OSAM-Formations
Consultation

Practical preparation training For the examination

Health insurance specialist
with federal diploma

For exam success
a federal certificate in health insurance.

Duration

12 months of training: hybrid, online and face-to-face

Start

Choose between our February, May or September start dates.

Approach

High-level active trainers and personalised teaching.

Schooling

CHF 10,900. Reimbursed to 50% by the confederation*.

Context and issues

The Swiss healthcare system is one of the most complex and demanding in the world. Governed by the LAMal, it involves a multitude of players - insurers, service providers, authorities and policyholders - whose interactions are governed by a constantly evolving body of legislation. Faced with increasing pressure on healthcare costs, regular reforms to the legal framework and rising policyholder demands, professionals in the sector can no longer be satisfied with basic operational expertise.

The Health Insurance Specialist federal diploma is precisely this: it certifies in-depth, nationally-recognised skills covering customer advice, benefits processing, inter-insurance coordination and the management of complex situations. This protected qualification, awarded by the SEFRI, positions its holder as a benchmark expert within his or her organisation, capable of assuming managerial or specialist responsibilities. In a sector where there is a documented shortage of qualified profiles and where the demand for specialised skills continues unabated, obtaining this federal diploma is a powerful strategic lever, both for individual career development and for team performance.

Your comments

Programme

Module A: Basics and advice

Advice for health insurance clients: obligation to take out insurance, exceptions and suspensions, special forms of insurance, taking out and changing insurance policies under the KVG/LAMal and the VVG/LCA, financing. Analysis of individual situations to propose appropriate solutions that comply with the legal framework in force.

Module B: Services

Processing of entitlement to benefits: examination of entitlement to benefits, contribution to costs, checking invoices, answering questions about benefits charged, cost effectiveness. Rigorous application of the legal bases and principles of efficiency in handling insured files.

Module A+B Bilateral

International dimension: implementation of the obligation to insure and the right to benefits under international agreements. Taking into account the specific features of cross-border mobility and insured persons working abroad.

Module C: Coordination

Coordination with stakeholders: responsibilities of other social insurers, appeals, inter-insurance cooperation, information on coordination. Management of interactions between institutions to ensure consistent, seamless care for insured persons.

Module D: Daily benefits

Purpose and forms of daily allowance insurance, providers, calculation of daily allowances, coordination with other insurance policies. Mastery of calculation mechanisms and conditions for granting benefits in a variety of situations, particularly in the event of incapacity for work.

Cross-disciplinary module: Social security and law

The social security system as an integral part of social policy, its origins and development, and the players involved. Handling legal disputes under private and public law in the field of health insurance. Developing an overall understanding of the legal and institutional issues surrounding the system.

  • SKILLS ACQUIRED

  • Mastering the KVG/LAMal
  • Advising policyholders
  • Analysing services
  • Inter-insurance coordination
  • Applying the law
  • Managing appeals
  • Calculating benefits
  • Handling complex cases
  • Navigating the bilaterals
  • Managing processes
Simon Pawolleck

Let's discuss your training project!

Simon Pawolleck - Training Director

They train with us

OSAM Customers - Companies

FAQ

Two profiles will be admitted to the professional examination: 

Profile A - Hold a CFC in the santésuisse branches (health insurance, social insurance or private insurance) and have at least two and a half years' professional experience in health insurance under the KVG/LAMal.

Profile B - Hold another CFC or equivalent qualification (maturité fédérale, recognised business school diploma) and have at least three and a half years' professional experience, including at least two years in the field of health insurance under the KVG/LAMal.

This course is aimed at professionals working in the field of social health insurance (LAMal) who wish to validate and deepen their skills with a federally-recognised qualification.

It is particularly suited to benefits managers, customer advisers, co-ordinators and administrative staff working for health insurance funds, social insurers or related organisations.

It is suitable for anyone wishing to move into a specialist or managerial role within their organisation, or to enhance their value on the job market in the healthcare sector.

The Federal Professional Examination for Health Insurance Specialists is organised by once a year, in the spring, under the responsibility of santésuisse, the umbrella association of Swiss health insurers. It is held in Switzerland, in the three national languages (French, German, Italian), and each candidate takes the exam in their own language.

Candidates must complete the official registration form and submit it to the professional examination secretariat. Candidates are personally responsible for their own registration and must enclose the required certificates and confirmations. Candidates will be notified of their admission in writing at least three months before the start of the examination.

The exact dates of each session are published by santésuisse at the end of the previous year. We invite you to consult the official website regularly or to contact OSAM Formations to be informed as soon as registrations open.

This course can be fully customised (content, format, language). Contact us for a free quote.

The aim of the professional examination is to verify that candidates have acquired the skills needed to competently carry out a demanding professional activity in social health insurance and related fields. Santesuisse

It consists of three separate written tests, covering all the subjects in the official reference framework:

Test 1 -> Basic insurance (LAMal): customer advice, obligation to take out insurance, benefits, contribution to costs, financing.

Test 2 -> Supplementary social insurance and coordination: interaction with other social security branches (AA, AI, APG, daily allowances), appeals management, international dimension and bilateral agreements.

Test 3 -> Cross-disciplinary practical case: handling of a complex situation involving several areas of the reference framework, demonstrating the candidate's ability to analyse and apply the law and propose practical solutions.

The tests are written. Authorised aids (law reports, etc.) are specified in the official guidelines published before each session. At the end of the marking conference, the examination board informs the candidates in writing of their results. The federal certificate is awarded by SEFRI to candidates who have passed the examination.

For more information, contact us!

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OSAM Training / Training as a health insurance specialist with federal certificate