Checking a TARDOC bill: tariff and outpatient flat rates with examples

What has changed on medical bills since 2026

Since 01.01.2026, medical practices and hospitals no longer bill outpatient services under TARMED, which had applied since 2004. It has been replaced by an overall tariff system made up of two parts: the fee-for-service tariff TARDOC and around 300 outpatient flat rates. Your benefits from basic health insurance remain the same, as do the deductible and retention fee. What is different is how the bill looks.

Source: FOPH, as of 25.09.2026. A treatment is always billed either under TARDOC or via a flat rate; combinations are not allowed. According to the FOPH, which structure applies depends on the diagnosis and the relevant main service, and is determined automatically by the billing software.

The Federal Council approved the system on 30.04.2025 for a limited period until 31.12.2028, and approved adjustments and additions on 05.11.2025. As of 25.09.2026: on 02.06.2026, the tariff partners submitted the first revision (version 2027) to the Federal Council; it is due to apply from 01.01.2027. The FOPH and OAAT will provide information about the approval.

Step by step: checking your bill

1. Get a copy of the invoice. If the bill goes directly to the insurer (tiers payant, where the insurer pays the provider), the practice or insurer must send you a copy of the invoice without being asked (Art. 42 para. 3 of the Federal Health Insurance Act, KVG). On request, you receive it on paper free of charge (Art. 42 para. 3ter KVG). Many insurers make it available in their customer portal.
2. Check the dates. Every bill contains a calendar of the treatments (Art. 59 para. 1 let. a of the Health Insurance Ordinance, KVV). Do the days match your appointments?
3. Check the tariff code. 007 for TARDOC, 005 for a flat rate. If a flat rate and individual TARDOC services are listed for the same procedure on the same day, ask about it.
4. Check the items and time. With TARDOC, consultations are often shown in time units. Compare the time billed with your impression of the appointment; a telephone conversation is also a service.
5. Recalculate the amount. Tax points × point value = amount of the item. The point value is shown on the bill.
6. Ask about anything unclear. The bill must be understandable for you, in particular the type, duration and content of the treatment (Art. 59 para. 4 KVV). Ask the practice first.
7. Report mistakes to your insurer. If an item remains wrong, report it to your insurer. It can refuse payment, and under tiers payant it reclaims amounts paid without justification (Art. 56 para. 2 KVG).
8. Compare with the statement of benefits. When your insurer’s statement with deductible and retention fee arrives, compare it with the corrected bill.

The rules behind the bill

Tax points and point value

TARDOC is a fee-for-service tariff: it sets tax points for each service, and the point value turns them into francs (Art. 43 para. 2 let. b KVG). The tax points are the same throughout Switzerland, because fee-for-service tariffs and outpatient flat rates must each be based on a single nationwide tariff structure (Art. 43 para. 5 KVG). The point value, by contrast, is usually agreed at cantonal level between insurers and service providers and approved by the cantonal government (Art. 46 para. 4 KVG). The same service can therefore cost a different amount in Basel than in Zurich. According to the FOPH, the same point value applies to TARDOC and the flat rates.

Flat rates take precedence

If there is an approved outpatient flat rate for a treatment, all service providers must apply it (Art. 43 para. 5ter KVG). According to the FOPH, flat rates are intended for the time being mainly for treatments primarily provided by hospitals, such as arthroscopies or cataract operations. The flat rate covers all services of the treatment, including medicines, implants and laboratory analyses; from 01.01.2027, according to the FOPH, also the related pathology services.

What must be on every bill

Under Art. 59 para. 1 KVV, the bill contains at least the calendar of treatments, the services in the level of detail of the tariff, the diagnoses and procedures required for the tariff, the number of the health insurance card and the AHV number (old-age and survivors’ insurance number). Benefits of basic health insurance and other services, such as a certificate for your employer or a service covered by supplementary insurance, appear on separate bills (Art. 59 para. 2 KVV).

Tariff protection and cost-effectiveness

Nobody may charge you more than the tariff for benefits of basic health insurance (Art. 44 para. 1 KVG). Doctors must limit themselves to what is in the interest of the insured person and necessary for the purpose of the treatment (Art. 56 para. 1 KVG). According to the FOPH, the new system does not force anyone to spread a treatment over several days if it can be done in one. You should report irregularities to your insurer.

Example: recalculating a TARDOC bill and a flat rate

Example with fictitious people. Elena, 58, lives in Basel and has a CHF 1,000 deductible. In the canton of Basel-Stadt, the previous TARMED point value of CHF 0.91 applies in 2026 as a provisional tariff for medical practices and hospital outpatient departments (cantonal government, 10.02.2026). The tax points of the items and the amount of the flat rate are assumed; the real values are in OAAT’s tariff structure.

Item	Tax points	Point value BS	Amount
Consultation, time units	80	CHF 0.91	CHF 72.80
Examination	40	CHF 0.91	CHF 36.40
Total	120		CHF 109.20

A few weeks later, Elena has an outpatient procedure in hospital. It is billed via an outpatient flat rate (code 005), assumed to be CHF 2,500. The bill lists the medicines used, but no individual price.

Whether a different deductible pays off with such costs is shown by the deductible calculator. You compare the insurers’ 2026 premiums in your municipality in the premium calculator.

Special cases

Bill to you instead of to the insurer (tiers garant)

Unless otherwise agreed, you owe the payment yourself (Art. 42 para. 1 KVG): under tiers garant, the practice sends you the bill, you pay it and submit it to your insurer with the reimbursement claim form. Here you check before paying. If you find a mistake, ask the practice for a corrected bill; under tiers garant, you yourself are entitled to reclaim anything you overpaid (Art. 56 para. 2 let. a KVG).

Accident, disability and military insurance

According to the FOPH, the Medical Tariffs Commission UVG, the FMH and H+ have agreed that TARDOC and the flat rates also apply in accident, military and disability insurance. The bill therefore looks the same; it is, however, paid by the responsible insurance, without the health insurance deductible.

Inpatient stay

If you stay overnight in hospital, TARDOC does not apply, but the inpatient flat rate per case under SwissDRG. Nothing changed in 2026 regarding the billing of inpatient services (FOPH).

Your insurer won’t pay

If your insurer refuses a bill in full or in part, this is not a tariff question but a question of benefits. How to proceed in that case is explained in the article Benefit refused. If you simply think a bill is too high, the article Bill too high helps. If you get no further with your insurer, the Office of the health insurance ombudsperson mediates free of charge.

Common mistakes

• Paying the copy of the invoice. A copy under tiers payant is not a request for payment. You only pay when your insurer claims back the deductible and retention fee.
• Mistaking tax points for francs. Only multiplying by the point value gives the amount. In Basel-Stadt in 2026, 120 tax points are CHF 109.20.
• Thinking missing individual prices are a mistake. With a flat rate (code 005), medicines appear on the bill without an individual price. This is intended.
• Accepting codes 005 and 007 for the same procedure. A treatment is billed either as a flat rate or item by item, never both. Ask about it.
• Ignoring small mistakes. As long as you have not reached your deductible, you pay every franc too much yourself. After that you pay 10 %, and the rest burdens everyone’s premiums.

You will find further basics of basic health insurance, from the deductible to the premium, in the Understanding basic insurance section. The contact details you can use to reach your insurer with questions about bills are in the health insurer profiles. You can save the results of our tools in your account.