Objection

What is an objection?

An objection is the first formal step if you disagree with a decision by your health insurer in basic health insurance. With it, you ask the insurer to review its decision once more. An objection is always directed against a written decision, that is, a written decision with reasons and with information on how to challenge it.

The procedure is governed by the ATSG, the Federal Act on the General Part of Social Insurance Law. It applies to health insurance unless the Federal Health Insurance Act (KVG/LAMal) provides otherwise (Art. 1 para. 1 KVG). That is why an objection to a health insurer works in the same way as one to accident insurance or to old-age and survivors’ insurance (AHV).

It is important to draw the line with basic health insurance: objections only exist in compulsory health insurance under the KVG. For supplementary insurance under the Insurance Contract Act (ICA), the insurer does not issue written decisions. There, a dispute is a contractual dispute under civil law that belongs before a civil court. Some cantons have designated their insurance court as the sole instance for such cases (Art. 7 CPC).

How it works

Insurers pay most benefits without a written decision, in what is known as the informal procedure. In health insurance this even applies to substantial benefits (Art. 80 para. 1 KVG). If the insurer rejects or reduces a bill, you therefore often only receive a letter or a statement of benefits. You cannot yet object to such a letter.

The procedure therefore looks like this:

1. Ask for a written decision. If you disagree with an informal decision, write to the insurer saying that you request a written decision that can be challenged (Art. 51 para. 2 ATSG). The insurer must then issue a written decision.
2. Note the deadline. The 30-day deadline runs from delivery of the written decision. It starts on the day after delivery (Art. 38 para. 1 ATSG). If you do not collect a registered letter, it is deemed delivered on the seventh day after the first delivery attempt at the latest (Art. 38 para. 2bis ATSG).
3. File the objection. You send the objection to the office that issued the decision. It needs a request (what should the insurer decide differently?) and a statement of reasons (why?) (Art. 10 para. 1 ATSV). If filed in writing, it must be signed. You can also raise it orally with the insurer; the insurer then records it in minutes that you sign (Art. 10 paras. 3 and 4 ATSV).
4. Wait for the response to the objection. The insurer decides “within a reasonable time”, gives reasons for its decision and adds information on how to challenge it (Art. 52 para. 2 ATSG).
5. Appeal if necessary. You can appeal against the response to the objection to the Cantonal Insurance Court within 30 days (Art. 56 and 60 ATSG).

If your objection lacks the request, the reasons or the signature, the insurer may not simply reject it. It must give you a deadline to correct it (Art. 10 para. 5 ATSV). The insurer is not bound by your request and can also change the written decision to your disadvantage; in that case it must first give you the opportunity to withdraw the objection (Art. 12 ATSV).

As a rule, an objection has suspensive effect (Art. 11 para. 1 ATSV). However, the insurer can remove this effect in the written decision (Art. 49 para. 5 ATSG).

Legal basis

The core provision is Art. 52 ATSG. Paragraph 1 allows an objection to written decisions within 30 days, filed with the office that issued the decision; procedural decisions and decisions on the conduct of proceedings are excluded. Paragraph 2 requires a response to the objection with reasons and information on how to challenge it, and paragraph 3 makes the procedure free of charge; as a rule, no compensation for party costs is awarded.

The deadlines are governed by Art. 38–41 ATSG: they start on the day after notification, move to the next working day if the last day falls on a Saturday, Sunday or public holiday (Art. 38 para. 3), and are suspended from the seventh day before to the seventh day after Easter, from 15 July to 15 August and from 18 December to 2 January (Art. 38 para. 4). A deadline set by law cannot be extended (Art. 40 para. 1). If you were prevented from acting through no fault of your own, you can request restoration within 30 days after the obstacle ceases and file the objection late (Art. 41).

Form and procedure are set out in Art. 10–12 ATSV. For health insurance, Art. 80 and Art. 85 KVG add two points: the informal procedure also applies to substantial benefits, and there are no internal levels of review.

Example: an objection over the summer holidays

Lara is 38. Her insurer has refused to cover an outpatient treatment. Lara asks for a written decision. The decision arrives by post on Friday, 10.07.2026. This is how she calculates the deadline:

Lara’s objection has four parts: a statement of which written decision it is directed against (date, reference number), the request “The written decision of … is to be set aside and the costs of the treatment are to be covered”, the reasons with the medical report attached, and her signature.

What this means for you

• Check whether you have a written decision. Only a letter with information on how to challenge it (“An objection to this decision may be filed within 30 days …”) can be challenged. If it is missing, first ask in writing for a written decision.
• Note the date of delivery. Keep the envelope or the tracking record. You calculate the deadline from it.
• Give specific reasons. Enclose medical reports, invoices or cost approvals. The insurer must establish the facts, but your documents speed this up.
• Get free help. The Office of the health insurance ombudsperson mediates between you and the insurer free of charge. However, it does not stop the objection deadline: file your objection in time anyway.
• Think about the appeal. If the insurer sticks to its decision, you can challenge the response to the objection at the Cantonal Insurance Court within 30 days.

A dispute with your insurer is not a reason to switch, but it can become one. You can see how insurers differ under health insurers at a glance. The premium calculator shows the premiums of all insurers for your municipality, and the deadlines for switching are under switch insurer. Every insurer must offer you basic health insurance on the same terms, even after a dispute.

Common mistakes

• Objecting to the statement of benefits. A statement is not a written decision. Ask for a written decision first; otherwise the insurer will not consider the objection.
• Counting the deadline from the date on the decision. What counts is delivery, not the date on the letter. The deadline starts on the following day.
• Hoping for an extension. The 30 days are set by law and cannot be extended. If necessary, file a short objection and send the supporting documents later.
• Only contacting the ombudsperson. Mediation does not replace the objection. If the deadline expires, the written decision becomes final.
• Trying to object in supplementary insurance. There is no objection procedure for supplementary insurance; the contract, the ICA and the Civil Procedure Code apply.