Definition of tiers garant and tiers payant: what’s the difference?

1. Definition and meaning: tiers garant

In the case of tiers garant, the doctor or other service provider sends the invoice directly to you. You are responsible for paying the bill.

You then send the bill to your health insurance provider. The health insurer checks it. If the services are covered by your health insurance, you will receive a refund. However, you will only receive a refund after deducting your out-of-pocket expenses.

How long does it take for me to get a refund?

You will usually get a refund within 30 days after the health insurance company has received your invoice. However, the law does not set a deadline for reimbursement. 

Health insurers may extend the refund period, for example, if invoice components are missing or the health insurance company has to obtain information from the service provider. This may also apply if the health insurer consults an independent medical examiner to review the service.

What can I do if the refund is taking too long?

If you do not receive any money from the health insurance company despite being entitled to a refund, you can contact a health insurance ombudsman.

2. Definition and meaning: tiers payant

In the case of tiers payant, the invoice of the service provider goes directly to the health insurance company. The health insurance company pays the bill. Here too, the health insurer checks whether the benefits should be reimbursed by basic or supplemental insurance. If you have not already paid your out-of-pocket expenses, the health insurer will send you an invoice.

Good to know: you will receive a copy of the invoice from either the service provider or the health insurance company.

What is tiers soldant?

In the case of tiers soldant, the service provider sends the invoice to the health insurer. Unlike tiers payant, the health insurance only pays the amount after deducting your out-of-pocket expenses. The service provider must then request the remaining amount from the policyholder.

Tiers soldant is usually only used for accident insurance, as there are no out-of-pocket expenses. 

3. When is tiers payant or garant used?

In general, the service providers and health insurance companies determine whether tiers payant or tiers garant is used for outpatient treatments. If the service providers and health insurance companies have not agreed otherwise, tiers garant usually applies. For inpatient stays, tiers payant is prescribed by law (KVG, Art. 42, in German, French and Italian only).

4. I cannot pay the health insurer’s bill. What can I do?

With tiers garant, you will generally only receive refunds after the invoice has been paid. Furthermore, this applies only once you have fully already paid your out-of-pocket expenses.

This can cause problems if you’re in a tight spot financially. There are different solutions for this:

• Extend the payment period: ask the service provider for a later due date. Send the invoice to the insurer as soon as possible. This way you will receive the refund before you have to pay the invoice.

• Use tiers soldant: ask the service provider if you can use tiers soldant. With tiers soldant, you pass on your claim for reimbursement to the service provider. If you’ve already paid your out-of-pocket expenses, the health insurer will cover the entire invoice.

Be sure to check with your service provider or health insurance company. Together you can usually find a solution.