Insurers offer premiums for defined geographical regions. The number of such “premium regions” is limited to
three per canton. Within every premium region, the basis for variation in premiums is limited to age category
(children up to age 18, young adults ages 19 to 25, and adults over age 25), level of deductible, and alternative
insurance plans (so-called managed care plans). In 2011, 53.2 percent of residents opted for basic coverage with
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a managed care insurer: a health maintenance organization, an independent practice association, or a fee-forservice
(FFS) plan with gatekeeping provisions. Within a given region, the premium charge variation between
insurers can be significant. However, this variation may be in large part because of risk selection (by insurers
and policy holders) rather than efficiency differences. All premiums for the subsequent year are controlled and
authorized by the FOPH, which puts a floor on the premiums they are allowed to offer to cover past, current,
and estimated future costs for the insured persons in a given premium region. Otherwise, the insurer has to
propose a new (higher) premium that satisfies the FOPH’s criteria