FAQ

Zutat is specialised in reimbursement for the following in the Swiss healthcare market:

• Medical devices
• Foods for Special Medical Purposes (FSMP)
• Services associated with these products

• Providing support with the development of a market access strategy
• Clarifying whether a product is reimbursed or whether reimbursement is possible
• Outlining the treatment pathway and calculating the cost implications
• Tracking down market statistics
• Guiding and supporting customers as they take steps towards obtaining reimbursement for medical devices
• Reimbursement for services in connection with the supply of medical devices

Yes. We also assist pharmaceutical companies with queries related to medical devices. However, we cannot provide assistance in the area of medicines. ‘Pharma’ is another world, which we are not so well acquainted with.

No. Zutat can aid in the search, but it does not play the role of a trading partner.

Yes. We offer a readily available service to eliminate the need for time-consuming searching. We can also answer close-ended questions. Simply book a time slot and we’ll provide answers. The service will be billed at the time of booking.

Yes. To some Rolf Müller is known as Mr MiGeL. He is very familiar with MiGeL practices and the structure and peculiarities of MiGeL.

No. Zutat’s services are only available in Switzerland. When it comes to other countries, we do not possess the level of knowledge/insight required to provide the quality that we strive for.

Zutat can provide publicly available statistics and a literature search.

Potential sources include:

• The Federal Statistical Office
• The National Agency for Cancer Registration
• Healthcare provider associations

Free competition exists in the medical device sector. Economic actors set the price of each product. There are no margin constraints.

Is the product marketable in Switzerland?

No: reimbursement will not be provided

Yes:

• Use by healthcare providers (without care)
  The product is an essential part of the service. Reimbursement is stipulated in the tariff contracts of the healthcare providers.
  Inpatient hospital services: medical devices are part of the flat rate and are not charged separately (SwissDRG)
  Outpatient services offered by a hospital or doctor’s surgery: TARMED tariff system for outpatient medical services, General Interpretation on the Reimbursement of Consumables and Implants (GI-20).
  Cost bearer: accident or disability insurance
  Cost bearer: health insurance
  Exception: if the service is not subject to reimbursement, the consumables cannot be reimbursed either (an essential part of the service).
  Tariff contract for physiotherapy
  Tariff contract for occupational therapy
  Tariff for wheelchair provision
  More tariffs/tariff structures are available on request.
• Use as part of a care service (medical care product)
  Medically prescribed services are provided by an outpatient or inpatient care organisation or self-employed nurses. Does the required medical care product correspond to a generic MiGeL item (please note the prohibition of analogy)?
  • No: no reimbursement e.g. separate reimbursement is provided. The application process is the sole process designed for listing. The application process must be completed for an amendment to be made to the MiGeL.
  • Yes: separate reimbursement is possible (with the exception of simple consumables related to the care service and multiple-use products for different persons)
• Self-use by the insured person
  Is the medical device used by the patient themselves, if necessary with the assistance of non-professional parties?
  • No: see ‘Use by healthcare provider’ and ‘Use as part of a care service’ above.
  • Ja: if the medical device corresponds to a generic MiGeL item (please note the prohibition of analogy)?
  • If a corresponding MiGeL item is missing: amendments to the MiGeL are possible. To this end, the application process must be completed.

Yes, in the area of compulsory health insurance. The MiGeL is an exhaustive approved list that is part of the FDHA (Federal Department of Home Affairs) Ordinance on Compulsory Health Insurance Benefits (HIBO).

Link MiGeL: list of medical supplies and devices (MiGeL) (admin.ch)

No. The HVB is the maximum amount that compulsory health insurance may reimburse. If a product is cheaper, the insurance company pays the actual costs. If a product is more expensive, the insured person pays the additional costs.

The HVB is the median of the products available on the market, taking into account foreign prices.

Amendments can only be obtained by submitting an application. All persons and organisations wishing to amend the MiGeL can submit an application.

Yes. Services such as clarifying the feasibility of reimbursement and assisting in the process of obtaining it are also offered for FSMP products.

The Federal Department of Home Affairs issues the MiGeL after consulting the Federal Commission for Analyses, Aids and Devices.

The Federal Office of Public Health issues a newsletter. It is highly recommended to sign up for this as soon as possible so that you receive timely updates regarding any changes.

The ‘valid from’ date shown for each MiGeL item is binding, and there is no entitlement to a further transitional period.

It is the invoicing party’s responsibility to apply the correct MiGeL item.

Yes. If:

• the product is not marketable in Switzerland;
• there is no doctor’s order/prescription;
• the product’s use does not meet the WZW criteria (with regard to efficacy, appropriateness and cost-effectiveness);
• the product does not correspond to a MiGeL item;
• a limitation rules out reimbursement; and/or
• dispensation took place via an unauthorised channel.