ABOUT THIS EDITION
Dear Insured Member,
We are delighted to present the January edition of the bimonthly UNSMIS newsletter!
In this issue we will discuss the following:
- Feedback - Let Us Know What You Think
- Changes in Swiss Invoices
- Weight Loss Treatment
The newsletter will be sent to insured members via email, will be published on the website and will appear as a pop-up window on the eClaims Portal.
We hope you find this newsletter helpful.
Kind regards,
The UNSMIS Team
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FEEDBACK - LET US KNOW WHAT YOU THINK
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We launched the bimonthly UNSMIS Newsletter almost two years ago to provide clear and useful information that supports your health insurance experience. To help us improve, we would appreciate your feedback.
Please take a few minutes to complete our short survey. Your responses will remain confidential.
You can access the survey by clicking the link below or by scanning the QR code:
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Thank you for helping us better meet your needs.
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CHANGES IN SWISS INVOICES
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Your Swiss medical invoices are evolving in 2026 – understanding TARDOC
Since 1 January 2026, the Swiss outpatient medical billing system has changed.
The TARMED tariff has been replaced by a new national tariff called TARDOC, complemented by ambulatory flat rates.
This change applies to all physicians, as is already the case for LAMal insurers, and leads to changes in the presentation and structure of your medical invoices.
UNSMIS wishes to support you during this transition and help you understand how to read and verify your new invoices.
Why this change?
The TARMED tariff no longer adequately reflected today’s outpatient medical practices.
The new TARDOC tariff aims to:
- describe medical services more precisely,
- improve invoice transparency,
- reduce the use of non-specific generic positions,
- harmonize billing at a national level.
In parallel, some outpatient treatments are now billed as ambulatory flat rates, grouping several services into a single amount.
What changes on your invoices
With TARDOC:
- services are more detailed and better defined,
- some services are billed per minute,
- certain treatments appear as ambulatory flat rates,
- former generic positions (e.g., 999) disappear.
Invoices may therefore look different, sometimes more detailed, but they are designed to be clearer and more transparent.
Tariff point value – what you should know
The invoice amount depends on the number of tariff points multiplied by the tariff point value applied by the physician.
This value is defined at cantonal level and represents the normal billing reference.
Indicative values:
- Geneva: CHF 0.94 or CHF 0.96
- Vaud: CHF 0.94
UNSMIS expects physicians to apply the cantonal TARDOC point value as a priority.
To protect its insured members, UNSMIS accepts a maximum point value of CHF 1.00 in Geneva.
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What UNSMIS reimburses
For outpatient treatments performed from 01.01.2026, UNSMIS reimburses:
- only services listed in the official TARDOC catalogue,
- officially approved ambulatory flat rates.
Former TARMED positions and generic positions (e.g., 999) are no longer accepted.
Your role as an insured member
You are the first person to know:
- what treatments were performed,
- how much time you spent at the medical practice.
By quickly reviewing your invoices you help ensure that only justified medical costs are reimbursed, contributing to cost control and the long-term sustainability, financial viability of your health insurance plan.
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If you have doubts about an invoice
If an invoice seems unclear or excessive:
- Do not pay it immediately.
- Consult the UNSMIS explanatory guides.
- Contact UNSMIS so we may help verify the invoice.
- If necessary, contact your physician to request any clarifications and/or corrections.
UNSMIS supports you
To support you during this transition, UNSMIS has implemented:
- full training for its staff,
- explanatory guides and infographics,
- a dedicated TARDOC page on our website,
- information sessions (on-site and via Microsoft Teams).
👉 More information is available at:
https://medical-insurance.unog.ch/en/TARDOC
In summary
- TARDOC has replaced TARMED as of 01.01.2026.
- Invoices are changing but becoming more transparent.
- The cantonal point value is the expected standard.
- UNSMIS applies a clear framework to protect its insured members.
- Your vigilance is essential.
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This article provides an overview of one of the most frequently requested medical services by our insured members: weight loss treatment. Given the high cost of these therapies, it is important to understand the conditions that apply to their reimbursement, designed to find the right balance between a good reimbursement level for the insured and protect the financial sustainability of the Fund.
Reimbursement for weight loss medications requires prior authorization.
The initial authorization is granted for a period of 16 weeks, referred to as Phase 1. If the treatment proves effective, it may be extended for an additional six months under Phase 2. To support this decision, a medical report must be submitted, including evidence of weight loss (BMI).
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A reduction of 10 to 12% of body weight over a ten-month period is a requirement to be able to obtain prior authorization for continued treatment.
In addition to a valid prescription for the medication, the treating endocrinologist should provide UNSMIS with the patient’s height, weight, body mass index (BMI), and any comorbidities.
This documentation is essential for the Medical Adviser to assess the case.
It is important to note that some medications are approved exclusively for diabetes, while others are intended solely for weight loss. If a patient does not have diabetes, medications classed for diabetic patients will not be approved for weight loss purposes.
Authorization must be requested prior to the treatment commencing. Requests submitted after beginning treatment will not be accepted, and the cost of the treatment will not be considered for reimbursement.
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