my child born in February 2016?

Since your child was born in February 2016, you will not receive a credit for your child. The cut-off date is 1 January 2016 in all cases. This means that if your child were born on 1 January 2016, you would be entitled to the credit. However, if he or she were born on 2 January, you would not be entitled to the credit.

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The insured person died in February. Will the full amount be paid out?

No. It will be checked whether the insured person would still have been required to pay compulsory health insurance as of 1 June 2016. If this is not the case (due to death or moving abroad), the balance will not be paid out. If the death or departure occurs after 1 June 2016, the balance will be paid out.

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The social security office was responsible until the end of January 2016. Will the insured person receive a credit for this month?

If the insured person personally pays the premiums in June/July, they will receive the balance in the form of a deduction from the premium summary for July 2016, even if the social security office was still responsible for payment in January.

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What happens if there is a change of health insurer during the year? Who pays out the credit?

In accordance with the ordinance, if there is a change of insurer in the course of the year, the insurer with which the insured person is insured on 1 June is responsible for payment of the refund in all cases.

Example: An insured person changes from Helsana to Swica on 1 March. Since this person had insurance cover with Swica on 1 June, Swica is also responsible for any premium refunds in accordance with Art. 106 KVG.

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As a cross-border commuter working in Switzerland or a Swiss citizen abroad, am I affected by the premium adjustment?

No. What matters with regard to the premium adjustment is your official place of residence.

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Will there be any changes for people who receive disability insurance benefits, additional benefits or premium subsidies?

The amount paid by individuals remains the same for all social benefits. Individuals remain obliged to pay any monthly premium surcharge or are still entitled to a one-off premium credit. The premium credit will be paid in June. The premium surcharge will be charged each month.

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What does the premium surcharge in accordance with Art. 106a KVG mean?

Health insurers that have excess reserves pay out the health insurers' share from their reserves. Health insurers that do not have excess reserves must collect the amount from the insured persons in the form of a one-off surcharge. The Federal Office of Public Health (FOPH) requested that Avanex collect the one-off surcharge of CHF 33 from insured persons. This is equivalent to a premium surcharge of CHF 2.75 per month. 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. The other Helsana Group companies (Helsana, Progrès and Sansan) are able to pay the health insurer's share from their reserves.

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What does the fact that Avanex has no excess reserves mean?

Avanex meets all of the legal requirements relating to its reserves and passed the solvency test. The definition of "excess reserves" is based on a complicated calculation. Until recently, Avanex was of the opinion that its reserves were adequate to allow for payment of the health insurers' contribution from the reserves. However, the FOPH rejected our request. Specifically, this means that Avanex will have to collect a one-off surcharge of CHF 33 per insured person solely for 2016. This is equivalent to a premium surcharge of CHF 2.75 per month.

*The VOC levy is a Swiss incentive levy aimed at reducing emissions from volatile organic compounds (VOC).