Cantonal arbitration court

What is the cantonal arbitration court?

The cantonal arbitration court is a special court in health insurance. It decides disputes between health insurers and service providers, i.e. doctors, hospitals, pharmacies, physiotherapy practices and others who bill basic health insurance. The Federal Health Insurance Act (KVG) requires each canton to designate such a court (Art. 89 para. 4 KVG).

Despite its name, it is not a private arbitration tribunal freely agreed by the parties. It is a court provided for by law with a special composition: a neutral person as chair, plus representatives of the insurers and of the service providers concerned in equal numbers. This means that expertise from both sides goes into the decision. The cantons can also transfer the tasks to the cantonal insurance court, which is then supplemented by one representative of each of the parties involved.

The arbitration court only concerns basic health insurance under the KVG. Disputes arising from supplementary insurance or from private treatment contracts belong before the civil courts.

How it works

Typical disputes before the arbitration court are:

• Bills: a health insurer disputes that a bill complies with the applicable tariff, or claims back amounts that were overpaid.
• Cost-effectiveness: a service provider treats patients at significantly higher cost than comparable practices without justification. Under Art. 56 KVG, it must limit itself to what is necessary for the purpose of the treatment. Payments made without justification can be claimed back.
• Tariff protection: a service provider charges more than the tariff set by contract or by the authorities (Art. 44 KVG).
• Sanctions: at the request of a health insurer or an association of insurers, the arbitration court decides on a warning, repayment of fees, fines of up to CHF 20,000 or, for repeat offences, exclusion from working at the expense of basic health insurance (Art. 59 KVG).

Which arbitration court has jurisdiction is set out in Art. 89 para. 2 KVG: the court of the canton whose tariff is applied, or of the canton in which the service provider has its permanent establishment.

For you as an insured person, paragraph 3 is important. In the tiers garant system, you owe the service provider the bill and get the money back from your health insurer (Art. 42 para. 1 KVG). If a dispute about payment arises in this system, the arbitration court also has jurisdiction, and your health insurer represents you at its own expense. In the tiers payant system, the insurer owes the payment directly; in that case, it is the party to the dispute anyway.

The procedure is set by the canton. It must be simple and quick; the court establishes the facts with the participation of the parties and is free to assess the evidence (Art. 89 para. 5 KVG). Decisions are issued in writing, with reasons, with information on legal remedies and with the names of the members (Art. 89 para. 6 KVG). The Federal Act on the General Part of Social Insurance Law (ATSG) does not apply to this procedure (Art. 1 para. 2 let. e KVG).

The arbitration court does not have jurisdiction over the question of which tariff applies in the first place. If a cantonal government approves or sets a tariff, the route leads to the Federal Administrative Court (Art. 53 KVG). The arbitration court applies the applicable tariff agreement in the individual case.

Legal basis

Art. 89 KVG governs the cantonal arbitration court. Paragraph 1 assigns to it disputes between insurers and service providers. Paragraph 2 determines territorial jurisdiction, and paragraph 3 jurisdiction in the tiers garant system with representation by the health insurer at its own expense. Paragraph 4 requires the canton to designate an arbitration court and sets out the equal composition with a neutral chair. Paragraph 5 requires a simple and quick procedure, paragraph 6 written decisions with reasons.

Art. 91 KVG allows decisions of the arbitration court to be appealed to the Federal Supreme Court under the Federal Supreme Court Act. Art. 59 para. 2 KVG assigns sanctions against service providers to the arbitration court. Art. 1 para. 2 let. e KVG exempts proceedings before the arbitration court from the ATSG. Appeals against tariff decisions of cantonal governments, by contrast, go to the Federal Administrative Court (Art. 53 KVG).

Example: point value on the bill too high

On 10.02.2026, Basel-Stadt provisionally set a point value of CHF 0.91 for doctors’ practices and hospital outpatient departments until approved agreements are in place. Assume that a practice in Basel bills an item with 100 tariff points at CHF 1.00 instead of CHF 0.91 in 2026. Jonas, 36 years old, received the bill under the tiers garant system.

What this means for you

• You do not have to go to court yourself. Disputes about tariffs and bills are conducted by the health insurers. Under tiers garant, your health insurer represents you.
• Check the bill. Every bill must be detailed and comprehensible (Art. 42 para. 3 KVG). If the tariff, tariff points or point value are wrong, report it to your health insurer.
• Do not pay surcharges outside the tariff. For benefits under basic health insurance, the service provider may not charge more than the tariff. Exceptions concern aids and appliances under Art. 52 KVG.
• Know the right route. If the dispute is with your health insurer about a refused benefit, the arbitration court is not the right place; the route via a written decision, an objection and the insurance court applies.

You can see how the health insurers are positioned under Health insurers at a glance. You compare the premiums for your municipality in the premium calculator.

Common mistakes

• Confusing the arbitration court with the insurance court. The arbitration court is for insurers against service providers, the insurance court for you against your health insurer.
• Thinking of private arbitration. The cantonal arbitration court is prescribed by law and cannot be freely chosen.
• Simply paying the difference. If a practice charges more than the tariff, this breaches tariff protection. Clarify this with your health insurer before you pay.
• Wanting to take a cantonal tariff decision to the arbitration court. The Federal Administrative Court has jurisdiction over tariff decisions of the cantonal government.