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Reimbursement of benefits

How do I check a doctor's bill? 

Anyone who is not an expert and wants to check a bill from a doctor, therapist or hospital can be forgiven for getting confused. Here is some help.


doctor's bill

1 – 6 Personal details
Is the bill really meant for you?

7 Diagnosis

The diagnosis is hidden in the so-called “Tessiner Code”, which is unfortunately very difficult to decode.

8 Type of reimbursement

TG stands for “Tiers garant”: this means you pay the bill and then send ÖKK a reimbursement claim. TP stands for “Tiers payant”: the bills go straight to ÖKK and you only receive a statement of benefits.

9 Date
Did you actually receive treatment on this date? Please note: telephone consultations are also invoiced.

10 Tariff
The benefits are split into various tariffs. The most common are “001” for doctors’ services, “400” for medication and “316” for laboratory analyses.

11 Tariff number
This is a code including a short description of the benefit provided.

12 Amount

How frequently was the benefit provided or the medication dispensed?

13 Tax points of medical benefit (TP AL)
This is the number of tax points assigned to each medical benefit in Switzerland.

14 Tax point value of medical benefit (TPW AL)

The tax point value (TPW) varies according to the canton.

15 Tax points of technical benefit (TP TL)
This relates to reimbursements for the infrastructure (rent, power, cleaning) and non-medical personnel (practice
assistants).

16 Tax point value of technical benefit (TPW TL)
See point 14.

17 Mandatory benefit codes
If this is “0”, basic insurance covers the costs; if it is “1”, it does not.

18 Amount
The total of the individual benefits
TP AL × TPW AL plus
TP TL × TPW TL.

19 Total amounts of individual areas

20 Overall invoice total

Where should I send doctor’s bills I have paid myself?

Reimbursement documents or the original bill must be sent to your ÖKK branch office for reimbursement. You will then be reimbursed for the costs minus the cost sharing amount.

Why has ÖKK not yet paid my bill?

Your cost sharing amount (annual excess and deductible) is first deducted from the invoice amount until your share is fully paid. If the invoice amount is smaller than your annual excess, you will not receive a reimbursement, only a statement. This will show you that the invoice amount was already subtracted from your excess and how much of your annual excess remains.

Do I have to pay a doctor’s or hospital bill myself first and then contact ÖKK or the other way around? Should I attach the payment slip?

If the bill is made out to you, you must pay it yourself. For evaluation and quick reimbursement, however, send the bill to ÖKK beforehand. We recommend that you pay the bill only after you have received reimbursement from us. This helps us to avoid inflated bills from service providers (doctors, hospitals, etc.). In this way, we can jointly prevent you from paying more than necessary. If we do not yet have your account details yet, please give us a bank or post account for simple and quick reimbursement. If we do not have your account details, you will receive a cheque to be cashed at the post office.