As far as social health insurance is concerned the insurers are supervised by the Federal Office of Public Health, while complementary insurance (private sector) is supervised by the Federal Office for Private Insurance.
The practice of social health insurance is subject to the authorisation of the FOPH. To obtain this authorisation, insurers must have drawn up a business plan. Social health insurance is operated by a number of insurers that satisfy the legal requirements, particularly the need to fulfil their financial obligations at all times. As part of their remit, insurers process the health data of insured persons and must be able to guarantee the protection of such sensitive data.
The aim of supervision is to protect the interests of insured persons, particularly by guaranteeing the transparency of the social health insurance system and the solvency of the insurers. The FOPH is responsible for ensuring that the Federal Act on Health Insurance (HIA) is applied consistently and monitoring the financial situation of the insurers. Accordingly, the insurers must provide the FOPH with their annual reports, budgets and annual financial statements, as well as their premium rates for the following year for approval.
The FOPH can take precautionary measures when the solvency of an insurer is compromised and the interests of insured persons are jeopardised as a result. If an insurer becomes insolvent, the costs of its statutory benefits are taken over by a joint body funded by contributions made by the insurers on the basis of their social health insurance premium.
The role of the insurers is not restricted to reimbursing the cost of services provided to insured persons. They also work together with the cantons to encourage health promotion. Insurers and cantons operate a joint body whose aim is to promote, co-ordinate and evaluate steps aimed at promoting health and preventing illness.
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Last modification 04.10.2019