Industry agreement

What is the industry agreement?

The industry agreement (Branchenvereinbarung in German) is an agreement between health insurers on the work of insurance intermediaries. It sets out how intermediaries may win customers, how a consultation is documented and how much insurers may pay them for a contract. The current version was concluded on 22.03.2024 by the associations that existed at the time, santésuisse and curafutura; today it is supported by the association prio.swiss.

Its aim is to combat unwanted calls and abusive practices by individual intermediaries. An agreement between insurers normally binds only those who signed it. Since a change in the law, however, the Federal Council can declare important parts of it binding on all insurers. It has done so: since 01.09.2024, the core rules have applied to every health insurer in basic health insurance and to every insurer offering supplementary health insurance.

The law defines who counts as an intermediary: anyone who, in the interest of one or more insurers and in return for remuneration, proposes or arranges for insured persons to join an insurer, whatever they call themselves. This includes self-employed brokers, sales forces and comparison websites that earn money from contracts.

The agreement does not protect you from all advertising. Letters, online ads and calls within an existing customer relationship are still allowed. What is banned is cold calling by telephone.

How it works

The rules declared generally binding cover four points:

There is also a clawback rule: if a contract ends within 365 days, the intermediary must repay the entire remuneration; between 366 and 730 days, at least half of it. A contract that you cancel again after a few months therefore earns the intermediary nothing.

Formally, the rules bind the insurers. They may only remunerate intermediaries who comply with the rules. If an insurer does not comply, the supervisory authority can ban it from remunerating external intermediaries for up to one year or limit its acquisition costs. You can report breaches to the reporting office fair-mittler.ch.

Legal basis

Art. 19b para. 1 of the Health Insurance Supervision Act (KVAG) allows insurers to conclude an agreement on telephone marketing, call centres, a ban on telephone marketing to non-customers or former customers, the training of intermediaries, the limitation of remuneration and consultation records. Under para. 2, the Federal Council can declare points c to f generally binding if insurers covering at least 66% of insured persons apply for this. Art. 19a KVAG defines who is an intermediary.

For basic health insurance, the general binding effect is set out in Art. 35b of the Health Insurance Supervision Ordinance (KVAV); Annex 2 quotes the binding clauses word for word, including clause 6 (cold calling), clause 8.2 (consultation record), clause 9.1.1 (CHF 70) and clause 9.2 (cancellation). For supplementary insurance, Art. 190e of the Insurance Supervision Ordinance (ISO) applies, with Annex 7, which sets the cap of 16 net monthly premiums in clause 9.1.2. If an insurer disregards the rules, the supervisory authority can, under Art. 38a KVAG, ban the remuneration of external intermediaries for no more than one year or restrict its acquisition costs.

The rules apply to insurers and, through them, to intermediaries. Untied intermediaries in supplementary insurance are also subject to the obligations of the Insurance Supervision Act (ISA), such as registration with FINMA.

Example: the most an intermediary can receive

The Keller family, two adults and two children, switches basic health insurance through an intermediary and takes out supplementary hospital insurance for one adult. Assume the net monthly premium of the supplementary insurance is CHF 60.

We disclose how we handle remuneration ourselves under Disclosure.

What this means for you

You do not have to do anything for the rules to apply. But it helps to know them:

1. Turn down unwanted calls and report them. Note the date, time, number and company, and report the call to fair-mittler.ch.
2. Read the consultation record before you sign. Among other things, it must confirm that the appointment did not result from a cold call. If that is not true, do not sign.
3. Ask about the remuneration. Untied intermediaries may only accept remuneration from the insurer if they have expressly informed you about it (Art. 45b ISA).

You can switch basic health insurance without an intermediary: compare premiums, cancel by 30 November and register with the new insurer. All the steps are explained under Switching, and the insurers with their data under Health insurers. If you would like advice on supplementary insurance, you can use Request advice, without a call you did not ask for.

Common mistakes

• Believing that all advertising is banned. Cold calling by telephone is banned; letters, online advertising and calls to existing customers are still allowed.
• Answering health questions on the phone. Do not give out health data or your insurance number during unexpected calls.
• Signing a record without reading it. With your signature, you also confirm where the appointment came from.
• Thinking that switching basic health insurance is complicated. You do not need an intermediary; every insurer must accept you in its area of activity (Art. 5 let. i KVAG).