Premium refund

What is a premium refund?

A premium refund is a repayment by the health insurer to its insured persons because the premiums of basic health insurance in a canton were set too high. Every health insurer must estimate its premium in advance and have it approved by the Federal Office of Public Health (FOPH). If the actual costs then turn out to be significantly lower than the premiums collected, the health insurer may pay back the surplus. The law speaks of the “adjustment of excessive premium income”.

In everyday language, the term has several meanings. This page is only about the refund in compulsory health insurance under the Health Insurance Supervision Act (KVAG). Three other things are often confused with it:

• Reimbursement of medical bills: if you pay a bill yourself and submit it to your health insurer, it reimburses its share. This is the normal payment of benefits, not a premium refund.
• Redistribution of the CO2 levy: the Confederation distributes the revenue from the CO2 levy on heating and process fuels via the health insurers to everyone insured under the Federal Health Insurance Act (KVG) who is resident in Switzerland, the same amount per person. Here, the health insurer only acts as the paying agent.
• Bonus in supplementary insurance: some supplementary insurance policies reward years without claims. This is governed by the contract under the Insurance Contract Act, not by the KVAG.

A genuine premium refund in basic health insurance is voluntary. The law says that the health insurer “may” make an adjustment. You have no entitlement to it.

How it works

The process follows a fixed calendar. Take the premium year 2025 as an example:

1. Setting premiums: the health insurer calculates its premiums for 2025 in the previous year and submits them to the FOPH. The premium approval checks whether the premiums cover the costs in the canton without being inappropriately higher.
2. Settling accounts: after the end of 2025, the health insurer compares premium income with costs for each canton. The income is “significantly” too high if the deviation between the expected and the actual ratio of costs to premiums exceeds the standard deviation. The formula is set out in the annex to the supervision ordinance.
3. Submitting the application: if the health insurer wants to make an adjustment, it submits the application to the FOPH by the end of June 2026 and justifies the amount.
4. Paying out: the refund is made in the same calendar year as the application, so in 2026. The health insurer distributes the amount among insured persons using an appropriate key, informs you of your share and deducts it from the premiums or pays it out separately.

You are entitled if you had basic health insurance with the health insurer on 31 December 2025. If you switch health insurer on 1 January 2026, you still receive the refund for 2025 from your former health insurer. The health insurer may offset the amount against outstanding premiums or co-payments that you owe it.

Full premium subsidies are a special case: if the canton paid your entire premium through the premium subsidy or supplementary benefits, the share goes to the canton in which you lived on 1 January of the year concerned. This is logical, because the money came from the canton.

There is also a second route: the voluntary reduction of reserves. If a health insurer has significantly more reserves than the minimum required, it can reduce them with a reduction plan. It must first calculate its premiums tightly. If that is not enough, it can also distribute an adjustment amount to insured persons. This amount is deducted from the approved premium and shown separately on the bill.

Legal basis

The rules are set out in the Health Insurance Supervision Act (KVAG) and the associated ordinance (KVAV):

• Art. 16 KVAG: the FOPH approves the premium tariffs. It refuses approval if the premiums do not cover the costs, are inappropriately high compared with the costs or lead to excessive reserves (para. 4).
• Art. 17 KVAG: if a health insurer’s premium income in a canton in one year was significantly higher than the cumulative costs, it can make a premium adjustment in the following year. It submits the application by the end of June of the following year (para. 1). The adjustment is intended to restore the balance between premiums and costs (para. 2).
• Art. 18 KVAG: the refund goes to the persons who were insured on 31 December of the year concerned (para. 1). If the premium was fully covered by a premium subsidy or supplementary benefits, it goes to the canton of residence (para. 2). It is made in the calendar year of the application (para. 3).
• Art. 30a and 31a KVAV: “significantly higher” means that the deviation exceeds the standard deviation under Annex 1 KVAV. The health insurer distributes the amount using an appropriate key.
• Art. 33 KVAV: the health insurer informs you of the amount, deducts it from the premiums or pays it out separately and may offset it against outstanding claims.
• Art. 26 KVAV: voluntary reduction of reserves with a reduction plan; any adjustment amount appears separately on the premium bill.

There is no comparable statutory rule for supplementary insurance. There, the Insurance Contract Act (ICA) and the contractual conditions of your health insurer apply.

Example: who receives a refund for 2025 in 2026

Suppose a health insurer collected significantly too much in premiums in the canton of Zurich for 2025 and submits an application by the end of June 2026. The FOPH approves it. Who receives something? The table applies Art. 18 KVAG to four fictitious people. We deliberately do not give amounts, because each health insurer sets its own distribution key.

Whether your health insurer collected too much in a given year is not shown on its website, but in the FOPH supervisory data: they list premiums, costs and reserves for each health insurer. An overview of health insurers with key figures is available under Health insurers.

What this means for you

A premium refund is a side effect, not a reason to choose a health insurer. It is voluntary, comes irregularly and cannot be planned in advance. What counts for your budget is still the premium you pay every month.

• Compare premiums: you compare the premiums for next year in the premium calculator. A health insurer that calculates tightly today will not need a refund tomorrow.
• Switch without losing out: if you want to switch, you do not lose any refund for the current year as long as you are still with your former health insurer on 31 December. Dates and procedures are listed under Switching health insurer and Deadlines.
• Check your bill: if there is a deduction on your premium bill, read the description. “CO2 levy” or “redistribution of environmental levies” is the Confederation’s redistribution; “premium adjustment” or “refund” is a genuine refund from your health insurer.
• Outstanding amounts: if you are in arrears with premiums or co-payments, the health insurer may offset the refund against them.

Common mistakes

• Taking the CO2 redistribution for a refund from your health insurer. It comes from the Confederation every year, is the same for everyone and says nothing about your health insurer’s finances.
• Counting on a refund. The health insurer “may” make an adjustment; it does not have to. Plan with the premium, not with a possible repayment.
• Not switching for fear of losing out. The reference date is 31 December of the year concerned. Switching on 1 January does not cost you a refund.
• Demanding the refund. You have no legal entitlement. But you can check whether the health insurer has offset the amount correctly and ask if anything is unclear.

We explain how we process the premiums and key figures of health insurers under How we calculate.