Unpaid premiums and debt enforcement: can I still switch health insurer?

Unpaid premiums block a switch

People who cannot pay their premium are often paying an expensive insurer. Switching to a cheaper one would help, but it is blocked as long as debts are unpaid. The law says: an insured person in arrears cannot switch insurer as long as outstanding premiums, co-payments, default interest and debt enforcement costs have not been paid in full (Art. 64a para. 6 of the Federal Health Insurance Act, KVG).

What matters is the time of the reminder. You are considered in arrears from the date it is delivered (Art. 105l para. 1 of the Health Insurance Ordinance, KVV). A late payment without a reminder does not yet block a switch.

By when you have to pay

To switch on 1 January, you have to meet two deadlines:

1. Notice of cancellation: It must reach your old health insurer by 30 November (Art. 7 para. 2 KVG). The FOPH recommends sending it by registered mail or A Mail Plus by 15 November.
2. Payment: All premiums, co-payments and default interest for which you received a reminder up to one month before the end of the notice period, as well as the debt enforcement costs incurred up to then, must be paid in full by the end of the notice period (Art. 105l para. 2 KVV). For the change of year, according to the FOPH, this means: pay the amounts for which you received a reminder by 30 November by 31 December.

If you cancel while in arrears, the insurer must point out that your notice of cancellation has no effect without payment in full (Art. 105l para. 2 KVV). If money is missing at the end, it informs you that you remain insured with it and notifies the new insurer within 60 days (Art. 105l para. 3 KVV). You then switch on the next possible date at the earliest.

Pay early, and in such a way that the amount is in the insurer’s account before 31 December. Ask your insurer for the exact amount including interest and debt enforcement costs so that no balance remains. The dates for your situation are shown by the deadline calculator.

From reminder to debt enforcement: the procedure

The procedure for payment arrears is laid down by law:

1. Reminder. If you do not pay premiums or co-payments that are due, the health insurer sends you at least one written reminder.
2. Request for payment. It then serves a request for payment with a 30-day grace period and points out the consequences (Art. 64a para. 1 KVG). It must do so no later than three months after the due date, separately from other arrears (Art. 105b para. 1 KVV).
3. Default interest and fees. You owe default interest of 5 % per year on premiums that are due (Art. 105a KVV). The insurer may only charge processing fees if its provisions allow for this, and only up to the amounts set by the FDHA (Art. 105b para. 2 KVV).
4. Debt enforcement. If you still do not pay after the grace period, the insurer must initiate debt enforcement. Per calendar year, it may bring debt enforcement proceedings against you at most twice each for your own arrears and for a child’s arrears (Art. 64a para. 2 KVG).
5. Certificate of unpaid debt. If the seizure does not cover the claim, the insurer receives a certificate of unpaid debt (Verlustschein). It counts as an acknowledgement of debt, and you owe no interest on the claim it documents (Art. 149 para. 2 and 4 of the Federal Act on Debt Enforcement and Bankruptcy, DEBA). The canton takes over 85 % of the claims that led to a certificate of unpaid debt (Art. 64a para. 4 KVG). Your debt nevertheless remains.

You can file an objection to the payment order within ten days of it being served (Art. 74 para. 1 DEBA). For basic health insurance premiums, this mainly postpones debt enforcement: the insurer can decide on its claim itself with a written decision, and enforceable written decisions are equivalent to enforceable court judgments (Art. 54 of the Federal Act on the General Part of Social Insurance Law, ATSG). An objection makes sense if you actually dispute the amount, for example because you have already paid.

List of insured persons in arrears and suspension of benefits

Some cantons keep a list of insured persons in arrears. People who do not pay their premiums despite debt enforcement are put on the list. For these persons, the insurer suspends cost coverage on notification by the canton, except for emergency treatment (Art. 64a para. 7 KVG). Emergency treatment is treatment that cannot be postponed because otherwise there is a risk of damage to health or death. Whether your canton keeps a list can be found out from the cantonal office responsible for premium arrears.

The suspension of benefits ends as soon as the outstanding claims have been paid; the insurer notifies the canton that it has been lifted (Art. 64a para. 7 KVG). Without a list, the insurer continues to pay its benefits as normal. It may never offset benefits against unpaid premiums (Art. 105c KVV): it must therefore pay you a reimbursement for a doctor’s bill.

Example: paying by 31 December or staying another year

Example with fictitious people. Luca is 35 and lives in Zurich. For a CHF 300 deductible with accident cover, he pays CHF 580.00 per month, the median of all offers in his municipality. The cheapest offer with the same deductible costs CHF 517.70 (premiums 2026, municipality of Zurich, region 1, adults, with accident cover; source FOPH). Luca has not paid the premiums for October and November and received a reminder in November.

There is no such thing as half a switch: even a small balance blocks the entire switch.

Premium subsidies: so that new debts do not arise in the first place

The cantons subsidise the premiums of insured persons of modest means and pay the contribution directly to the health insurer (Art. 65 para. 1 KVG). This lowers the premium bill. For children and young adults in education from households with lower and middle incomes, minimum rates of 80 % and 50 % respectively apply (Art. 65 para. 1bis KVG). Each canton sets its own eligibility, income limits and application deadlines; you can find the rules for your canton under Premium subsidies.

If you already have debts, the subsidy gives you breathing space for your current premiums. It does not cover old arrears. If you have difficulty paying, ask the social services of your municipality early, before debt enforcement starts.

Special cases: children, young adults, moving, supplementary insurance

• Arrears only for the children. Parents who only have arrears for their children may switch themselves. The children cannot switch health insurer as long as there are arrears for them (Art. 64a para. 6 KVG). The parents owe the premiums of minor children, and the procedure is directed against them (Art. 64a para. 1bis KVG).
• Turning 18. When you come of age, you can switch at the end of the calendar year despite arrears from the time when you were a minor (Art. 64a para. 7bis KVG). At 18, the insurer must inform you that you are not considered in arrears for these amounts (Art. 105l para. 2bis KVV).
• Moving or changing jobs. If you have to leave your health insurer because you move or change jobs, the insurance ends with the move or the start of the new job despite arrears (Art. 7 para. 3 and Art. 64a para. 6 KVG). The debts remain with the old insurer.
• Insurer withdraws from basic health insurance. If your health insurer no longer provides basic health insurance, the insurance relationship ends when its licence is withdrawn, even if there are arrears (Art. 7 para. 4 KVG).
• Supplementary insurance. Here the Insurance Contract Act (ICA) applies. After a reminder with a 14-day deadline, the insurer’s obligation to pay benefits is suspended from the end of the deadline (Art. 20 ICA). If the insurer does not take legal action to collect the premium within two months, it is deemed to have withdrawn from the contract (Art. 21 para. 1 ICA). For a new contract, the insurer may later ask health questions and reject you. What counts are the general terms and conditions and the information from your insurer.

Common mistakes

• Paying only the premium, not the interest and costs. A switch requires premiums, co-payments, default interest and debt enforcement costs to be paid in full. Ask for the exact total amount.
• Transferring the money on 31 December. What counts is that the money reaches the insurer in time. A transfer on the last day may arrive too late.
• Forgetting co-payments. Unpaid bills for the deductible and retention fee also count as arrears.
• Not cancelling because debts are still unpaid. Cancel in time by 30 November anyway. If you pay by 31 December, the switch works; you can create the cancellation letter with the cancellation letter generator.
• Not applying for premium subsidies. Check your eligibility every year; the subsidy eases the burden of your current premiums.

The whole procedure for switching is shown in the overview Switching health insurer. What else you should check before 30 November is in the premium increase checklist. How a switch works in the middle of treatment is explained in the article Switching during treatment. You will find the health insurers at a glance under Health insurers, and all articles on the subject in the topic section Switching health insurer.