In which cases do I need prior approval or opinion from the Third-Party Administrator?

You need a prior approval by the Third-Party Administrator for:

  • transport (except emergency transport);
  • refractive surgery;
  • thermal spa therapy, convalescence stays, rehabilitation stays, stays in a respite care home or in a unit for those waiting for space to become available in a suitable establishment;
  • home nurses;
  • hire or purchase of auxiliary appliances;
  • cost of accommodation in a hospital for a family member, other than one of the two parents, whose presence is required by the hospitalisation of a child of less than ten years of age.

For all these benefits, it is necessary to submit a written request for prior approval to the Third-Party Administrator, UNIQA, at least 14 calendar days before the medical expenses are incurred, except in the case of cures and convalescence cures where the notice period is at least 30 calendar days before the expenses are incurred.

You need prior opinion from the Third Party Administrator for:

  • dental treatment, prostheses and orthodontics,

if the total cost for the treatment exceeds 25% of the annual ceiling (i.e. CHF 800.00), except in case of emergency. The request for a prior opinion must be made by submitting to UNIQA, at least 14 calendar days before the start of the treatment, the CHIS/F03- Estimate for dental and orthodontic treatment and prostheses completed by the attending dentist.

Expenses incurred without the required prior approval or opinion will not be reimbursed by the CHIS.

FAQ category