Tariff protection

What is tariff protection?

Tariff protection is a rule in the Federal Health Insurance Act (KVG) that protects you from additional bills. Anyone who provides basic health insurance benefits must keep to the set tariffs and prices and may not charge anything extra for them. This applies to doctors, hospitals, pharmacies, laboratories, physiotherapists, nursing care at home (Spitex) organisations and all other authorised service providers.

The idea behind it: basic health insurance is compulsory, and its benefits should cost the same for everyone. If every practice could add its own surcharges, the co-payment made up of deductible and retention fee would lose its protective effect. That is why the prices for basic health insurance benefits are conclusively regulated.

Tariff protection only applies to benefits under the KVG. Services that are not part of basic health insurance, such as a cosmetic treatment, a single room in hospital or complementary medicine provided by therapists who are not doctors, can be freely agreed. They are paid by a supplementary insurance under the Insurance Contract Act (ICA) or by you.

How it works

Tariffs for basic health insurance benefits come about in two ways. Either insurers and service providers agree them in a tariff agreement, which the authority approves, or the authority sets them itself. A tariff can be based on time, on individual services with tax points, or on flat rates. Since 01.01.2026, medical services in practices and hospital outpatient departments have been billed under the fee-for-service tariff TARDOC and outpatient flat rates; inpatient treatment is billed with case-based flat rates.

Once a tariff has been set, it is binding on both sides:

• No surcharges: an “administration fee”, an “appointment surcharge” or a “comfort contribution” for a basic health insurance benefit is not allowed.
• No differences: if the actual work involved is more than the tariff, the difference may not be charged to you.
• Whoever pays: the protection applies under the tiers garant system, where you pay the bill yourself first, and under the tiers payant system, where the health insurer pays directly.

The law itself names one exception: for aids and appliances on the Aids and Appliances List (MiGeL), such as dressings, inhalers or walking aids, the health insurer pays at most a maximum reimbursement amount. If the product is more expensive, you bear the difference.

A service provider can also withdraw from basic health insurance altogether. It must notify the office designated by the cantonal government of this withdrawal. It is then no longer entitled to remuneration under the KVG and must tell you so before treating you. In this case, the health insurer pays nothing.

Legal basis

Art. 44 para. 1 KVG states that service providers must keep to the tariffs and prices set by agreement or by the authorities and may not charge any further remuneration for services under the KVG. The rules for aids and appliances under Art. 52 para. 1 let. a no. 3 KVG are reserved. Art. 44 para. 2 KVG governs withdrawal, with a duty to notify and a duty to inform insured persons.

The principles of tariff setting are in Art. 43 KVG: bills based on tariffs or prices, time-based, fee-for-service and flat-rate tariffs, agreement in a tariff agreement or setting by the authority. For the MiGeL, Art. 24 para. 3 KLV provides that the health insurer pays only up to the maximum reimbursement amount and that any difference is borne by the insured person.

Enforcement is governed by Art. 59 KVG. Failure to respect tariff protection is expressly named as a breach in para. 3 let. d. Under para. 1, possible sanctions are a warning, repayment of fees, a fine of up to CHF 20,000 and, for repeat offences, temporary or permanent exclusion from working at the expense of basic health insurance. The cantonal arbitration tribunal decides on this at the request of an insurer.

Example: two bills, two cases

Mia is 29 and has received two bills. The amounts are chosen for illustration; the rules are those set by law.

Bill	Item	allowed?	Mia pays
Physiotherapy	9 sessions according to the tariff	yes	deductible and retention fee as usual
Physiotherapy	“Evening appointment surcharge” CHF 20 per session	no, basic health insurance benefit	CHF 0
Pharmacy (MiGeL)	inhaler CHF 180, maximum reimbursement amount assumed at CHF 150	yes, legal exception	CHF 30 difference plus co-payment on CHF 150

What this means for you

Read every bill before you pay it or submit it to your health insurer. Under tiers payant, you receive a copy of the bill sent to the health insurer; it may also contain items that are not allowed.

Look out for these points:

1. Is the service a compulsory benefit? Then the tariff applies and surcharges are not allowed.
2. Were you told beforehand about costs outside basic health insurance? Without information and your consent, you do not simply have to accept such costs.
3. Has the practice declared that it has withdrawn? Then the health insurer pays nothing. You must have been informed beforehand.

If anything is unclear, contact your health insurer first. It checks bills and can take action against service providers. You can find the insurers’ contact details under Health insurers. Tariff protection is the same with every health insurer; the differences lie in the premium, which you can compare in the premium calculator. If you want cover outside basic health insurance, for example for a single room, consider a supplementary insurance. The page general ward explains the differences between hospital wards.

Common mistakes

• Paying surcharges without checking. They are not allowed for compulsory benefits. Ask for a corrected bill.
• Assuming tariff protection applies to all services. It only applies to basic health insurance benefits, not to optional services or benefits from supplementary insurance.
• Thinking the MiGeL difference is a mistake. With the maximum reimbursement amount, the difference is allowed by law. Ask for a product at the maximum reimbursement amount.
• Going to a practice that has withdrawn without knowing it. At a new practice, ask whether it bills at the expense of basic health insurance.

How we prepare sources and examples is explained under How we calculate.