Chances are good that the National Council and the Council of States will abolish blacklists in health insurance in 2022. These may then also collect outstanding children's premiums only from the parents.
In late 2017, several daily newspapers reported on a man with HIV infection who died because his health insurer refused to cover the cost of medical treatment. The 50-year-old man had outstanding debts with his health insurance company. The insurance company put him on a blacklist. He asked for therapy twice, but his health insurance rejected him both times.
Blacklists are of little use and are unfair
In some cantons, people who do not pay their health insurance premiums or cost-sharing despite debt collection end up on a so-called blacklist. As a consequence, those affected can only take advantage of emergency treatments. The health insurance companies want to exert pressure in this way in order to motivate defaulting premium payers to pay the outstanding amounts after all. Every year, around 166,000 people in Switzerland fail to pay their premiums, resulting in over CHF 453 million in outstanding payments. As of January 2019, 35,734 people ended up on such a list, according to Santesuisse.
Adaptation of the KVG in progress
A statistical analysis of the Federal Office of Public Health (FOPH) shows that these lists are not very successful. The FOPH concludes that cantons with such lists even have higher outstanding premiums than cantons without lists. However, the lists often cause human suffering, as the above example shows.
In addition to many protests, this has also triggered parliamentary initiatives. In April 2020, the Council of States Commission for Social Security and Health (SGK-S) drafted a bill for an amendment to the Health Insurance Act (KVG), which provides for the elimination of these blacklists.
Minors are no longer liable for premiums
It happens again and again that health insurance companies sue children who have come of age for outstanding premiums that their parents have not paid during their obligation to support them. According to the law, the parents have to pay the premiums for the child. However, the child remains the debtor. Some health insurance companies therefore prosecute them for unpaid premiums as soon as they have reached the age of majority. This has also led to young adults ending up on a blacklist. The consultation draft of the SGK-S now provides that in the future they will no longer have to be liable for outstanding premiums that have arisen during the parents' maintenance obligation.
The Federal Council has already responded to a parliamentary question that this practice actually violates the Convention on the Rights of the Child and that those affected could invoke it in court.
- Minors no longer owe premiums and cost sharing. The debts are borne only by the parents
- In order to save costs, health insurance companies should be allowed to operate a maximum of four times a year
- There is no longer a deferral of benefits for defaulting premium payers
- Those who do not pay despite debt collection should be insured in a more favorable form of insurance, with a limited choice of service providers
- The cantons can take over the loss vouchers of the health insurances, if they take over 90 percent of the costs. The insured person can then change insurance again, because the debt has been transferred from the insurance company to the canton
A minority proposal of the SGK-S commission wants to retain the possibility for those cantons that wish to do so to keep lists of defaulting premium payers.
Cantons buy back loss certificates
The draft law also regulates the handling of loss certificates. As before, the cantons are to reimburse the insurance companies 85 percent of the outstanding claims. The loss certificates remain with the insurance companies. The latter later reimburse the canton 50 percent of the amounts collected.
The cantons will now also have the option of assuming 90 percent of the costs, but in return they will also receive the loss certificates. The advantage of a debt assumption by the cantons is that they have access to the tax data of the defaulting payers and can operate more efficiently. For the health insurance company, on the other hand, the debt is paid off with this takeover and those affected can thus change insurance companies again and receive benefits.
Definition of emergency unclear
As long as the blacklists still exist, the question of what falls under emergency treatment will also be a source of conflict. There is no uniform definition and each canton or hospital answers it differently. For example, one health insurance company did not classify the delivery of a pregnant woman as an emergency, on the grounds that childbirth can be planned. The administrative court in St. The Federal Supreme Court of St. Gallen then ruled that an emergency exists if someone urgently needs help according to medical judgement. It has classified the delivery of the pregnant woman as an emergency. The Federal Council has recommended that the cantons adhere to this definition. Also, in the case of the above-mentioned man infected with HIV, the Federal Commission for Sexual Health (FSCG) has classified the treatment not granted as emergency treatment.
The real problem: the premium burden
The template seems to be widely accepted at the moment. But there is still the passage through the two councils to come. If all goes well, the amendment could come into force in 2022.
Some social organizations criticize that with the abolition of blacklists the real problem is not solved. The high health insurance premiums lead many people with scarce financial resources into debt or drive them into poverty.
The Skos sees the Individual Premium Reduction (IPV) as an effective means of avoiding premium arrears with the health insurance companies. The association pleads for not further restricting the IPV, as it is done in some cantons. Caritas would like to limit the amount of premiums to a maximum of one household's monthly salary. And the Swiss Federation of Trade Unions, in turn, demands that the premium burden be limited to a maximum of 10 percent of a household's disposable income and promotes the SP's premium relief initiative.
An initiative of the CVP also wants to relieve the premium payers. It calls for a cost brake by the federal government and cantons.