Invoices unjustifiably high Finma is now taking aim at health insurance companies

The Financial Market Supervisory Authority has identified significant shortcomings in supplementary insurance. It is now threatening to take strict measures to increase transparency.

The Swiss Financial Market Supervisory Authority (FINMA) has discovered serious shortcomings in supplementary health insurance policies. As early as 2020, Finma found that invoices in this area were often unjustifiably high.

There was double billing and invoices that were higher than the actual costs. In addition, doctors were billing fees without sufficient justification, and identical operations led to different costs being charged to supplementary insurers.

Reactions of the insurance industry

In response to these shortcomings, the insurance industry developed new models to make costs more transparent. As a result of these measures, prices for inpatient hospital stays in semi-private and private wards have largely stagnated or even fallen since 2020. As a result, premiums for supplementary hospital insurance have also remained stable or been reduced.

Despite this progress, FINMA still sees significant gaps, as reported by SRF. Although some insurers are working more transparently, there are still shortcomings in the application of the new calculation models.

Many contracts with hospitals or doctors do not meet the legal requirements, and some run beyond 2024 without meeting the regulatory requirements.

Future measures

FINMA is continuing its inspections and has found that the prices for certain services are still too high, particularly doctors' fees. Another problem is the double billing of medical services via basic and supplementary insurance.

One example shows that an insurer initially set the costs for a night in hospital at CHF 191, but then agreed with the hospital on CHF 855, which violates the applicable rules.

FINMA plans to continue to closely monitor the billing of supplementary insurance policies and to take measures in the event of significant deviations from the pricing model.

In the event of persistent deficiencies, stricter measures may be taken, including the initiation of enforcement proceedings. This is Finma's most severe instrument against financially active institutions. The sanctions range from a declaratory ruling - a reprimand - to the withdrawal of a business license.

The Financial Market Authority has the means to force health insurance companies to comply with laws and regulations.

The editor wrote this article with the help of AI.