Health insurance company
Private or not-for-profit public legal entity. Health insurance companies must be recognised by the Swiss Federal Department of Home Affairs (FDHA).
Health network agreements
These health networks sign an agreement with the health insurer in which they generally assume a budgeting responsibility. The agreement provides for lump-sum or flat-rate indemnities based on a predefined budget. The network is thus encouraged to provide best value for money.
Health networks, Health Maintenance Organisation (HMO) or group practices
Alternative model in the form of a regional group or network of doctors bringing together various medical disciplines in the same place (e.g. medical emergency services). The objective is to improve the coordination of treatments in order to avoid unnecessary consultations or duplicating tests. The patient’s first contact is always the same doctor, as a rule a GP, who refers the patient onwards to a specialist where necessary.
Are recognised as healthcare providers licensed to provide services under the compulsory health insurance: doctors, pharmacists, chiropractors, midwives, individuals administering care upon prescription or medical mandate, as well as the organisations which employ them, laboratories, diagnostic and therapeutic equipment delivery centres, hospitals, semi-hospital establishments, medico-social establishments, thermal cure centres, transport and rescue companies and institutions for outpatient healthcare administered by doctors (LAMal/KVG, Art. 35).
Medical treatment which involves minute doses prepared by dilution and dynamisation of mineral, plant and animal substances.
Hospitalisation anywhere in Switzerland
Hospitalisation coverage in a general ward; insureds can be admitted to any public or private hospital in Switzerland. This coverage covers any difference in costs compared to the canton of residence.
Inpatient: hospital stays of more than one day or including at least one night. A new system introduced in 2012 provides for a distribution key splitting the financing of services between the cantons, which pay 55%, and health insurance funds, which pay 45%. The tariff is based on the DRG system.
Outpatient: hospital stays of less than one day or which are not overnight. Fully financed by the health insurers in accordance with the TARMED rate.