Parliament has an amendment to the KVG was adopted in June 2024 with the aim of electronic data exchange between municipalities or cantons and health insurers, the clarification of residence issues when calculating premiums and the elimination of „phantom insureds“ from the risk equalization system. The Federal Council has now submitted the explanatory report on the implementing provisions in the KVV for consultation in March 2026:
The amendments to the ordinance are due to come into force on June 1, 2027.
Among other things, the FDHA is to be authorized to regulate the data exchange procedure in a separate ordinance. The data exchange should cover the following areas:
- Checking the insurance obligation, determining the canton of employment of cross-border commuters and the place of residence of the insured person
- Information from the cantons to insurers about double and multiple insurance policies
- Insured persons who cannot be contacted and whose insurance obligation is to be suspended
- Determination of the number of insured persons pursuant to Art. 16a para. 1 let. b KVG, in particular for the identification of asylum seekers, temporarily admitted persons and persons in need of protection without a residence permit who receive social assistance
Information on the receipt of social assistance is particularly sensitive personal data within the meaning of the FADP. Until now, cantons have not passed on such data to insurers due to a lack of legal basis. In the course of the aforementioned KVG revision, Art. 16a para. 2 KVG was therefore created as the formal legal basis for this data transfer.
The bill also regulates a staggered procedure for insured persons who cannot be contacted up to the exclusion of persons who cannot be contacted from the pool of insured persons.