Tariff agreement

What is a tariff agreement?

A tariff agreement governs how a service provider bills its basic health insurance services. The Federal Health Insurance Act (KVG) requires bills to be drawn up according to tariffs or prices (Art. 43 para. 1 KVG). As a rule, health insurers and service providers negotiate these tariffs themselves, in tariff agreements. Only where the law provides for it does an authority set the tariff (Art. 43 para. 4 KVG).

A tariff can be structured in different ways: according to time spent, as a fee-for-service tariff with tax points and a point value, or as a flat rate (Art. 43 para. 2 KVG). Since 01.01.2026, outpatient medical services have been billed under the overall tariff system made up of TARDOC and outpatient flat rates. In hospital, inpatient treatment is paid with flat rates, as a rule with case-based flat rates (Art. 49 para. 1 KVG).

In practice, there are often two levels:

• Tariff structure agreement: it sets out, for the whole of Switzerland, which services exist and how many tax points they are worth. Fee-for-service tariffs and outpatient patient flat rates must be based on a single tariff structure agreed for the whole of Switzerland (Art. 43 para. 5 KVG).
• Point value agreement: it sets out how much one tax point is worth in Swiss francs. For medical tariffs, this value is usually agreed per canton.

Tariff agreements only exist in basic health insurance. In supplementary insurance, health insurers and hospitals agree their prices under private law, without approval under the KVG.

How it works

The parties to the agreement are, on one side, one or more service providers or their associations and, on the other, one or more health insurers or their associations (Art. 46 para. 1 KVG). Many health insurers negotiate through purchasing groups or their industry association. If an association is a party, the agreement only applies to its members if they have joined it; non-members can join too (Art. 46 para. 2 KVG).

The law prohibits certain clauses, whether in the tariff agreement or in side agreements: bans on special agreements, non-competition clauses for association members, and exclusivity and most-favoured-nation clauses (Art. 46 para. 3 KVG). Before an association agreement is concluded, the organisations representing the interests of insured persons must be consulted (Art. 43 para. 4 KVG).

The agreement then needs approval: from the cantonal government if it applies in one canton, or from the Federal Council if it is to apply throughout Switzerland. The authority checks lawfulness, cost-effectiveness and fairness and must decide within one year of submission (Art. 46 para. 4 and 4bis KVG). If an approved agreement no longer meets the requirements, it can ask the parties to adjust it and, if they do not agree, set the tariff itself after one year (Art. 46a KVG).

If no agreement is reached at all, the cantonal government sets the tariff after consulting the parties concerned (Art. 47 para. 1 KVG). If the renewal of an existing agreement fails, it can extend it by one year and then set the tariff itself (Art. 47 para. 3 KVG). Such decisions of the cantonal government can be appealed to the Federal Administrative Court (Art. 53 KVG).

Once the tariff is in force, service providers must keep to it. They may not charge more for basic health insurance services (tariff protection, Art. 44 KVG). Disputes about its application in an individual case are decided by the cantonal arbitration tribunal (Art. 89 KVG).

Legal basis

Art. 43 KVG contains the principles: bills according to tariffs or prices (para. 1), types of tariff (para. 2), agreement in a tariff agreement or setting by the authority, calculated on business management principles (para. 4), and a uniform tariff structure for the whole of Switzerland for fee-for-service tariffs and outpatient patient flat rates (para. 5).

Art. 46 KVG governs the tariff agreement itself: parties (para. 1), joining and leaving association agreements (para. 2), prohibited clauses (para. 3), approval by the cantonal government or the Federal Council (para. 4), a one-year period for examination (para. 4bis) and a notice period of at least six months (para. 5). Since 01.01.2026, Art. 46a KVG has allowed the authority to adjust approved agreements. Art. 47 KVG governs the absence of a tariff agreement. Art. 47a KVG obliges the associations to set up a joint organisation with equal representation for the outpatient medical tariff structures. Art. 49 KVG applies to hospitals.

Example: the LOA V pharmacy tariff

The performance-based remuneration for pharmacies shows what a tariff agreement looks like in practice. The Federal Council approved the LOA V agreement on 29.10.2025 because it applies throughout Switzerland. It came into force on 01.01.2026 and is approved until the end of 2028.

A second example shows what happens without an agreement: in Basel-Stadt, there were no approved point value agreements for the new outpatient medical tariff at the start of 2026. On 10.02.2026, the cantonal government therefore set the previous point value of CHF 0.91 provisionally for medical practices and hospital outpatient departments until approved agreements are in place. This is a tariff set by the cantonal government under Art. 47 KVG.

What this means for you

• The bill follows the tariff. Every item on a basic health insurance bill comes from an approved or officially set tariff. Check the tariff code, the tax points and the point value.
• You do not have to pay more. If a service provider asks for more than the tariff, it breaches tariff protection. Report it to your health insurer.
• Tariffs affect premiums. Premiums must cover the costs in the canton. Higher tariffs therefore lead to higher premiums with a delay. Every year, compare what basic health insurance costs you with the different health insurers in the premium calculator.
• The benefits are the same with every health insurer. Which benefits basic health insurance pays for is set by law, not by a health insurer’s tariff agreement. The differences between health insurers are mainly in premium, models and service; the overview Health insurers shows the key figures.

Common mistakes

• Confusing the tariff agreement with the tariff structure. The structure sets the tax points, the tariff agreement usually the value in Swiss francs. Together they give the amount on the bill.
• Assuming a tariff applies without approval. Only approval by the cantonal government or the Federal Council makes a tariff agreement effective.
• Believing there is no tariff without an agreement. If there is no agreement, the cantonal government sets the tariff; the bill remains bound by a tariff.
• Counting supplementary insurance as well. Prices for supplementary insurance benefits are not part of a KVG tariff agreement and do not need approval under the KVG.