CSS: CHF 129 million reimbursement due to excessive premiums


ask for high premiumsCSS will return CHF 129 million to those with complementary insurance

The Swiss Financial Market Supervisory Authority, Finma, has concluded enforcement proceedings against the CSS Group. CSS now has to reimburse money to those with supplemental insurance.

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According to Finma, CSS had asked for too high a premium.

According to Finma, CSS had asked for too high a premium.

20 minutes/Matthias Spicher

The insurance company must now reimburse CHF 129 million.

The insurance company must now reimburse CHF 129 million.

20 minutes/Marco Zangger

As the Swiss Financial Market Supervisory Authority Finma in one writes a statement, the investigation against CSS, which has been ongoing since spring 2020, has been completed. Finma writes on its website: “Finma’s proceedings revealed that CSS Versicherung AG was responsible for serious violations of the supervisory law from 2013 to 2019. These are based on shortcomings in the brokerage business and within the group unilaterally at the expense of supplemental health insurance administrative expenses charged.”

CSS paid commissions that were not economically justified

During the period under investigation, the CSS worked closely with a certain insurance brokerage company. Despite repeated warnings from Internal Audit, the CSS did not adequately record, limit and monitor the risks arising from the business relationship with this intermediary and came to depend to a certain extent.

Thus, in the years 2012 to 2014 it paid commissions on occasions that were economically unjustified, which called into question the profitability of the new contracts. In addition, CSS charged all commission payments made by the Group to the ancillary insurance business until 2018. Therefore, the agency costs of all new contracts were borne exclusively by individuals with ancillary insurance, although this was also demonstrably related with compulsory health insurance.

Unjustified fee calculations

Calculations in the enforcement proceedings showed that, for the years 2013 to 2019, administrative costs of at least CHF 129 million were unjustifiably included in the fee calculations and transferred to the additional insured’s premiums.

In order to restore the orderly situation and protect policyholders, Finma obliges CSS to reimburse premiums in favor of the additional affected policyholders in the amount of CHF 129 million. The premium reimbursement benefits those with complementary health insurance who had complementary health insurance with CSS Versicherung AG between January 1, 2013 and December 31, 2019, the amount of which in each case will depend on the type of product. , the duration of the contract and the amount of the individual premium.

CSS recognizes Finma’s decision

Finma’s decision does not question the operational activities of CSS. The credits of the insured are guaranteed and the solvency regulations are complied with. Finma’s decision is not final and the CSS can appeal to the Federal Administrative Court.

The CSS itself comments on the accusations in a statement. “Finma’s decision is not final and the CSS can appeal to the Federal Administrative Court. CSS is now analyzing the decree in detail and examining how to proceed. In the event that the sentence is final, the CSS will draw up a detailed plan for the refunds and will inform its clients in the complementary insurance area about the amount of the payments in the years 2013 to 2019.»

The health insurance company also writes that the focus is on serious and sustainable management in the interest of the insured. “The largest Swiss basic insurer always adheres to legal and regulatory requirements,” CSS writes.

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