ATSG

What is the ATSG?

The ATSG is the Federal Act of 6 October 2000 on the General Part of Social Insurance Law (Bundesgesetz über den Allgemeinen Teil des Sozialversicherungsrechts). It came into force on 1 January 2003. Its purpose is set out in Art. 1: it coordinates federal social insurance law by defining principles and terms, laying down a uniform procedure, aligning the benefits of the various insurance schemes with each other and regulating recourse against third parties.

The ATSG does not apply automatically, only where a specific act provides for it (Art. 2 ATSG). For health insurance, Art. 1 para. 1 of the Federal Health Insurance Act (KVG) does this: the ATSG applies unless the KVG or the Health Insurance Supervision Act (KVAG) expressly states otherwise. The same applies, for example, to accident insurance under the UVG, old-age and survivors’ insurance (AHV) and invalidity insurance (IV). That is why objections and appeals follow the same rules in all of these schemes.

As an insured person, the ATSG matters to you mainly in two situations: when you want to challenge a decision made by your health insurer, and when several insurance schemes could be responsible for the same case, for example your health insurer and the accident insurer.

The ATSG does not apply to supplementary insurance. Supplementary insurance is subject to the Insurance Contract Act (VVG) and to civil law.

How it works

The ATSG is divided into chapters. Four areas are particularly relevant for health insurance:

Terms. Art. 3 ATSG defines illness as any impairment of physical, mental or psychological health that is not the result of an accident and that requires a medical examination or treatment or results in an inability to work. Art. 4 ATSG defines an accident as the sudden, unintentional harmful effect of an unusual external factor on the body. This distinction determines whether your health insurer or the accident insurer pays.

Rights and obligations. Anyone claiming benefits must cooperate free of charge and provide the necessary information (Art. 28 ATSG). The insurer investigates the facts of its own accord (Art. 43 ATSG). Benefits received unlawfully must be repaid; if you acted in good faith and repayment would cause serious hardship, it can be waived (Art. 25 ATSG).

Procedure. If a benefit is substantial or you disagree, the insurer issues a written decision (Art. 49 ATSG). You can lodge an objection against it within 30 days (Art. 52 ATSG). Against the response to the objection, you can appeal to the cantonal insurance court (Art. 56–61 ATSG) and then to the Federal Supreme Court (Art. 62 ATSG).

Coordination. If benefits from several social insurance schemes coincide, this must not lead to overcompensation (Art. 69 ATSG). If it is unclear which scheme has to pay, you can ask for advance benefits; health insurance must, among other things, pay in advance for benefits in kind where it is disputed whether health, accident, military or invalidity insurance is responsible (Art. 70 para. 2 let. a ATSG).

The KVG deviates in some places. In health insurance, even substantial benefits are granted without a formal decision (Art. 80 KVG). And Art. 1 para. 2 KVG excludes entire areas from the ATSG: the authorisation and exclusion of service providers, tariffs, prices and global budgets, premium subsidies, disputes between insurers and the procedure before the cantonal arbitration court.

Legal basis

The ATSG has the number SR 830.1. Implementing provisions are found in the Ordinance on the General Part of Social Insurance Law (ATSV, SR 830.11), for example the formal requirements for an objection in Art. 10 ATSV.

Art. 1 KVG forms the bridge to health insurance. Paragraph 1 declares the ATSG applicable unless the KVG or the KVAG expressly deviates from it. Paragraph 2 lists the areas in which the ATSG does not apply: authorisation and exclusion of service providers (Art. 35–40 and 59 KVG), tariffs, prices and global budgets (Art. 43–55 KVG), premium subsidies under Art. 65, 65a and 66a KVG and the federal contributions under Art. 66 KVG, disputes between insurers (Art. 87 KVG) and the procedure before the cantonal arbitration court (Art. 89 KVG).

The most important rules on deadlines are in Art. 38–41 ATSG: the deadline starts on the day after notification, it moves to the next working day, it is suspended at Easter, in summer and over Christmas, statutory deadlines cannot be extended, and a deadline can be restored within 30 days if you missed it through no fault of your own.

Example: suspension of deadlines at Easter 2027

At Easter, the suspension periods under Art. 38 para. 4 ATSG depend on the calendar. For 2026 and 2027, the periods are as follows:

What this means for you

• Know the 30 days. Objections and appeals each have a 30-day deadline. Both start on the day after delivery.
• Ask for a written decision. If you disagree with an informal decision, you are entitled to a written decision.
• Cooperate, but within limits. You must provide the information needed for your claim. However, the insurer may only investigate what it needs for its decision.
• Report accidents correctly. Whether something is an illness or an accident is decided by the definition in the ATSG. If you are employed, your employer’s accident insurer usually pays in the event of an accident.
• Ask for advance benefits if insurers disagree. If the health insurer and the accident insurer argue about who pays, the health insurer must pay for benefits in kind in advance.

An overview of all insurers is available under Health insurers. You compare the premiums for your municipality in the premium calculator.

Common mistakes

• Confusing the ATSG with the VVG. The ATSG only applies to basic health insurance. There is no objection procedure for supplementary insurance.
• Thinking the suspension extends the deadline by 30 days. The deadline only pauses during the suspension days and then continues to run.
• Refusing to cooperate. If you refuse to provide information without a valid excuse, you risk a decision based on the file (Art. 43 para. 3 ATSG), after a written reminder.
• Believing the ATSG also governs tariffs. Tariff disputes between insurers and service providers are excluded from the ATSG and go to the arbitration court.