Does the general rule apply to all benefits?

No. Not all benefits are reimbursed in accordance with the general rule described under the previous question. To check whether the rule applies, please consult the list of benefits that you will find on the site. There you will see that, if you opt for a private hospital that is not approved by the CHIS, your reimbursement will be limited to 80% of your expenditure and the amount at your expense will be unlimited since the general rule does not apply. You may therefore be required to pay large sums of money out of your own pocket.
The table below summarizes the rates that apply, according to whether or not the hospital is subject to the general rule. The same mechanism applies to all benefits that are not subject to the general rule.

 

Establishment

Agreement Sector  Reimbursement rate

Maximum FCA
(cost borne by the member)

Method of payment of invoice
Private Approved All sectors

General rule (80%, 90% or 100%, depending on the annual FCA)

3 000 CHF (annual FCA) Paid directly by the third-party administrator

Non Approved

All sectors 80% Unlimited Paid by the member

 

FAQ category