Health insurer

What is a health insurer?

A health insurer is a company that provides social health insurance under the Federal Health Insurance Act (KVG): compulsory basic health insurance and voluntary daily allowance insurance under the KVG. In everyday language, people in Switzerland call it a health insurance fund. The Health Insurance Supervision Act (KVAG) distinguishes two types:

• Health insurance funds: non-profit legal entities under private or public law that provide social health insurance (Art. 2 para. 1 KVAG).
• Private insurance companies: companies that are subject to the Insurance Supervision Act (ISA, VAG in German) and hold a licence for social health insurance (Art. 3 KVAG).

The law treats both as “insurers”, and they have the same obligations in basic health insurance. Many insurers also offer supplementary insurance, for example for a semi-private hospital ward, dental treatment or complementary medicine. This is governed by the Insurance Contract Act (ICA, VVG in German), not by the KVG (Art. 2 para. 2 KVAG). For you, this means: in basic health insurance, the obligation to accept you and uniform benefits apply; in supplementary insurance, freedom of contract and health checks apply.

The FOPH publishes a list of insurers every year. As at 01.01.2026 it contains 39 entries: 34 insurers provide basic health insurance, and 5 offer only voluntary daily allowance insurance under the KVG. In 1996, the first year of the KVG, there were still 145 insurers. Their size varies widely: as at 01.01.2025, 8 insurers had no more than 10,000 insured persons, and 7 had more than 500,000.

How it works

Licence and obligations

Anyone wishing to provide basic health insurance needs a licence from the supervisory authority, the Federal Office of Public Health (FOPH). The FOPH publishes a list of licensed insurers (Art. 4 KVAG). The requirements are set out in Art. 5 KVAG. Among other things, an insurer must:

• be organised as a public limited company, cooperative, association or foundation and have its registered office in Switzerland;
• have sufficient capital and the necessary reserves, and be solvent at all times;
• provide basic health insurance on the principle of mutuality, treat all insured persons equally and use the funds of basic health insurance only for basic health insurance;
• offer voluntary daily allowance insurance under the KVG;
• accept every person required to take out insurance within its local area of activity: the obligation to accept. Which cantons these are is described by the insurer’s area of operation.

Premiums, reserves and costs

Each insurer sets its own premiums, graded by canton, region and age group. Before it may publish or apply them, the FOPH must approve them (Art. 16 KVAG). It refuses approval if the premiums do not cover the costs, are unreasonably higher than the costs or lead to excessive reserves.

Reserves are the safety cushion for bad years. The insurer must build up sufficient reserves (Art. 14 KVAG). The minimum amount is calculated with the KVG solvency test: the reserves must be high enough to cover the risks of one year with a high degree of probability (Art. 11 KVAV). The FOPH publishes the solvency ratio of every insurer.

The insurer must limit its administrative costs to what is needed for economical management; these also include advertising and intermediaries’ commissions, which it must show separately in its annual accounts (Art. 19 KVAG). In 2024, the administrative costs of all health insurers together amounted to CHF 1.7 billion, which is CHF 193 per insured person per year or 4.6% of premiums.

Equalisation between insurers

Because every insurer has to accept everyone, some have more older or ill policyholders than others. Risk equalisation balances out these differences within each canton. It is carried out by the Common Institution under the Federal Health Insurance Act (Gemeinsame Einrichtung KVG), which also steps in if an insurer becomes insolvent.

Legal basis

• Art. 2 and 3 KVAG: types of insurer; health insurance funds may offer supplementary insurance under the ICA in addition to social health insurance.
• Art. 4 and 5 KVAG: licensing requirement, list of licensed insurers, licensing conditions including mutuality, the ring-fencing of funds and the obligation to accept.
• Art. 14 KVAG and Art. 11 KVAV: reserves and the model for calculating their minimum amount.
• Art. 16 KVAG: approval of premium rates by the supervisory authority.
• Art. 19 KVAG: limit on administrative costs, separate disclosure of advertising and intermediaries’ commissions.
• Art. 34 KVAG: tasks of the supervisory authority, including monitoring solvency and protecting insured persons against abuse.
• Art. 4 and 7 KVG: insured persons are free to choose their insurer and can switch within the statutory deadlines.

Example: where a premium goes

Tom is 45 and lives in the city of Zurich. He chooses an offer with a CHF 300 deductible and accident cover that corresponds exactly to the median: CHF 580.00 a month (premiums 2026, municipality of Zurich, region 1, adults, with accident cover, median of 128 offers; source FOPH).

If Tom switches insurer, his benefits stay the same. So he compares the premium, the model, the service and key figures such as solvency and administrative costs.

What this means for you

1. Use your free choice. You can choose from all licensed insurers operating in your canton of residence. Acceptance is guaranteed without health questions.
2. Compare premiums. Because the benefits are the same, the premium calculator shows you directly which insurer charges less for your profile.
3. Look at the key figures. The solvency ratio, reserves and administrative costs say something about an insurer’s financial position and efficiency. You will find both in the insurer profiles.
4. Keep basic and supplementary insurance separate. You can have basic health insurance with one insurer and supplementary insurance with another. When you switch basic health insurance, your current insurer may not force you to cancel your supplementary insurance (Art. 7 para. 7 KVG). How switching works is explained under switching health insurer.
5. Get help in a dispute. If an insurer refuses to pay for a benefit, ask for a written decision. The Office of the health insurance ombudsperson mediates free of charge.

Common mistakes

• Believing that a large insurer pays more. In basic health insurance, the benefits are the same with every insurer, regardless of size or brand.
• Treating basic and supplementary insurance as the same. For supplementary insurance, the insurer may ask health questions and turn down applications. The obligation to accept applies only to basic health insurance.
• Assuming that insurers earn money from basic health insurance. The funds of basic health insurance are ring-fenced. Profits arise, if at all, in supplementary insurance.
• Ignoring solvency. The premium alone says nothing about an insurer’s financial position. The solvency ratio from the KVG solvency test shows how well its reserves cover its risks.
• Taking an insurer for a public authority. Insurers are private or public-law companies under state supervision. The official federal service for premium information is the FOPH’s Priminfo.

How we prepare the insurers’ key figures is explained under how we calculate.