Act on Health Insurance in the Canton of Basel-Stadt (GKV) (GKV)

1. To ensure the population of the canton has enduring, financially sustainable health insurance, the canton regulates social health insurance in accordance with the following provisions, insofar as it is not definitively regulated by the Federal Act on Health Insurance (KVG).

2. The canton ensures compliance with the general insurance obligation in accordance with the provisions of the KVG.

3. The canton is committed to the maintenance and improvement of social health insurance. In the interest of prudent management of public funds, the best possible coordination of healthcare planning with the financial support of health insurers is sought.

4. ...

1. Insurance obligation is governed by federal law.

1. The canton verifies compliance with the insurance obligation. Upon request, insured persons must present a copy of their insurance card. Persons who do not fulfill their insurance obligation in a timely manner shall be assigned to an insurer. The assignment must equitably consider all insurers.

2. The government council designates the competent office responsible for this, which also decides on exceptions to the insurance obligation according to federal law.

1. The canton regulates contractually the cooperation with insurers in the areas of mandatory insurance monitoring and premium contributions, including the compensation for the additional expenses of the insurers.

2. The canton may agree with the insurers on the waiver of benefit assitance according to Art. 9 KVV in exchange for compensation for irrecoverable premiums and cost participations.

1. Compulsory health insurance policyholders residing in the Canton of Basel-Stadt, as well as the persons mentioned in Art. 65a KVG, are entitled to premium subsidies if they live in modest economic circumstances. The contributions are paid to the insurers and credited against the premium. In exceptional cases designated by the Council of State, the contributions may be paid directly to the insured.

2. The Council of State determines the relevant income groups for receiving premium subsidies for the category of single individuals on one hand, and for the category of married individuals and registered partners on the other. The premium subsidies are calculated so that insured persons in lower income groups receive greater relief than those in higher income groups within the same category. For individuals living in a de facto partnership with children residing in the household, as well as for single parents, the same income groups apply as for married individuals.

3. For insured retirees entitled to supplementary benefits and/or cantonal assistance, entitlement to premium subsidies is determined exclusively according to the Federal Law on Supplementary Benefits to AHV/IV. Persons receiving social assistance generally receive premium subsidies based on the Social Assistance Act. For individuals receiving social assistance who also receive contributions based on the GKV, the GKV benefits are credited against social assistance benefits. The switch to cost-reducing insurance forms should be equipped with an incentive. The competent department regulates the specifics.

4. ...

5. The canton ensures that its residents are informed clearly and understandably about the possibility of premium reduction. Individuals who might be entitled to premium subsidies based on tax data are personally contacted. The Council of State regulates the specifics.

1. The Calculation of the Relevant Income of the Relevant Economic Household Unit is Governed by the Provisions of the Law on the Harmonization and Coordination of Means-Tested Social Benefits of June 25, 2008 (Social Benefits Harmonization Act).

1. The claim for premium contributions must be asserted by the insured with the competent authority and substantiated with the necessary written documents.

2. The notification obligation of those entitled to contributions in the event of changed circumstances is governed by § 16 of the Act on the Harmonization and Coordination of Needs-Based Social Benefits of June 25, 2008 (Harmonization of Social Benefits Act).

3. The competent authority shall regularly verify the eligibility for claims.

4. The reimbursement of improperly received contributions and waivers is governed by § 17 of the Act on the Harmonization and Coordination of Needs-Based Social Benefits of June 25, 2008 (Harmonization of Social Benefits Act).

5. ...

1. The entitlement to premium contributions arises from the beginning of the month following the submission of the application.

2. The government council shall regulate the commencement of entitlement in the event of relocation to the canton during the year, subject to the mandatory jurisdictional rules of federal law.

1. The entitlement to premium contributions ceases upon the elimination of personal and financial prerequisites.

2. Furthermore, the entitlement ceases upon relocation abroad. For individuals residing in a member state of the European Community, the entitlement ceases upon the elimination of the conditions specified in Art. 65a KVG.

3. Upon relocation to another canton, the entitlement ceases at the end of the year in which the relocation occurred.

4. The government council may issue provisions regarding the suspension or cessation of the entitlement if insured persons fail to comply with the request to verify their entitlement.

1. Claims for Reimbursement from Premium Reductions and Supplementary Benefits can be Offset Against Due Premium Contributions.

1. A decision fee is levied for tariff-setting procedures according to Art. 47 para. 1 KVG.

2. The decision fee amounts to between CHF 500 and CHF 3,000.

3. The decision fee is typically allocated between the tariff partners according to the outcome of the proceedings.

4. In justified cases, the decision fee may be waived in whole or in part.

5. The government council regulates the details.

1. The Social Insurance Court acts as the Cantonal Insurance Court in accordance with Article 57 of the Federal Law on the General Part of Social Insurance Law (ATSG). It is also responsible for resolving disputes arising from supplementary insurance to mandatory health care insurance.

2. Disputes between insurers and service providers pursuant to Article 89 KVG are decided by the Arbitration Court in Social Insurance Matters.

1. Appeals against decisions regarding the obligation to join the Swiss health insurance pursuant to § 4 of this Act as well as regarding the allocation or calculation of premium contributions pursuant to §§ 17-22 of this Act may be filed orally or in writing with the issuing authority within 30 days of their issuance. Exempt from this are procedural and interim orders. Regarding the procedure, the provisions of the Law on the Social Insurance Court of the Canton of Basel-Stadt and the Arbitration Court in Social Insurance Matters (SVGG) and the ATSG shall apply.

1. Against objection decisions or orders, against which an objection is excluded, the affected parties may file an appeal with the Social Insurance Court within 30 days of their announcement. Otherwise, the provisions of the SVGG and the ATSG apply.

2. ...

1. To adjudicate disputes arising from state contribution relationships based on this law, the competent authority is the Executive Council, or in cases of decisions made by the Executive Council, the Cantonal Administrative Court, in accordance with the Law on the Organization of the Executive Council and the Administration dated April 22, 1976, as well as the Law on Administrative Jurisdiction dated June 14, 1928.

1. The Government Council shall issue the implementing provisions necessary for the execution of this Act.

1. Funds that implemented the partial obligation according to the law on mandatory health insurance dated November 19, 1942, before this law came into effect, are entitled to implement the obligation pursuant to this law.

1. In order to fulfill the cantonal contractual conditions pursuant to § 16 paragraph 3, a three-year transitional period is granted to the insurers for adapting the premium conditions in existing collective agreements. After two years, the premium difference to the minimum premium pursuant to § 16 paragraph 3 may not exceed 15%.

1. The ÖKK Basel is the legal successor of the Public Health Insurance Fund of the Canton of Basel-Stadt established pursuant to the law of November 11, 1943.

2. Until the effectiveness of the statutes and performance regulations of the ÖKK Board of Directors, the insurance benefits shall be provided in accordance with the existing law after this law comes into force.

3. The rights of employees of the ÖKK Basel-Stadt who are in an employment relationship under public law with the canton and its pension fund shall be preserved. In the event of the closure of the fund, the canton is obliged not to place the personnel of the ÖKK in a less favorable position than in comparable public law employment relationships.

4. The balance sheet of the ÖKK Basel-Stadt shall be adjusted as the opening balance sheet of the ÖKK Basel at the time of the entry into force of this law, as follows

a) Formation of the ordinary reserves required under federal law;

b) Formation of a voluntary fluctuation fund of the health care insurance amounting to twenty million francs;

c) Reduction of the previous free reserves from daily sickness benefit and supplementary insurances to fifteen million francs.

5. The financial requirements of the ÖKK Basel for the year 1991 (base year according to § 36 of this law) are assessed at 73.5 million francs.

6. Subsidy contracts valid as of January 1, 2004, are not affected by the repeal of the provisions concerning risk and operating contributions. From 2007 to 2012, the risk contributions to the ÖKK will be reduced to zero in the following steps

Risk Contribution

2007 = 80% of the total risk contributions for the year 2006

2008 = 70% of the total risk contributions for the year 2006

2009 = 60% of the total risk contributions for the year 2006

2010 = 50% of the total risk contributions for the year 2006

2011 = 40% of the total risk contributions for the year 2006

2012 = 20% of the total risk contributions for the year 2006

2013 = 0

1. To the extent that the reserves existing according to the takeover balance sheet of ÖKK Basel-Stadt are insufficient, the canton shall equip ÖKK with the necessary funds according to the opening balance sheet for the establishment of the ordinary and voluntary reserves.

1. Effective as of the date this law comes into force, the following decrees are amended: [8]

1. Upon the effective date of this law, the following shall be repealed

a) the Act concerning Mandatory Health Insurance of November 19, 1942;

b) the Act concerning the Public Health Insurance Fund of the Canton of Basel-Stadt of November 11, 1943, subject to § 59 paragraph 2 of this Act;

c) the Act on State Contributions in the Health Sector (GSG) of November 10, 1966.

1. This law is to be published and presented to the entirety of eligible voters. It will become effective as of January 1st of the year following the referendum upon entering into legal force.