No contract with Geneva private clinics

Despite intensive negotiations in the supplementary insurance sector, Sanitas was not able to reach an agreement with the Geneva private clinics Hirslanden-Kliniken Grangettes and La Colline, SMN-Klinik Générale-Beaulieu, Hôpital de la Tour and the Association des Médecins du Canton de Genève (AMGe) on a regulation for the invoicing of (documented) medical services. This current contractless situation in the canton of Geneva is challenging for everyone involved. This is because Sanitas can no longer accept and cover the costs for hospital and medical services in these clinics as it did previously and in accordance with the additional conditions.

Nevertheless, the path Sanitas has chosen is important and decisive because it enables Sanitas to ensure compliance with FINMA's regulatory requirements and protect the interests of policyholders. Sanitas also wants to ensure good additional benefits for its policyholders at a reasonable price through persistent and constructive negotiations. Unfortunately, depending on the supplementary hospital insurance, being without a contract can have negative consequences for insured persons. We very much regret this situation.

FINMA-compliant means: Compulsory basic insurance covers clinical and medical services as well as hospital services. These costs cannot be reimbursed again (practically twice) via supplementary insurance. This means that supplementary insurance only covers clinical and medical costs that demonstrably exceed the standard of basic insurance. These additional benefits must be well documented, clearly distinguishable from the basic insurance benefits and/or demonstrate added value for the insured person.

In particular, the AMGe medical association refuses to apply a proven and compliant tariff model and to bill accordingly. Instead, AMGe uses an old tariff model with several thousand individual services that mainly relate to procedures covered by basic insurance rather than to additional services that can be differentiated from basic services.