Premium approval

What is premium approval?

Premium approval is the procedure in which the Federal Office of Public Health (FOPH) reviews the premiums of basic health insurance every year before they take effect. Each health insurer sets its own premiums, for every canton, every premium region, every age group, every deductible and every model. It submits these premium tariffs to the FOPH. Without approval, it may not publish any premium and may not charge any premium.

The procedure is laid down in the Health Insurance Supervision Act (KVAG), which has been in force since 2016. According to the FOPH, this strengthened its role: it can intervene if premiums are inappropriately high and require a lower premium in order to prevent excessive reserves.

The approval only concerns basic health insurance and voluntary individual daily allowance insurance under the Federal Health Insurance Act (KVG). FINMA reviews the tariffs of supplementary insurance under different rules.

How it works

The procedure follows the same calendar every year:

1. Submission by the end of July: health insurers submit their premiums for the following year, together with their numbers of insured persons and cost estimates for the current and the next year. The deadline is five months before the premiums apply.
2. Opinion of the cantons: the cantons may comment on the estimated costs and the premiums for their canton. The FOPH sets them a deadline that must not delay the procedure.
3. Review by the FOPH: the FOPH first reviews the financial security of the health insurer at national level, then checks for each canton whether the premiums cover the costs. It also checks the discounts for excluding accident cover, for optional deductibles and for models with a restricted choice of doctor.
4. Approval and publication at the end of September: the FOPH approves the premiums for one calendar year and publishes the approved tariffs. The data are available on priminfo.admin.ch and opendata.swiss.
5. Notification by 31 October: your health insurer notifies you of the new premium and points out your right to switch insurer.

If the premiums do not meet the requirements, the FOPH refuses approval and orders what the health insurer must do. If premium income in a canton was significantly higher than the costs, the health insurer can apply for an adjustment in the following year and pay money back to insured persons (premium refund).

Legal basis

Art. 16 para. 1 KVAG makes premium tariffs subject to approval and prohibits publishing or applying them before approval. Under para. 3, premiums cover the costs, which differ from canton to canton; the place of residence is decisive. Para. 4 lists the grounds for refusal: the premiums do not comply with the legal requirements (let. a), do not cover the costs (let. b), are inappropriately high compared with the costs (let. c) or lead to excessive reserves (let. d). Para. 6 gives the cantons the right to submit an opinion.

The Health Insurance Supervision Ordinance (KVAV) adds the details: Art. 25 states that the estimated income must cover the estimated expenditure. Art. 27 governs submission, deadline and the duration of approval. Art. 71 let. c KVAV requires the FOPH to publish the approved tariffs. Art. 17 KVAG governs the adjustment of excessive premium income, and Art. 7 para. 2 KVG the notification of insured persons.

Example: the calendar for the 2027 premiums

The dates follow from the statutory deadlines. The example shows what happens up to a switch on 1 January 2027.

What this means for you

Between the announcement at the end of September and 30 November, you have about two months to compare the new premiums and switch. The premium calculator shows all approved premiums for your municipality as soon as the FOPH has released them. Figures published earlier are forecasts, not approved premiums.

You can find the key figures on the reserves and costs of every health insurer in the overview Health insurers. The deadlines for switching are listed under Deadlines. The entry premium increase explains how much your premium rises.

Common mistakes

• Taking forecasts for approved premiums. Before the FOPH announcement there are only estimates; only the approved tariffs are binding.
• Overlooking your health insurer’s notification. The new premium starts the deadline for switching at the end of the year.
• Holding the FOPH responsible for the amount of the premium. The health insurer sets the premium; the FOPH reviews it.
• Treating supplementary insurance the same way. FINMA approves its tariffs, and the notice periods are set out in the general insurance conditions (GIC).