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Tariff agreements
Agreements regulating the relationship between health insurers and health care providers and setting tariffs (tariff protection).
- LAMal/KVG agreements: agreements covering compulsory health care services (AOS/OKP). Disputes are settled by the canton in the first instance. Cantonal decisions may be appealed before the Federal Court, as the court of last instance, whose decisions are final.
- LCA/VVG agreements: agreements on supplemental insurance which are privately negotiated directly between health insurers and health care providers.
TARMED
Medical fees’ system which serves as the basis for all outpatient health services at the doctor’s surgery, patient’s home and in hospital outpatient services. The nomenclature of medical acts - comprising 4,600 tariff positions - is standardised for the whole of Switzerland, but TARMED point values vary from one canton to another.
Telemedicine model
Insureds who choose this alternative model are required to contact a medical call centre for advice before seeing a doctor. The medical staff of the call centre analyses the situation and makes recommendations (self-medication or referral to a doctor or a hospital).
Third-party guarantor
Unless otherwise agreed, the insured is the debtor of the health care provider’s fees. Accordingly, the insured pays the invoice and then claims reimbursement from his insurer. This is called the «third-party guarantor» system.
Third-party payer
In this system, an agreement provides that the insurer is the debtor of the invoice and pays the health care provider directly; the insurer then claims the insured’s participation (deductible, co-insurance) from the insured.
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