KVAV (Health Insurance Supervision Ordinance)

What is the KVAV?

The KVAV is the Federal Council’s ordinance to the Health Insurance Supervision Act (KVAG). The act lays down that and how the Confederation supervises health insurers in basic health insurance. The ordinance fills in the details: deadlines, calculation methods, documents, thresholds. The Federal Council adopted it on 18 November 2015, and it has been in force since 1 January 2016 (Art. 74 KVAV). It has the number SR 832.121 and is amended regularly, most recently with changes that came into force on 01.07.2026.

The supervisory authority is the Federal Office of Public Health (FOPH). The KVAV is therefore addressed primarily to health insurers and the FOPH. It still matters to you as an insured person, because it determines how your premium comes about, how much in reserves your insurer must hold and which rules apply to phone calls and intermediaries.

The KVAV only applies to social health insurance, meaning basic health insurance and voluntary daily allowance insurance under the Federal Health Insurance Act (KVG). When reserves are determined, business from supplementary insurance under the Insurance Contract Act (ICA) is expressly not taken into account (Art. 10 para. 4 KVAV). Supplementary insurance is supervised by FINMA under the Insurance Supervision Act.

How it works

The KVAV is divided into chapters. The parts that matter most to insured persons are:

Reserves and solvency. At the start of each calendar year, every insurer determines its available reserves and the minimum amount (Art. 12 para. 1 KVAV). The reserves are the difference between assets valued at market prices and liabilities (Art. 10 KVAV). The minimum amount is calculated with a model set by the Federal Department of Home Affairs. It takes into account insurance risks, market risks and credit risks. The reserves must be high enough that the average of the possible reserve levels below a threshold is zero; the threshold is the value that the reserves exceed with 99% probability over the course of a year (Art. 11 KVAV). This check is called the solvency test.

Approval of premiums. The insurer submits its premium tariffs to the FOPH at the latest five months before applying them (Art. 27 para. 1 KVAV). The FOPH checks whether the estimated income covers the estimated expenditure (Art. 25 para. 1 KVAV) and approves the tariffs for one calendar year (Art. 27 para. 4 KVAV). The cantons can comment beforehand. If an insurer publishes its premiums, it must publish the premiums for all forms of insurance (Art. 28 KVAV). More on this under premium approval.

Reduction of reserves and premium adjustment. An insurer can voluntarily reduce excessive reserves if it remains above the minimum afterwards (Art. 26 KVAV). It then calculates its premiums tightly or pays out an adjustment, which it shows separately on the premium invoice. If premium income in a canton was significantly higher than the costs, a premium adjustment can be paid to insured persons (Art. 30a–33 KVAV).

Intermediaries. Annex 2 of the KVAV declares parts of the insurers’ industry agreement generally binding (Art. 35b KVAV): no first contact by telephone with people who have never been customers or have not been for more than 36 months, a cap on variable remuneration of CHF 70 per insured person in basic health insurance, recovery of the remuneration if the contract is short-lived, and an obligation to keep an advice record.

Legal basis

The KVAV is based on the KVAG, in particular its provisions on reserves, approval of premiums, premium adjustment and the activities of intermediaries. Art. 16 KVAG requires that premium tariffs for basic health insurance may neither be published nor applied before they are approved and that they must cover costs, which differ from canton to canton. For this purpose, the KVAV sets the five-month deadline (Art. 27 para. 1) and the review criteria (Art. 25). Art. 19b KVAG allows the Federal Council to declare parts of an agreement between insurers on telephone advertising, intermediary remuneration and advice records generally binding; it has done so with Art. 35b and Annex 2 KVAV.

Art. 7 para. 2 KVG is linked to the approval procedure: your insurer must notify you of the new premiums approved by the FOPH at least two months in advance and point out your right to switch.

Example: how the 2027 premium comes about

The deadlines in the KVAV and the KVG result in this process for the premiums that apply from 01.01.2027:

What this means for you

• The premium is checked, but not uniform. The FOPH approves each insurer’s premium individually. That is why you pay different amounts for the same benefits depending on the insurer. The premium calculator shows the comparison for your municipality.
• Reserves protect you. The minimum reserves are meant to ensure that your insurer can pay even in an expensive year. You can find the insurers’ key figures under health insurers.
• Cold calling is restricted. Under the generally binding rules, first contact by telephone without an existing business relationship is prohibited for all insurers and their intermediaries. More on remuneration under intermediary commission.
• Look out for refunds. If your insurer pays a premium adjustment or reduces its reserves, the amount is shown separately on the premium invoice.

Common mistakes

• Confusing the KVAV and the KVV. The KVV governs health insurance itself, for example deductibles and benefits. The KVAV governs the supervision of insurers.
• Believing the FOPH sets the premiums. Insurers calculate their own premiums; the FOPH reviews and approves them.
• Treating reserves as savings belonging to insured persons. Reserves are the insurer’s safety capital. Only excessive reserves can flow back to insured persons through a reduction or an adjustment.
• Applying the KVAV to supplementary insurance. There, the ISA and the AVO apply, with FINMA as the supervisory authority.