All health insurers must prove that discounts granted for framework contracts are justified. People insured under a framework contract must represent a better risk structure than those with individual insurance. In concrete terms, this means that in the case of two people of the same age and gender, one of whom is insured under a framework contract and the other under individual insurance, the person covered by the framework contract must cause fewer benefit payments – at a ratio equal to the discount granted.

FINMA stipulates that discount-worthiness under a framework contract must be verified individually for each product. It is therefore essential that, in the context of a given product, the person insured under the framework contract claims fewer benefits than an insured person who is similar in terms of age and gender but does not belong to a collective. The means of verifying this can vary from product to product.

There are framework contracts for which proof of discount-worthiness cannot be provided with regard to certain products. This results in proportionate adjustment of the discount.

There are other framework contracts for which such proof cannot be provided with regard to any products. In these cases, the discount can no longer be granted at all.

Unfortunately, there is no single answer to this question, as every insured person’s contractual situation is different. The rises vary according to product combination, age, gender etc.

You do not need to take any action in the event of either a discount adjustment or contract termination. The contractual partner, e.g. your employer, will be informed of any changes. Your insurance cover remains fully intact.

In the event of discount adjustment, the name of your framework contract and the contract number are displayed as before. The discount is adjusted automatically.

If the framework contract with the contractual partner (i.e. your employer, association or club) is terminated, the collective discounts and any special conditions cease to apply.

You can ascertain this from your policy if the name of the framework contract, its contract number and the discounts are missing. Your insurance cover remains fully intact.

Nothing changes with regard to your insurance cover or insurance status. If the framework contract is terminated, you are automatically transferred to the corresponding individual insurance. You do not need to take any action. There will be no gaps in your cover – it will be just as good as before.

The framework contract remains attractive, even if you are currently benefiting from little or no discount. Discount-worthiness is reviewed annually, so if it can be proven at a later date, discount will be granted again from 1 January in the following year.

With your framework contract, you not only benefit from discounts on top-up insurance, but also from exclusive extra points with myPoints. Quite simply, this helps you to reach your annual target of 120,000 points faster and to enjoy an annual bonus of CHF 150 instead of CHF 120.

More information: visana.ch/mypoints-collective