prio.swiss

What is prio.swiss?

prio.swiss is the industry association of Swiss health insurers. The association represents the common interests of its members in basic health insurance: in politics, before the Confederation and the cantons, and in negotiations with doctors, hospitals and other service providers. According to the association, the name stands for the “priority” of working towards a healthcare system that is easily accessible and sustainably financed.

The association is young. Until the end of 2024, two associations represented the health insurers: santésuisse and curafutura. prio.swiss started operating on 06.01.2025, pools the strengths of the two former associations and has since taken over the political and public representation of the health insurers’ interests with a single voice.

At the start, prio.swiss had 10 members representing around 90 % of persons with basic health insurance. Today, the association states that it and its members represent 100 % of insured persons in Switzerland. Its head office started with around 30 employees.

Important for you as an insured person: prio.swiss is neither a health insurer nor an authority. The association does not offer insurance, does not pay bills and does not decide on your benefits. Complaints against your health insurer go to the health insurer itself and then to the Office of the health insurance ombudsperson.

How it works

prio.swiss works in several areas that the Federal Health Insurance Act (KVG) assigns to or opens up for associations of insurers:

• Tariffs: on the insurers’ side, the association is responsible for negotiating and maintaining the tariff structures. For outpatient medical services, the associations of service providers and insurers must jointly set up a national tariff organisation with equal representation.
• Health policy: prio.swiss comments on draft legislation, consultations and cantonal projects, for example on hospital planning or long-term care.
• Hospital planning: since 2024, organisations of insurers have been able to appeal against cantonal hospital lists. prio.swiss did so, for example, against the hospital list of the canton of Schwyz; the Federal Administrative Court did not consider this appeal.
• Quality and catalogue of benefits: the association submits topics for health technology assessments (HTA), with which the Confederation reviews benefits for effectiveness, appropriateness and cost-effectiveness.
• Industry rules: prio.swiss co-sponsors the industry agreement on the activities of insurance intermediaries, which among other things prohibits cold calling by telephone and caps commissions.

The members of the association are the health insurers themselves, not the insured persons. The positions of prio.swiss are therefore the positions of the health insurers.

Legal basis

prio.swiss is an association under private law, not a body of health insurance. There is therefore no law on prio.swiss. However, the KVG and the Health Insurance Supervision Act (KVAG) give associations of insurers certain roles.

Art. 47a of the Federal Health Insurance Act (KVG) requires the associations of service providers and of insurers to set up an organisation for the tariff structures of outpatient medical treatment, in which both sides have equal representation. Art. 53 para. 1bis KVG gives organisations of insurers of national or regional importance the right to appeal against cantonal hospital planning under Art. 39 KVG.

Art. 19b of the Health Insurance Supervision Act (KVAG) allows insurers to conclude an agreement on telephone advertising, call centres, training of intermediaries, remuneration and records of advice. At the request of insurers that together represent at least 66 % of insured persons, the Federal Council can declare parts of it generally binding. This has been done with the industry agreement, which has applied to all health insurers since 01.09.2024.

Example: the reporting office for intermediaries

The industry agreement co-sponsored by prio.swiss has its own reporting office: fair-mittler.ch. There, you can report breaches such as unwanted calls. prio.swiss has published the following figures:

The figures come from the association itself. Regardless of this, the agreement covers intermediaries whether they are self-employed or employed by a comparison portal or by a health insurer.

What this means for you

In everyday life, you have little to do with prio.swiss. Your point of contact for premiums, benefits and bills is always your health insurer. The association is useful in two places:

1. Putting policy and tariffs into context: the positions and statements of prio.swiss show where the health insurers stand on reforms. Read them as the industry’s view, not as neutral information.
2. Protection against unwanted calls: through the industry agreement and fair-mittler.ch, you can defend yourself against cold calling.

If you want to compare health insurers, use official data: the premium calculator shows the FOPH-approved premiums of all health insurers, and the profiles under Health insurers show key figures from supervision. You plan a switch with the dates under Deadlines.

Common mistakes

• Taking prio.swiss for a health insurer. The association does not insure anyone and does not pay bills.
• Sending complaints to the association. For a dispute with your health insurer, the health insurer is responsible first, then the Office of the health insurance ombudsperson.
• Reading the association’s positions as facts. prio.swiss represents the interests of the health insurers; figures and statements on reforms are the industry’s view.
• Trusting calls that refer to “the association”. prio.swiss does not sell insurance. Anyone who invokes the association on the phone to offer you a switch is a case for fair-mittler.ch.