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.
1 – 6 Personal details
Is the bill really meant for you?
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.
Did you actually receive treatment on this date? Please note: telephone consultations are also invoiced.
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.
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
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.
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