Submitting a doctor’s bill

What does submitting a doctor’s bill mean?

Submitting a doctor’s bill means sending your health insurer the bill from a doctor, a therapist or another service provider so that it covers the costs under basic health insurance or counts them towards your deductible. Whether you have to do this depends on who owes the bill.

There are two systems in Switzerland. Under the tiers garant system, the practice sends the bill to you. You pay it and submit the reimbursement claim form to your insurer. The insurer reimburses the part it owes after the deductible and retention fee. Under the tiers payant system, the service provider bills the insurer directly; the insurer then invoices you for your share. Tiers garant always applies when the insurer and the service provider have not agreed otherwise. The bill shows which system applies. For inpatient treatment in hospital, the insurer always owes its share directly.

The term doctor’s bill here stands for all bills under basic health insurance: doctors’ practices, physiotherapy, laboratories, pharmacies, nursing care at home (Spitex) or midwives. For supplementary insurance, the rules of your contract apply; many insurers process both parts in one go.

How it works

1. Receive the bill. The bill must be detailed and understandable. Among other things, it states the dates of treatment, the services according to the tariff, the diagnoses insofar as they are necessary for the tariff, and the number of your health insurance card. Services under basic health insurance and other services must appear on two separate bills.
2. Check the bill. Are the date and the services correct? Were you really in treatment for that long? Clarify anything unclear with the practice first.
3. Pay. Under tiers garant, you owe the amount to the service provider within the payment period stated on the bill.
4. Submit. You send the reimbursement claim form by post or upload it to your insurer’s customer portal or app. No form is required.
5. Settlement. The insurer checks the bill, deducts the deductible and retention fee and sends you a statement of benefits. If an amount remains in your favour, it transfers it to you.

Since 01.07.2026, the KVG has obliged service providers to send bills electronically to the party liable for payment. On request, you receive them on paper free of charge. Service providers and insurers still have to agree on the common standard for electronic transmission; if they do not succeed within 2 years, the Federal Council will set it.

Under tiers payant you do not need to submit anything. You do, however, receive a copy of the bill. Check it anyway: only you know whether the treatment took place as billed.

Legal basis

Art. 42 para. 1 of the Federal Health Insurance Act (KVG) provides that, unless the insurer and service provider have agreed otherwise, insured persons owe the remuneration and are entitled to reimbursement from the insurer (tiers garant). Under Art. 42 para. 2 KVG, the insurer and service provider can agree that the insurer owes the remuneration (tiers payant); for inpatient treatment, the insurer owes its share in any case.

Art. 42 para. 3 KVG requires a detailed and understandable bill. Under tiers payant, the service provider must send you a copy of the invoice without being asked. Art. 42 para. 3ter KVG, in force since 01.07.2026, prescribes electronic transmission and gives you the right to a paper bill free of charge. Under Art. 42 para. 5 KVG, you can request that medical information only goes to the insurer’s medical adviser. Art. 42 para. 6 KVG states that no form is required to claim benefits.

The information a bill must contain is set out in Art. 59 KVV. The deadline follows from Art. 24 para. 1 ATSG: the entitlement to outstanding benefits lapses 5 years after the end of the month for which the benefit was owed. Under Art. 103 para. 3 KVV, the date of treatment determines which year’s deductible and retention fee a bill counts towards.

Example: three bills in one year

Jonas, 29, has a deductible of CHF 1,000. In 2026 he receives three bills under the tiers garant system. The calculation uses the statutory values (10% retention fee).

What this means for you

• Submit everything. Even small bills below the deductible belong with the insurer. Submitting once a month keeps the effort low.
• Use digital channels. Many insurers offer a customer portal or an app where you photograph and upload receipts. The overview of health insurers shows how to reach your insurer.
• Collect your receipts. In your account on die-krankenkasse.ch you can store bills and keep track of your year.
• Check the statement of benefits. Compare the statement with your bills. If something is missing or was settled incorrectly, contact your insurer.
• Reconsider your deductible. If you see at the end of the year that your costs are regularly above or below your deductible, use the premium calculator to check a different deductible for the next year. The dates for this are listed under deadlines.

Common mistakes

• Throwing away bills below the deductible. They are then missing from the annual total, and the insurer starts paying later.
• Thinking the bill is meant for the insurer. Under tiers garant you owe the doctor the amount, even if the insurer has not yet paid.
• Ignoring the copy under tiers payant. The copy of the invoice is your only way of spotting incorrect billing.
• Waiting too long. After 5 years the entitlement has lapsed. And the later you submit, the harder it is to clarify errors with the practice.
• Forgetting supplementary insurance. Services such as glasses or complementary medicine are covered by supplementary insurance. Submit these receipts too if you have such cover.

We explain how we work with figures and examples under How we calculate.