Flat-rate tariff

What is a flat-rate tariff?

A flat-rate tariff is a way of paying for medical services: there is a fixed amount, a flat rate, for a particular treatment. Everything that is part of the treatment is included, such as the doctor’s work, nursing care, materials, medicines during the treatment and laboratory analyses. It makes no difference whether a little more or a little less work is involved in an individual case.

The counterpart is the fee-for-service tariff. There, every service is valued and billed individually with tax points. Until the end of 2025, outpatient medical billing in Switzerland mainly worked this way, using the TARMED tariff, which had applied since 2004. Since 01.01.2026, the fee-for-service tariff TARDOC has applied instead, and for certain treatments the outpatient flat rates.

In hospital, flat rates have long been the rule. Inpatient treatment in acute care is billed with case-based flat rates under SwissDRG: each hospital stay is assigned to a case group on the basis of the diagnosis, the treatment and other characteristics, and each case group has a fixed cost weight.

The law distinguishes two forms. A per-patient flat rate pays for the treatment of an individual person, as with SwissDRG or the outpatient flat rates. A per-insured-group flat rate pays for the care of a whole group of insured persons, for example per head and per year in a doctors’ network.

How it works

The tariff partners, that is the associations of service providers and of insurers, agree the flat rates in a tariff agreement. For outpatient per-patient flat rates there must be a single, uniform nationwide tariff structure, approved by the Federal Council. If the partners cannot agree, the Federal Council sets the structure.

For the outpatient medical tariffs, the tariff partners FMH, H+ and prio.swiss founded the organisation for outpatient medical tariffs (OAAT AG). It develops TARDOC and the outpatient flat rates further. The Federal Council approved the overall tariff system on 30.04.2025 and adjustments on 05.11.2025, for example for emergency departments and wound care. Both have applied since 01.01.2026. The changeover must be cost-neutral; the FOPH monitors volumes and costs.

If a treatment falls under an outpatient flat rate, every doctor’s practice and every hospital must bill it that way. The law has required this since an approved structure was introduced. At regional level, the tariff partners may agree their own flat rates for certain treatments if regional circumstances require it; the national structure, however, takes precedence.

For you as an insured person, the co-payment stays the same. The flat rate is an amount billed like any other: it counts towards the deductible, after which you pay a 10% retention fee up to the maximum amount. In hospital, the contribution of CHF 15 per day is added.

Legal basis

Art. 43 para. 2 KVG lists the permitted types of tariff: the time-based tariff (let. a), the fee-for-service tariff with tax points (let. b) and flat-rate payments, the flat-rate tariff (let. c). Under Art. 43 para. 3 KVG, the flat-rate tariff can relate to treatment per patient (per-patient flat rate) or to care per group of insured persons (per-insured-group flat rate).

Art. 43 para. 5 KVG requires that fee-for-service tariffs and outpatient per-patient flat-rate tariffs each be based on a single, uniform tariff structure agreed nationwide. Under para. 5ter, all service providers must apply an approved structure for outpatient flat rates; para. 5quater allows regional flat rates. For inpatient treatment, Art. 49 para. 1 KVG prescribes flat rates, usually case-based flat rates, related to the service and based on uniform nationwide structures. The co-payment on all bills is governed by Art. 64 KVG.

Example: outpatient procedure with a flat rate

Reto is 45 and has a minor outpatient procedure in hospital in 2026. The treatment falls under an outpatient flat rate. The amount of CHF 1,200 is assumed for the bill; the deductible, retention fee and maximum amount are the statutory values. Reto has had no other bills so far this year.

Deductible	Deductible share	Retention fee 10%	Reto’s share	Health insurer’s share
CHF 300	CHF 300	CHF 90	CHF 390	CHF 810
CHF 1,000	CHF 1,000	CHF 20	CHF 1,020	CHF 180
CHF 2,500	CHF 1,200	CHF 0	CHF 1,200	CHF 0

The tariff determines what the treatment costs; your deductible determines how much of it you bear. The premium calculator shows the 2026 premiums for every deductible.

What this means for you

You do not have to calculate flat rates yourself, but you can understand and check them:

1. Read the bill. Look at the tariff code: 005 for outpatient flat rates, 007 for TARDOC. A flat rate combines the whole treatment in one item.
2. Spot double billing. Services included in the flat rate may not also be billed individually. If you notice this, ask the service provider or the insurer.
3. Choose a suitable deductible. Because a flat rate can trigger a larger amount at once, it is worth looking at your deductible before a planned procedure. You give notice of a switch to a lower deductible by 30 November with effect from 1 January; the dates are listed under deadlines.

You will find the insurers and their key figures under health insurers. The glossary explains the tariffs of basic health insurance term by term.

Common mistakes

• Mistaking the flat rate for a fixed price for you. The flat rate is the price for the insurer; your co-payment is added according to the usual rules.
• Believing flat rates only exist in hospital. Since 01.01.2026 they have also existed for certain outpatient treatments.
• Thinking a flat rate is too high because the procedure was short. The flat rate covers the average effort; in an individual case it may be lower or higher.
• Overlooking the hospital contribution. For inpatient stays you also pay CHF 15 per day.