Choice of service providers

In principle, every insured person is free to choose a doctor. With regard to the assumption of costs, a distinction has been made between two forms of mandatory health insurance (OKP) since January 1, 2014: The previous "standard" OKP and the extended OKP.

Compulsory health care insurance (standard OKP)

For outpatient treatment, the standard OKP (Obligatory Health Care Insurance) exclusively covers services offered by eligible service providers who are authorized to provide OKP. These service providers, such as physicians and physiotherapists, must have a contractual agreement with the insurance association. The standard OKP does not provide reimbursement for services rendered by outpatient service providers who are not admitted to the OKP.

Extended compulsory health care insurance (extended OKP)

Within the scope of extended OKP, 100% of the costs for outpatient treatments are covered, even by service providers not admitted to OKP, up to a maximum of the applicable tariffs.

Extended OKP is a variant of mandatory insurance that must be offered by all recognized health insurance funds. The benefit catalog aligns with that of the standard OKP. However, extended OKP is uniquely accessible to all compulsory insured individuals, irrespective of age or health status. This includes individuals beyond the statutory retirement age.

The premium for extended OKP is annually determined by the government as a supplement to the standard OKP premium. This surcharge is uniformly applied across all health insurance funds. Presently, it stands at CHF 40 per month for adults, CHF 20 for young people, and CHF 10 for children. Cost-sharing, including the franchise and deductible, is managed in the same manner as in the standard OKP.