The Federal Office of Public Health FOPH has sent new recommendations to health insurers. Observers are rubbing their eyes at what it says.
The FOPH expresses itself from time to time via circulars to all health insurance companies and issues recommendations that sometimes downright leave one speechless.
Today, Thursday, the FOPH again sent such ‘orders’ to Helsana, Swica, Sanitas, Groupe Mutuel, Visana, Concordia, Assura & Co., and this time, according to research by muula.ch, it is about insureds who have no health insurer, although this is actually not possible under the basic insurance.
Regional delimitations
The issue is now coming up more than 25 years after the launch of the KVG in 1996. However, it is not, as one might initially think, about newcomers who simply do not seek basic insurance after moving to Switzerland.
No, rather, the FOPH is addressing cases where insureds simply no longer live within the licensed health insurer’s area of operation.
This can occur because the FOPH only approves premiums to insurers for their area of operation. However, many Swiss health insurers only operate in one region of Switzerland and not nationwide.
Relocation as a problem
So, if an insured person moves to the other end of Switzerland and his or her existing health insurance company is not active there, he or she must look for a new health insurer.
According to the KVG, however, the insurance relationships of the insured persons concerned end as a result of such a move, and they must leave the insurer.
When the insurer is notified of the move or notices it themselves, they inform the insured person that he/she must choose an insurer active at the new place of residence.
Passive clientele
A similar situation can also happen if a health insurance company withdraws from a particular regional market. According to the KVG, the insurance relationships also end in this case.
In both cases, according to the FOPH, the question arises as to how insurers and cantons should deal with those people who do not choose a new health insurance company licensed for their place of residence and who thus do not comply with their insurance obligation?
Authority wants big stick
According to the FOPH, uninterrupted insurance coverage is a central principle of mandatory basic health insurance. The authority therefore believes that the instrument of compulsory assignment by the cantons should be used for insured persons who, despite being asked to do so, have not chosen a new insurer by the end of a set period.
These residents fall into a regulatory gap, because moving inland is not a new residence in Switzerland, for which the law provides an obligation to register within three months and penalties for failure to do so.
Actually, it looks like the authorities can’t do anything about it. In the two cases, the law does not provide for an obligation to register, nor does it provide for penalties for a lack of action on the part of citizens.
Blackening with cantons
The FOPH therefore intends to initiate a revision of the law and thus propose a clear legal basis for the “questions that have not been completely clarified.”
However, because a revision of the law takes several years, the FOPH is issuing some recommendations, i.e. “orders”, for the meantime.
In both cases – i.e. change of residence to an area where the health insurance company has no authorization, or withdrawal from a market area where insured persons are left without basic insurance – the health insurance companies themselves should first approach those persons concerned.
If they do not comply with the insurance obligation, the health insurers are to report the persons to the cantons, which are then to make an allocation.
Blind spots
Why the issue is coming up now is not clear. After all, this problem has actually existed since the beginning of the KVG, but may never have been noticed until now because of the low mobility of the population.
It is also possible that this situation has arisen as a result of the current refugee problem and the colorful shuffling around of people seeking protection throughout Switzerland who do not register with a new health insurer.
Blame the insurers
Of course, it could also be that there are currently an increasing number of health insurance companies that are withdrawing from certain regions and the insured then simply do not register with a new insurer.
Currently, numerous health insurance companies are merging, as muula.ch reported, for example, about the ailing Lucerne health insurance group CSS, and there the problem described by the FOPH could occur more frequently.
If the merged health insurance company does not have a license in a premium region where a merger partner was previously active, the insured are all suddenly left without their traditional health insurance coverage. Thus, the basic insureds are not even to blame.
Breach recommended
The FOPH writes that with the “recommendations”, on the one hand, insurance gaps could be avoided. And on the other hand, there would be no long insurance periods with insurers who no longer had a license or approved premiums for the region or canton in question.
The latter sounds particularly sinister, however, because with the blessing of the supervisory authority, health insurance companies are apparently still allowed to conduct insurance business even though they no longer have any authorization for it and the KVG also clearly prohibits this according to the FOPH’s own circular.
The authority recommends, with all understanding for the problem, literarily speaking, a breach of the law.
15.12.2022/kut./ena.
