Reimbursement claim form

What is the reimbursement claim form?

The reimbursement claim form is the document you use to claim money back from your health insurer for treatment you have already received. On many doctor’s and therapy bills, it is a separate sheet or a copy of the bill marked as intended for the health insurer. It contains the same information as the bill: who treated you, when, with which services and at which tariff.

The reimbursement claim form exists because basic health insurance has two billing methods. In the tiers garant system, you yourself owe the practice the amount of the bill. You pay the bill and claim the insurer’s share back; to do so, you submit the reimbursement claim form. In the tiers payant system, the practice sends the bill directly to the insurer, and you only receive a copy of the invoice for checking. Which system applies is agreed between insurers and service providers; if there is no agreement, tiers garant applies.

In practice, tiers garant is mainly used for outpatient treatment in doctors’ practices, for physiotherapy and for other therapies. By law, hospitals bill inpatient treatment under the tiers payant system. You can tell from the doctor’s bill whether your practice bills the insurer directly: if it contains a payment slip or QR code addressed to you, it is tiers garant.

The term belongs to basic health insurance. For supplementary insurance, you often submit bills too, but the rules for this are set out in the insurance terms and conditions. Often, a single form is enough for both types of insurance: the insurer first checks basic health insurance and then supplementary insurance.

How it works

The process in five steps

1. Receive the bill. The practice issues you a detailed, comprehensible bill with treatment dates, services and tariff items.
2. Pay the bill. You pay the full amount within the practice’s payment deadline.
3. Submit the form. You send the reimbursement claim form to your insurer, by post, via the customer portal or the app. No special form is needed.
4. Review by the insurer. The insurer checks whether the benefit is insured and counts it towards your co-payment.
5. Reimbursement. The insurer transfers its share to you and sends you a statement of benefits.

What the insurer deducts

The insurer does not reimburse you the full amount. First, the bill is counted towards your deductible, i.e. the amount you pay yourself each calendar year. If your bills exceed the deductible, the insurer deducts the 10% retention fee, up to the maximum amount of CHF 700 a year for adults and CHF 350 for children. You get the rest back. What counts is the date of treatment, not the date of the bill.

Electronic bills

Since 01.07.2026, service providers must send their bills electronically to the debtor. If you ask for it, you receive them on paper free of charge. Service providers and insurers must agree on a uniform standard for electronic transmission; if they fail to do so within two years, the Federal Council will set it. For you, this means that reimbursement claim forms increasingly arrive digitally and can be forwarded directly.

Two bills for two types of insurance

Service providers must issue two separate bills for benefits under basic health insurance and for other benefits. If you receive two forms, they often belong to different types of insurance, for example basic health insurance and a supplementary insurance policy. Submit both.

Legal basis

• Art. 42 para. 1 of the Federal Health Insurance Act (KVG): unless insurers and service providers have agreed otherwise, insured persons owe the service providers the payment. They are entitled to reimbursement from the insurer (tiers garant system).
• Art. 42 para. 2 KVG: insurers and service providers can agree that the insurer owes the payment (tiers payant). For inpatient treatment, the insurer owes its share directly.
• Art. 42 para. 3 KVG: the service provider must send a detailed and comprehensible bill. Under tiers payant, the insured person must receive a copy without having to ask.
• Art. 42 para. 3ter KVG: bills must be sent electronically to the debtor; at the insured person’s request, on paper free of charge. In force since 01.07.2026.
• Art. 42 para. 6 KVG: no form is needed to register claims for benefits.
• Art. 59 of the Health Insurance Ordinance (KVV): among other things, the bill must contain the calendar of treatments, the services provided, diagnoses and procedures where necessary for the tariff, the health insurance card number and the AHV number (para. 1). Two separate bills are required for basic health insurance and other benefits (para. 2). The bill must be comprehensible to you (para. 4).
• Art. 64 KVG and Art. 103 KVV: deductible, 10% retention fee and its maximum amount of CHF 700 for adults and CHF 350 for children; the date of treatment is decisive.
• Art. 24 para. 1 of the Federal Act on the General Part of Social Insurance Law (ATSG): the entitlement to outstanding benefits expires five years after the end of the month for which the benefit was owed.

Example: three forms in one year

Nina is 31 years old, has the standard deductible of CHF 300 and has basic health insurance under the standard model. Her GP practice bills under the tiers garant system. In 2026, she submits three reimbursement claim forms. The bill amounts are chosen for the example; the deductible and retention fee correspond to the statutory values.

The statement of benefits that Nina receives after each form shows the status of her deductible and retention fee. Keep it; it will also help you choose your deductible for the following year.

What this means for you

1. Submit all forms. Even small bills below the deductible count. That is the only way you reach the deductible and then get money back.
2. Check the bill before you forward it. Are the date, name and services correct? If anything is unclear, ask the practice first; the bill must be comprehensible to you.
3. Submit promptly. The statutory five-year deadline is long, but the later you submit, the harder it becomes to clear up mistakes.
4. Submit digitally where possible. Most insurers offer a customer portal or an app. The profiles under Health insurers show which insurer offers which service.
5. Use your costs to choose your deductible. The total of your forms for a year is the best basis for your next deductible. Compare the options in the premium calculator and save the results in your account.

Common mistakes

• Throwing away forms below the deductible. The amount is then missing from your deductible, and later bills are counted towards it first.
• Not paying the bill because the insurer has not yet reimbursed you. The practice can send you reminders and initiate debt enforcement, regardless of the insurer.
• Submitting only one of two forms. Separate bills for basic and supplementary insurance must both go to the insurer.
• Forgetting the old insurer when you switch. Forms for treatment in the old year belong to the insurer you were insured with on the date of treatment.
• Confusing the copy of the invoice with the reimbursement claim form. The copy under tiers payant is only for checking; the insurer already has the bill.

We explain how we calculate examples of co-payments under How we calculate.