Reimbursement from environmental taxes

The most important questions and answers concerning the compensation 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 handled?
  9. How high is the credit voucher?
  10. How high is the credit voucher for my child, who was born in February 2017?
  11. The insured person died in February. Will the full sum be paid out?
  12. Social services were responsible until the end of January 2017. Will the insured person receive a proportionate sum for this month?
  13. What happens if the insurer is changed during the course of the year? Who pays out the credit voucher?
  14. As a cross-border commuter working in Switzerland or a Swiss citizen abroad, am I affected by the premium adjustment?
  15. Will there be any changes for people who receive disability insurance benefits, additional benefits or premium subsidies?
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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 2017, you fall into one of the following groups of cantons:

Canton group 1: AI, FR, GE, GR, TG, TI, VD, ZG, ZH

If your statutory place of residence on 1 January 2017 is in one of these cantons, you will receive a one-off premium credit voucher in June 2017 (comprising a premium deduction and a premium reimbursement). The level of this is the same for all insured persons in the respective canton. You will not receive a credit voucher if you relocate your place of residence before this reporting date to one of the cantons in canton group 2 or 3.

Canton group 2: AR, BE, BL, GL, JU, LU, NW, OW, SH, SO, UR

For the year 2017, the previous monthly surcharge will be waived.

Canton group 3: AG, BS, NE, SG, SZ, VS

If your statutory place of residence on 1 January 2016 or 1 January 2017 is in one of these cantons, you will not be affected by the premium correction. You will receive the ordinary sum to redistribute the environmental levies. Details are set out in your KVG policy.

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I have moved home. What happens now?

The reporting date is 1 January 2017. Moves to other cantons that take place after this 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 do anything. Both the surcharge as well as the credit voucher will be issued automatically. Any possible premium surcharge will be cited on your policy only in the years 2015 and 2016. Any possible premium credit voucher for the period from 2015 to 2017 will automatically be reimbursed to you in June.

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How will the payment be handled?

The payout will in each case be performed for the period from 2015 to 2017 in the form of an annual credit voucher.

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How high is the credit voucher?

Table of premium credit vouchers per canton

Canton Credit voucher per person in CHF 2016 Credit voucher per person in CHF 2017
ZH 37.00 *
ZG 13.35 *
FR 16.25 *
AI 20.75 *
GR 0.45 *
TG 48.10 *
TI 60.75 *
VD 86.05 *
GE 57.30 *

*Sum will be set by the FOPH in February 2017

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How high is the credit voucher for my child, who was born in February 2017?

As your child was born in February 2017, you will not receive any credit voucher. The reporting date is always 1 January 2017. That is to say, if your child was born on 1 January 2017, you would have been entitled to the credit voucher. If your child was born on 2 January, then you would not have had an entitlement to a credit voucher.

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

Yes, the credit voucher will be paid out to the heirs in June.

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Social services were responsible until the end of January 2017. Will the insured person receive a proportionate sum for this month?

If the insured person paid the premium himself or herself in June/July, then he or she will receive the credit voucher in the form of a deduction on the premium calculation for July 2017, even if the social services agency was responsible for him or her in January.

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What happens if the insurer is changed during the course of the year? Who pays out the credit voucher?

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.