Suspension of benefits

What is a suspension of benefits?

A suspension of benefits is a measure against insured persons who persistently fail to pay their premiums for basic health insurance. The health insurer then stops covering treatment costs for the time being. It is sometimes also called a benefits freeze. The term “suspension” is more precise: the insurance continues, and once the debts have been paid, the suspension is lifted.

A suspension of benefits does not happen automatically. It requires the canton of residence to keep a list of insured persons in arrears. The law allows cantons to keep such a list but does not require them to. The insurer only suspends benefits when the canton reports you. The list is accessible only to service providers, the municipality and the canton.

The suspension only concerns basic health insurance under the Federal Health Insurance Act (KVG). For supplementary insurance, the rules of the Insurance Contract Act (ICA) and the insurer’s contract terms apply, which set out their own consequences for late payment. Emergency treatment is always excluded from the suspension.

How it works

It takes time before benefits are suspended, and every step is prescribed:

1. Reminder. If you do not pay a premium or co-payment that is due, the insurer sends you at least one written reminder. From this reminder onwards, you are considered to be in arrears.
2. Demand for payment. No later than 3 months after the due date, the insurer sends you a demand for payment, separate from any other arrears. It gives you a grace period of 30 days and points out the consequences.
3. Debt enforcement. If you still do not pay, the insurer must initiate debt enforcement proceedings. In each calendar year, it may initiate proceedings against you at most twice for your own arrears and twice for arrears relating to a child.
4. Certificate of unpaid debt. If debt enforcement ends without payment, the insurer receives a certificate of unpaid debt (Verlustschein). It reports the claim to the canton, which covers 85% of it.
5. List and suspension. If your canton keeps a list and puts you on it, it reports this to the insurer. From then on, the insurer suspends coverage of costs, except in emergencies.

Throughout this time, premiums continue to fall due. The insurer may not offset unpaid premiums against benefits it owes you. And as long as there are arrears, you cannot switch to another insurer.

Legal basis

The procedure is set out in Art. 64a KVG. Para. 1 requires at least one written reminder, a demand for payment with a grace period of 30 days and a notice of the consequences before any further steps. Under para. 2, the insurer must initiate debt enforcement proceedings; a person may be subject to proceedings at most twice per calendar year for their own arrears and twice for arrears relating to a child. Paras. 3 and 4 govern the report to the canton and the canton’s coverage of 85% of claims for which there is a certificate of unpaid debt. Para. 6 rules out a switch of insurer for insured persons in arrears until everything has been paid.

The suspension of benefits itself is set out in Art. 64a para. 7 KVG: cantons can record insured persons who do not meet their obligation to pay premiums despite debt enforcement on a list. When the canton reports them, insurers suspend coverage of costs for these persons, with the exception of emergency treatment, and report when the suspension is lifted once the claims have been paid. Emergency treatment exists when, without immediate treatment, there is a risk of damage to health or death, or the health of others is at risk.

The ordinance adds the following: under Art. 105b KVV, the demand for payment must be sent no later than 3 months after the due date. Art. 105c KVV prohibits offsetting benefits against premiums. Art. 105l KVV provides that a person is considered to be in arrears from the reminder onwards and that a notice of cancellation has no effect unless everything has been paid. For minor children, the rules are addressed to the parents, who owe the premiums (Art. 64a para. 1bis KVG).

Example: from an unpaid premium to a suspension

Daniel is 34 and lives in a canton that keeps a list of insured persons in arrears. Assume his premium is CHF 580.00 a month; that is the median 2026 premium in the municipality of Zurich (region 1) for adults with a CHF 300 deductible and accident cover, source FOPH. He does not pay his premiums for January to March 2026.

What this means for you

React to the first reminder. The sooner you act, the less interest, fees and debt enforcement costs are added. Ask your insurer about paying in instalments before debt enforcement starts. Also check whether you are entitled to a premium subsidy. It is handled by the canton and reduces the premium you pay yourself.

If the premium is simply too high for your budget, check a cheaper combination of insurer, deductible and model in the premium calculator. You can only switch, however, once there are no more arrears. You can find your insurer’s addresses and contact details in the health insurer profiles, and the dates for a later switch under deadlines.

If you are in a dispute with the insurer, for example about the amount of the claim or whether a treatment was an emergency, the Office of the health insurance ombudsperson helps free of charge. If you have unpaid premiums, also ask your municipality’s social services about support.

Common mistakes

• Ignoring reminders. From the reminder onwards, you are considered to be in arrears. Every further step costs more and restricts you.
• Cancelling to escape the debts. As long as there are arrears, a notice of cancellation has no effect. You stay with your insurer.
• Believing the canton has paid the debts. If the canton covers 85% of a claim, you still owe the debt until you pay it.
• Not seeing a doctor in an emergency. Emergency treatment is always covered, even during a suspension.

We explain how we prepare legal rules and examples under how we calculate.