Health insurance: CSS will have to reimburse 129 million francs to its policyholders

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Health InsuranceCSS will have to reimburse 129 million francs to its policyholders

FINMA has revealed that the fund charges part of its distribution and management costs to the sole responsibility of the policyholders of the complementary insurance.

The CSS should reimburse a nice sum to its policyholders of the complementary insurance.

20min/Marco Zangger

The CSS group will have to reimburse supplementary health insurance premiums of up to 129 million francs. He received the order of the Swiss Financial Market Supervisory Authority FINMA, announced the latter in a statement on Tuesday.

What happened? In April 2020, FINMA opened proceedings against CSS Assurance SA, a CSS group company subject to its supervision. “It was guilty of serious violations of surveillance law between 2013 and 2019”, denounces the regulator.

Supplementary policyholders have paid too much

According to FINMA, CSS Assurance SA has charged the supplementary insurance policyholders solely with all the costs related to the conclusion of new contracts by external brokers – who were also prospecting in the field of compulsory insurance – “then that they obviously also concerned compulsory health insurance, ”she writes.

In addition, FINMA noted that management costs had also been poorly distributed among policyholders. “The supplementary insurance, for example, has for years assumed the major part of the marketing costs and all the advertising costs of the entire CSS group”, she explains.

The regulator further specifies that its decision to reimburse CSS 129 million does not call into question the group’s operational activity. The claims of the insured are guaranteed and the solvency requirements respected, he specifies. His decision has not entered into force and can be appealed to the Federal Administrative Court.

CSS defends itself

In a statement on Thursday, CSS, which is the country’s largest basic insurer, said it was aware of FINMA’s decision. She is “astonished by the extent and the absolute nature of the criticisms made”, she underlines. She notes that until now there was no clear guideline regarding the allocation of administrative costs. The CSS believes that it was carried out according to standard theory and practice, “a view also supported by the external reviewers”.

The group will examine the possibilities open concerning the continuation of the procedure. “If the ordinance were to come into effect, CSS would draw up a detailed reimbursement plan and inform its customers of the supplementary insurance between 2013 and 2019 of the amount of the payments”.

Who will be entitled to a refund?

The refund of premiums will benefit people who had taken out supplementary health insurance with CSS Assurance SA between 1 January 2013 and 31 December 2019. The amount of the refund will depend on a case-by-case basis on the type of product, the duration of the contract and the amount of the individual premium paid.

(cht)

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