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SWICA’s opinions on health policy

In its opinion pieces, SWICA sets out its position on major political issues and developments in relation to healthcare and health insurance.

SWICA’s opinions

Basic insurance models (managed care)

Managed care makes it possible to achieve a higher quality of care through coordinated treatment, while positively influencing costs at the same time. A service provider assumes the responsibility of providing care for his or her patients. This responsibility is then shared by all those involved in administering the treatment, and it also includes financial and medical aspects.

The advantage for patients is that the provider supports them throughout the treatment as the contact partner from the first consultation until completion of the treatment. He or she knows the patient's medical history and coordinates all the steps.

Persons covered by basic insurance will benefit from lower premiums if they choose an integrated care plan. Such premium discounts are possible because a coordinated approach to the treatment and the right incentives help to contain the overall costs.

A FAVORIT insurance plan from SWICA is designed to give customers outstanding value for their money and allows them to save several hundred francs a year. The only difference with a STANDARD basic insurance plan is that the insured person can choose the point of contact. In all other respects, the scope of cover under the KVG is the same.

Premium policy

SWICA is committed to a sustainable premium policy. Given that health insurance premiums reflect the cost of healthcare, there is no way over the medium and long term of avoiding premiums that are capable of covering costs. In other words, the more medical services the population uses and the better these services are, the higher the costs. Administrative expenses account for only a small proportion (5%) of total costs.

As a healthcare organisation, we reward our insured persons when they take responsibility for their own health. We do this by offering attractive premium discounts on our FAVORIT insurance models in basic insurance. In supplementary insurance we offer generous support for preventive measures. With the BENEVITA bonus programme, SWICA customers also receive individual premium discounts of up to 15% on selected supplementary insurance plans.

Risk balancing

Risk balancing reduces the imbalances in benefits utilisation which result from diverse insurance structures. SWICA welcomes comprehensive risk balancing because it encourages competition in the area of quality. Health insurers should compete on the basis of good service quality, attractive products, and the provision of professional advice and support to insured persons who are the victims of illness or accident.

A single statutory insurance

Three times in the past ten years Swiss voters have said a clear “No” to the proposal for a single health insurer. On the last time of asking (28 September 2014) 62 % of Swiss voters and a majority of the cantons rejected the initiative. The result clearly shows that our healthcare system enjoys broad support across the population and that most people wish to retain regulated competition and freedom of choice. Social health insurance is regarded as being capable of reform without the need to put the entire system in jeopardy through experiments with extremely uncertain outcomes. The "No" vote on the single health insurer initiative is also a "Yes" vote in favour of private health insurers who meet their responsibilities to the satisfaction of those insured with them. Indeed, as annual customer satisfaction and image surveys show, SWICA's customers are very happy with the service they receive.

Unwanted cold calls

Unscrupulous agents repeatedly use aggressive cold-calling methods and false information in an attempt to persuade clients to meet them. Some of these agents make promises about premiums and claim to be working with SWICA.

SWICA rejects all dubious practices of this sort.

  • SWICA does not work with brokers or agents who call from abroad or make promises about reduced premiums. Insurance cover depends on the individual requirements of insured persons. These circumstances can be clarified only during a professional advisory meeting. If you have questions about your insurance cover, please call our free customer service line on 0800 80 90 80 (24 hours a day). Of course, you can also request a quotation online or ask for a face-to-face consultation either at your home or at one of our branches.

SWICA does not share customer information with third parties. If someone calls you, allegedly on behalf of SWICA, please ask the caller the following questions:

  • How did you get my/our number?
  • What company do you work for?
  • Where did you get my information?
Please make a note of the information you receive and pass it on to us. Please also ask for the caller's phone number and forward it to swica@swica.ch. You can also report dubious agents to santésuisse, the association of Swiss health insurers, or to the State Secretariat for Economic Affairs SECO. Thank you for your help.

Profits in basic insurance

Health insurers are not permitted to make a profit in the context of basic insurance and are required instead to apply the actuarial equivalence principle under which premiums must be used to cover the cost of benefits. Under the Federal Health Insurance Supervision Act (KVAG), health insurers are non-profit legal entities which are permitted at most to accrue surpluses. Financial means derived from social health insurance must be used for social health insurance. Every surplus franc from premiums therefore remains in social health insurance in order to form the reserves defined in law. You can find out more about reserves in the separate “Opinion” entitled “Reserves”.

Health insurers are required to submit their premiums for the coming year to the Federal Office of Public Health by the end of July. The Federal Office of Public Health reviews these submissions and announces the premiums at a press conference at the beginning of October.

The situation is different for supplementary insurance plans which are governed by the Insurance Contract Act (VVG). This is profit-oriented private insurance business. These two areas of activity are subject to different statutory provisions and different regulatory regimes. While basic insurance is supervised by the Federal Office of Public Health (BAG), supplementary insurance falls within the remit of the Swiss Financial Market Supervisory Authority (FINMA).


Reserves

The Federal Office of Public Health defines a minimum reserve requirement. A health insurance company which fails to meet this requirement must be recapitalised, which means that it must either introduce substantial premium surcharges or cease trading. In SWICA's view, companies which hold no more than the minimum level of reserves defined in law are acting negligently.

The purpose of basic insurance is to set premiums for the following year in such a way that they cover the benefits to be paid out – neither too high nor too low. However, since the Federal Office of Public Health must be informed in July about premiums for the following year, it can be problematic to predict any potential increase in benefits accurately at that stage. If surpluses arise, they flow into reserves, acting as a buffer for any unexpected expenditure in the following year and helping ensure that excessive premium increases are avoided. This creates a certain degree of stability.

SWICA’s reserves are solid, but not above average for the sector. This means that there is no need to refund premiums or increase them unexpectedly.

Premium regions

If healthcare costs differ sharply with a canton, larger cantons are broken down into two or three premium regions.The Federal Department of Home Affairs (EDI) defines the regions and sets the maximum permitted premium differentials between them. In Cantons Bern, Graubünden, Lucerne, Sankt Gallen and Zurich there are three premium regions, while Basel-Landschaft, Freiburg, Schaffhausen, Ticino, Vaud and Valais each have two. All the other cantons have one premium region. Health insurers can define differing premiums for the premium regions, but these differentials are limited, as follows:

  • maximum of 15 % between region 1 and region 2,
  • maximum of 10 % between region 2 and region 3.

The EDI is planning a new approach
At present, premium regions are defined on the basis of municipalities. The EDI is planning to redefine the regions on the basis of districts, not municipalities. SWICA is opposed to this change because significant cost differentials within districts would give rise to cost levelling. This would enable neither a definition of premium regions which properly reflects costs nor a correct determination of maximum discounts.

The redefinition would mean that approximately three million insured persons in around 1,200 municipalities would face increases in their premiums, some of them very substantial. The impact would be felt most acutely in rural municipalities which often have cheaper offering structures and cost-conscious insured persons.

Premium regions must therefore continue to be defined at municipal level. Redefinitions should of course be possible within the context of regular reviews, but they must be based on statistically adequate and reliable data from several years. The targeted reassignment of a municipality can be considered if there is a stable trend across several years.

Blacklist

Since 2012, cantons have had the option under the new Art. 64 of the Federal Health Insurance Act (KVG) to keep a list of individuals who default on their premium payments. Cantons using such a list can therefore blacklist insured persons who haven’t paid their basic insurance premiums despite debt collection proceedings. Insured persons on this list will have their benefits suspended and be covered only for medical emergencies, although they can always pay for the treatment themselves. With this measure, the cantons that keep a blacklist are hoping to prompt individuals to improve their payment behaviour in the health sector and thus to achieve savings.

Every canton can decide individually whether to keep a blacklist. As of June 2018, nine cantons have done so, which means that health insurers there are obliged by law to notify the cantonal authorities about insured persons who are subject to debt collection proceedings due to unpaid premiums or co-payments. Some of these nine cantons have already done away with these blacklists again or intend to do so because it costs money to maintain the lists but does not improve payment behaviour.

Our analyses have also failed to detect any change in payment behaviour in cantons that have introduced a blacklist, and we therefore consider this measure to be ineffective. A study by the Health Department of Canton Zurich has come to the same conclusion. In fact, the findings there have shown that premium debt in those cantons has reached a record high. Since notifying the cantonal authorities about insured persons incurs additional administrative costs, fails to produce the desired effect, and negatively impacts customer satisfaction, SWICA rejects the use of a blacklist.

Insurance fraud

As a health insurer, SWICA has a statutory duty in the area of basic insurance to check submitted invoices and determine whether they are cost-effective, appropriate and effective. In fulfilling its duty, SWICA checks around six million invoices every year. Although most benefit statements are correct, we regularly identify errors. However, not every mistake is a deliberate mistake. It is therefore important for insured persons to make their own careful check of each invoice. Clear, well-structured benefit statements help insured persons to identify errors themselves and report them to SWICA. We can then carry out targeted checks.

Deliberately receiving or charging for unjustified services is not only unfair, it is also against the law. Cases like these constitute insurance fraud and harm the entire community of insured persons. SWICA takes action to combat abuses of this kind. If we find discrepancies or specific indications of abuse, the department responsible for combating insurance fraud launches an investigation. Around one hundred cases of insurance fraud are detected in this way every year. SWICA complies with the requirements of social security law at all times.