Outpatient flat rates

What are outpatient flat rates?

Outpatient flat rates are fixed amounts for a complete outpatient treatment in basic health insurance. Outpatient means that you go home on the same day, without staying overnight in hospital. Instead of billing every minute, every examination and every item of material separately, the service provider charges a single price for the treatment. The law calls this a flat-rate tariff per patient.

Since 01.01.2026, a new tariff system for outpatient medical services has applied in Switzerland. It consists of two parts: the fee-for-service tariff TARDOC and a tariff structure with around 300 outpatient flat rates. Together they replace TARMED, which applied for around 20 years. The system was developed by the tariff partners, that is, the associations of doctors, hospitals and insurers. The organisation for outpatient medical tariffs (OAAT AG) is responsible for maintaining and developing it.

According to the FOPH, the flat rates mainly cover standardisable procedures that require complex infrastructure, such as arthroscopies or cataract operations, which usually take place in hospital outpatient departments. A flat rate includes all services that belong to the treatment, including medicines, implants and laboratory analyses.

Outpatient flat rates must be distinguished from the inpatient case-based flat rates under SwissDRG, which have applied for years when you stay overnight in hospital. The general term for flat-rate remuneration is flat-rate tariff. Supplementary insurance under the Insurance Contract Act (ICA) is not directly affected by the flat rates; it has its own contracts with service providers.

How it works

The overall system follows a simple rule: every treatment is billed either under TARDOC or with an outpatient flat rate. Mixed billing is not permitted. If there is a flat rate approved by the Federal Council for a treatment, all service providers must apply it to that treatment.

The amount of a flat rate is based on the actual average cost of such treatments in Swiss hospitals. If a procedure takes longer or less time than average, the amount stays the same. This is intended to simplify billing and reduce the incentive to bill as many individual services as possible.

On your bill you can recognise an outpatient flat rate by the tariff code 005. You see the total amount, but no individual prices for medicines, because these are included in the flat-rate amount. The OAAT shows how flat rates are made up in its tariff browser.

The introduction follows a set framework: the Federal Council approved the tariff structures on 30.04.2025 for three years and approved adjustments on 05.11.2025. The law requires the change of tariff model in itself to be cost-neutral. In the year of introduction, the new tariff structure must produce the same volume of services as the old one; after that, an annual growth corridor applies. On 22.01.2026 the Federal Administrative Court declined to consider appeals against the flat rates; this decision is final.

Legal basis

The basis is Art. 43 of the Federal Health Insurance Act (KVG). Under Art. 43 para. 2 let. c KVG, a tariff may provide for flat-rate remuneration (flat-rate tariff). Art. 43 para. 3 KVG specifies that a flat-rate tariff may relate to the treatment per patient (flat rate per patient).

Art. 43 para. 5 KVG requires fee-for-service tariffs and flat-rate tariffs per patient relating to outpatient treatment each to be based on a single uniform tariff structure agreed for the whole of Switzerland. Under para. 5ter, an approved flat-rate structure must be applied by all service providers to the treatments concerned. Para. 5quater allows the tariff partners to agree regional flat rates for certain treatments where regional circumstances require it; nationwide structures take precedence.

Art. 47a KVG obliges the associations of service providers and insurers to set up a joint organisation with equal representation for the outpatient tariff structures; this is OAAT AG. Its tariff structures are submitted to the Federal Council for approval (Art. 47a para. 7 KVG). For the bill, Art. 59 of the Health Insurance Ordinance (KVV) applies: it must show the services in the level of detail of the tariff and be understandable for you (Art. 59 para. 4 KVV).

Example: co-payment on a flat rate

Tobias is 52, has a deductible of CHF 1,500 and has already had CHF 400 in doctor’s costs in the current year. He now has a knee arthroscopy as an outpatient in hospital, which is billed with an outpatient flat rate. We assume a flat-rate amount of CHF 3,000 for illustration; the actual amounts are set out in the approved tariff structure.

What this means for you

For you as an insured person, it is mainly the bill that changes, not your entitlement. Basic health insurance pays for the same services as before, and your co-payment follows the same rules. Three points are nevertheless useful:

1. Read the bill. Look at the tariff code. Code 005 means a flat rate; in that case, the bill should not also list individual services under TARDOC for the same treatment.
2. Ask if anything is unclear. The new system started in 2026, and the tariff partners are adjusting it continuously. If a bill looks implausible, ask the hospital or practice first, then your health insurer. The insurers’ contact details are in the profiles under health insurers.
3. Plan your deductible. If you know that an outpatient procedure is coming up, a lower deductible for the next year may make sense. You must request a lower deductible by 30 November; all dates are listed under deadlines.

The premium does not depend directly on the tariff that an individual practice uses. The premium calculator shows how expensive basic health insurance is with the insurers where you live. The term outpatient before inpatient explains why lawmakers promote outpatient treatment.

Common mistakes

• Confusing a flat rate with “all inclusive, free of charge”. The flat rate is a price, not an exemption from costs. The deductible and retention fee apply as with any other bill.
• Confusing outpatient and inpatient flat rates. Inpatient case-based flat rates under SwissDRG apply to hospital stays with an overnight stay. Outpatient flat rates cover treatments without an overnight stay.
• Taking missing individual items for an error. With a flat rate, medicines and materials are not listed separately on the bill. That is intended.
• Only asking the insurer about the bill. The bill is issued by the service provider. It must be able to explain it; the insurer then checks it.

We explain how we build our examples and calculators under How we calculate.