Processes

Outpatient & inpatient care

Billing CSS correctly: these information sheets shows you the administrative process for checking outpatient and inpatient care services.

Specialty List

For medicines to be included in the Specialty List, they must meet certain eligibility criteria, i.e. they must be effective, appropriate and cost-effective.

Specialty List for a limited period

The Federal Office of Public Health (FOPH) can include a medicine in the SL for a limited period (Art. 33 para. 3 KVG).

This may happen, for example, if it is not yet possible for the FOPH to reach a definitive conclusion about satisfaction of the eligibility criteria when assessing a medicine for inclusion in the list. In particular, a medicine will be given a temporary listing if initial findings show that it promises to benefit patients, but further study results or price reviews are required for a sound assessment.

Commitment to provide cover for temporarily listed medicines

If you request a commitment to provide cover for a medicine that is temporarily included in the SL, we can only issue a commitment that provides cover up to the date on which the temporary listing period expires.

If the limitation remains in effect at the end of the period of temporary inclusion in the SL, our commitment to provide cover will automatically be extended (up to the next temporary limitation date, if any). You don't have to do anything.

If the FOPH revises the listing, you will need to request a new commitment to provide cover.