The doctor is sitting with her patient on a sofa near the hospital reception. They discuss the records together.

Additional VVG services: transparent and fair tariffs

CSS is actively committed to agreeing clear, easy-to-understand tariffs with service providers under the Federal Insurance Contract Act (VVG), and to creating greater transparency at the billing level. We aim to ensure that supplementary insurance remains attractive to all clients in the future.

Our principles regarding additional services

CSS is guided by the 11 principles set out in the industry framework drawn up by the Swiss Insurance Association (SVV), which are also recognised by the Swiss Financial Market Supervisory Authority (FINMA). These principles help us to agree appropriate tariffs for transparent additional services that we can then offer to our clients:

  1. Comparison with OKP standards: Additional services are regarded in comparison to the standard level of services delivered by the service provider under mandatory healthcare insurance (OKP). Where necessary, the market view is also taken into consideration so as to avoid false incentives or systematic discrimination.
  2. Categorisation of additional services: Additional services agreed between service providers and individual insurers can be divided into three categories: clinical services, medical services and hotel services/comfort.
  3. Clear contractual definition: An additional service must be contractually defined, collectible, measurable and usable.
  4. Drawing up a catalogue of additional services: A catalogue of additional services agreed between the service provider and the individual insurer forms the basis for measuring, billing and controlling the services.
  5. Payment of medical services: Additional medical services are reimbursed on the basis of clear contractual agreements – medical services chargeable under mandatory healthcare insurance are considered to be fully compensated on the basis of the applicable inpatient and outpatient tariffs.
  6. Establishing measurement criteria: The criteria for measuring additional services are determined by the individual insurers.
  7. Focus on benefit to the patient: Additional services are also defined by the added value they deliver to the patient and not merely by any additional costs.
  8. Justifying measurement differences: Clear reasons must be given for differences in the measurement of identical additional services.
  9. Measurement on a package basis: Additional services are generally measured on the basis of service packages and not on a fee-for-service basis.
  10. Payment for services provided: Insurers will only reimburse additional services/packages of additional services that are actually delivered.
  11. Promoting innovation: Innovations that benefit the patient are encouraged. Trends such as ‘outpatient not inpatient’ present opportunities for new additional services.

 

Clearly defined added value as basis for progress

To translate the SVV principles successfully into practice, we have renegotiated all acute-care supplementary hospitalisation insurance contracts and concluded new contractual agreements on the pricing and invoicing of additional medical services. We will continue to conduct negotiations on this basis in the future. For additional services to be billed under supplementary insurance they must be clearly identified as such and must be shown to deliver quantitative or qualitative added value when compared with the services provided under basic insurance. Our goal remains to continually enhance the quality and attractiveness of our supplementary insurance lines and to meet the needs of our clients.