Health Insurance Benefits Division

The Health Insurance Benefits Division is responsible for defining the catalogue of benefits paid under compulsory health insurance, in particular the specialities list, the lists of analyses, aids and equipment, and for the health technology assessment.

As part of the Health and Accident Insurance Directorate, the division works with three specialist committees to draft and oversee the principles for the licensing of medical services, therapeutic products, analyses, aids and articles in the catalogue of benefits paid under compulsory health insurance. It also acts as a specialist arbiter in appeal proceedings before the Federal Administrative Court relating to rulings in the context of benefits. In addition, the division shapes the health insurance system by way of amendments to the law and ordinances governing the area of benefits outlined above.

Ryan Tandjung

Ryan Tandjung
Head of Health Insurance Benefits Division

Further information

Benefits and tariffs

What medical care does compulsory (basic) insurance pay for? What hospital can you go to for treatment? What about maternity benefits? Which tariffs and prices are set by the authorities?

Insurers and supervision

We at the FOPH are responsible for overseeing insurers that offer compulsory (basic) health insurance. Supplementary insurance plans fall under private insurance law and are overseen by FINMA, the financial market supervisory authority.

Description of services

Who decides what benefits compulsory (basic) health insurance pays? In this section you can find out who is responsible and the procedures for applying for coverage of new benefits.

Re-evaluation of compulsory health insurance benefits: HTA

Health technology assessments (HTAs) are an internationally recognised tool for the systematic evaluation of medical procedures and technologies, and are an important component of evidence-based policy advice and decision making.

Statutory foundation Health insurance

Find out here about the legislation regarding health insurance.

Current Revision Projects

Various revisions are under way in the field of health insurance. They affect legislation including the Federal Health Insurance Act (KVG/LAMal), the Health Insurance Ordinance (KVV/OAMal) and the Health Insurance Benefits Ordinance (KLV/OPAS).

Last modification 11.03.2019

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Contact

Federal Office of Public Health FOPH
Health and Accident Insurance Directorate
Health Insurance Benefits Division
Schwarzenburgstrasse 157
3003 Berne
Switzerland
Tel. +41 58 462 21 11
E-mail

Print contact

https://www.bag.admin.ch/content/bag/en/home/das-bag/organisation/direktionsbereiche-abteilungen/direktionsbereich-kranken-unfallversichrung/abteilung-leistungen-krankenversicherung.html