Basic insurance is compulsory, and so is the premium. What follows a missed payment is therefore not left to the insurer's discretion: the law sets the steps, the deadlines and what each party must do. Knowing them tells you where you stand, and what is still open.
First step: the reminder, then the formal notice
When premiums or cost-sharing that have fallen due are not paid, the insurer sends a formal notice, preceded by at least one written reminder. It sets a deadline of 30 days and explains the consequences of late payment. The ordinance adds that the formal notice is sent within three months of the amount falling due, and separately from any notice concerning other arrears.
Default interest runs on premiums that have fallen due, at a rate of 5 per cent a year. The insurer may also charge administrative fees, provided they are set out in its general terms and conditions and are of a reasonable amount.
Second step: debt collection
If, despite the formal notice, the premiums, cost-sharing and default interest are not paid within the deadline, the insurer must start debt-collection proceedings. This is not an option: the law obliges it to. The law does, however, limit their number: no more than two proceedings per calendar year for the insured person's own arrears, and two for those of a child.
The insurer may not pay itself out of benefits: the ordinance expressly forbids it to offset benefits against the premiums or cost-sharing owed to it. A reimbursement you are expecting therefore does not vanish to pay off a premium debt.
Third step: the certificate of loss, and the canton
When the proceedings end in a certificate of loss (acte de défaut de biens) or an equivalent document, the insurer reports the claim to the competent cantonal authority. The canton then covers 85 per cent of the reported claims. The insurer keeps the certificates of loss until payment in full, and passes 50 per cent of any amount it eventually receives back to the canton.
So the debt is not wiped out because the canton has stepped in: it is still owed to the insurer, which goes on recovering it. A canton may also cover a further 5 per cent; in that case the insurer assigns the claims to it, and the insured person can change insurer again.
Suspension of benefits, and its limits
Cantons may keep a list of insured people who do not pay their premiums despite debt collection. The list is accessible only to healthcare providers, the commune and the canton. When notified by the canton, the insurer suspends cover for treatment provided to these people, with the exception of emergency medicine.
The suspension is not permanent. Once the claims have been settled, the canton reports it and the insurer lifts the suspension. Treatment received in the meantime, however, remains payable by the insured person, emergencies aside: this is the heaviest consequence of the whole procedure.
Not every canton keeps such a list. The Federal Office of Public Health states in its FAQ that the cantons of Aargau, Lucerne, Ticino, Thurgau and Zug keep one. That page carries no date: the number of cantons concerned may have changed, and it is worth checking with your own canton.
Children, and young people who come of age
Where the insured person is a minor, the rules on non-payment apply to their parents, or to the parent who owes the premiums. A child cannot change insurer as long as there are arrears relating to them; insured people whose only arrears are for their children, on the other hand, can change insurer themselves.
The law also provides that an insured person who comes of age may change insurer despite arrears that arose while they were a minor. A debt run up by the parents therefore does not follow the young adult indefinitely in their choice of insurer.
What remains possible at each step
- Contact the insurer before the formal notice: a payment arrangement is easier to negotiate before the procedure has started.
- Check your entitlement to an individual premium reduction with the canton: it is paid directly to the insurer and reduces the premium itself.
- Pay the arrears in full, including interest and debt-collection costs, if you want to change insurer: the change stays blocked as long as any balance remains.
- If benefits are suspended, ask the canton and the insurer what is required to lift the suspension, and keep proof of your payments.
- Contact your commune's social services: the rules on assistance are cantonal and communal, and do not depend on the insurer.
These rules are federal and apply to every insurer: what changes from one canton to another is the list, social assistance and the premium reduction, not the procedure.