A new fee model for the billing of supplementary insurance benefits

The SMN VVG+ fee model developed by the doctors of the Swiss Medical Network will in a first step be launched at the Private Clinic Bethanien in Zurich. It meets the expectations of FINMA with regard to a transparent distinction between benefits under basic and supplementary insurance.


The Private Clinic Bethanien, doctors and Helsana have agreed a new tariff structure for supplementary insurance with effect from 1 April 2022. The SMN VVG+ tariff was developed by the doctors of the Swiss Medical Network and is the first of its kind in the current Swiss tariff system. The new model will be used for patients with supplementary insurance from Helsana for treatments at the Private Clinic Bethanien.

“The VVG tariff structure is based not on a catalogue of individual services, but on a comprehensive allowance, under which the additional services covered by supplementary insurance are clearly indicated and differentiated from medical services under basic insurance (KVG),” explains Rudolf Bruder, Member of the Executive Board of Helsana with responsibility for products and services. In order to gain practical experience with the newly developed system, the contract with the Private Clinic Bethanien was concluded for a 12-month pilot period.

A two-part medical tariff

In order that the benefits under basic and supplementary insurance can be transparently distinguished, the SMN VVG+ tariff is separated into two parts (KVG and VVG). Under Swiss DRG, the clinic pays the KVG portion to doctors directly in accordance with the model of the Schweizerische Belegärztevereinigung (Swiss Association of Attending Physicians, SBV). In addition, attending physicians receive an allowance defined in the SMN VVG+ tariff structure for all additional services provided under supplementary insurance. The tariff structure lists tax points for each DRG, which can be multiplied by a contractually predefined individual tax point value for each doctor. This means that attending physicians no longer need to issue a separate invoice for the additional services they provide as freely chosen doctors; instead they will be paid directly by the clinic based on the DRG coding. “This prevents different benefits from being offset against one another without transparency,” explains Dino Cauzza, CEO of Swiss Medical Network.

Innovative reference model

The new fee model is a broadly practicable and above all innovative solution which also meets FINMA’s requirements for transparency with regard to additional benefits under VVG. “We are seeking to develop contractual solutions based on this model for other insurance policies too,” continues Dino Cauzza.

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