Service provider

What is a service provider?

“Service provider” is the technical term used in the Federal Health Insurance Act (KVG) for everyone who examines, treats or cares for you medically, or supplies you with medicines and aids and appliances, and receives money from basic health insurance for doing so. The law uses this neutral term because it covers very different players: the individual GP as well as the university hospital, the pharmacy round the corner or the ambulance service.

What matters is not whether someone works in medicine, but whether they are allowed to work at the expense of compulsory health insurance. A naturopath without approval can treat you but is not a service provider within the meaning of the KVG; at most, supplementary insurance will pay their bill. Conversely, every approved service provider is obliged to follow the rules of basic health insurance: tariffs, invoicing, cost-effectiveness, quality.

Art. 35 para. 2 KVG lists service providers exhaustively:

• doctors, including institutions providing outpatient care by doctors (for example group practices, outpatient clinics)
• pharmacists
• chiropractors
• midwives
• nurses and organisations that employ nurses
• persons who work on a doctor’s prescription or on behalf of a doctor, and their organisations, for example physiotherapy and occupational therapy, speech therapy, nutritional advice, psychological psychotherapy and podiatry
• laboratories
• dispensaries for aids and appliances
• hospitals, birth centres, nursing homes and medicinal spas
• transport and rescue companies

In terms of figures, this is a large market. According to the FSO, of the CHF 97,201 million in healthcare costs in 2024, 36.2% went to hospitals, 16.3% to socio-medical institutions such as nursing homes and 15.8% to doctors’ practices. These figures include all sources of financing, not just basic health insurance.

How it works

Approval

Anyone who wants to bill basic health insurance needs approval from the canton in which they work. The Federal Council sets the training, further training and quality requirements for this; for the individual professions, the requirements are set out in Art. 47–52f KVV. Doctors must also have worked for at least three years in the specialist field applied for at a recognised Swiss further training centre and prove that they speak the language of their region. Cantons can limit the number of doctors in the outpatient sector per specialist field or region.

Hospitals, birth centres and nursing homes are only approved if they meet the cantonal planning and are on the Hospital List. Each canton designates a supervisory authority; in the event of breaches, it can issue warnings, impose fines of up to CHF 20,000 or withdraw approval temporarily or permanently.

Tariffs

Service providers bill according to tariffs or prices. These are agreed in a tariff agreement between insurers and service providers or set by an authority. Since 01.01.2026, outpatient medical services have been billed under the fee-for-service tariff TARDOC together with outpatient flat rates, while inpatient hospital treatment is billed using SwissDRG flat rates per case. Medicines are reimbursed at the prices in the List of Pharmaceutical Specialties.

Tariff protection is important for you: for benefits of basic health insurance, a service provider may only charge the tariff, with no surcharges. Anyone who generally does not want to bill under the KVG must report this to the cantonal office and inform you in advance (opting out).

Bill

The KVG has two ways of billing. Under tiers garant, the service provider sends the bill to you; you pay and claim the amount back from the insurer. Under tiers payant, the bill goes directly to the insurer, and you receive a copy. The insurer then charges you the deductible and the retention fee. Which system applies is agreed between insurers and service providers; for inpatient treatment, the insurer always owes its share directly. Every bill must be detailed and comprehensible.

Choice

For outpatient treatment in the standard model, you choose freely among all approved service providers that are suitable for your illness. For inpatient treatment, you choose among the hospitals on the list of your canton of residence or the canton where the hospital is located. In GP, HMO and Telmed models, you have restricted your choice in exchange for a premium discount; the insurer then only pays for what your first point of contact provides or arranges.

Legal basis

• Art. 35 para. 2 KVG: exhaustive list of service providers.
• Art. 36 and 36a KVG: service providers under Art. 35 para. 2 let. a–g, m and n may only work at the expense of basic health insurance if the canton has approved them; the Federal Council sets the requirements.
• Art. 37 KVG: special requirements for doctors, including three years of work at a recognised Swiss further training centre in the specialist field applied for and affiliation to the electronic patient record.
• Art. 38 KVG: cantonal supervision with measures ranging from warnings and fines of up to CHF 20,000 to withdrawal of approval.
• Art. 39 KVG: approval of hospitals, birth centres and nursing homes through cantonal planning and the Hospital List.
• Art. 41 KVG: free choice among approved service providers, restricted in special insurance models (para. 4).
• Art. 42 KVG: tiers garant as the rule, tiers payant by agreement; obligation to provide a detailed, comprehensible bill and, under tiers payant, a copy to you.
• Art. 43 and 44 KVG: billing according to tariffs; tariff protection with no further charges.
• Art. 55a KVG: cantons limit the number of doctors in the outpatient sector.

Example: physiotherapy with and without approval

Sandra is 38, has a CHF 300 deductible that she has already reached this year, and receives a prescription for physiotherapy from her specialist. She compares two practices. The invoice amount is assumed in order to show the calculation; the retention fee and the maximum amount are the statutory values.

What this means for you

• Ask before treatment. For therapies, advice and complementary medicine services, check whether the professional is allowed to bill basic health insurance and whether a doctor’s prescription is required.
• Check your bills. You are entitled to a comprehensible bill. Under tiers payant, you receive a copy. Clarify any unclear items directly with the service provider or the insurer.
• Choose a suitable model. If you want to choose your doctors freely, the standard model is the right choice. If you are willing to contact a first point of contact first, you save on premiums. The premium calculator shows the difference for your municipality.
• Know your insurer. The benefits of basic health insurance are the same at every insurer; what differs are premiums, models and service. You can find the key data under health insurers.

Common mistakes

• Assuming every therapist can bill the health insurer. Only approved service providers bill basic health insurance.
• Forgetting the doctor’s prescription. Basic health insurance only pays for physiotherapy, occupational therapy or nutritional advice with a doctor’s prescription.
• Accepting surcharges. Tariff protection applies to benefits of basic health insurance; you do not have to pay additional amounts, except for services that basic health insurance does not cover.
• Leaving tiers garant bills lying around. Submit them to the insurer, even if you have not yet reached your deductible. Only then do they count towards it.

We explain how we handle data and sources under how we calculate.