Your digital health solution deserves to be reimbursed. Here’s how.
Yet success is absolutely possible. Several startups have done it—and you can too, with a smart strategy, strong evidence, and the right allies. This quick guide walks you through the essentials and shares real-world insights from companies who’ve navigated the path to reimbursement with us, at the Future of Health Grant.
Before diving into reimbursement strategies, it’s essential to grasp the unique features of Switzerland’s healthcare system. It’s high-quality, heavily regulated—and fragmented. This complexity creates both opportunities and hurdles for digital health startups aiming to integrate their solutions into reimbursed care pathways.
Two pillars: mandatory and supplementary insurance
- Compulsory health insurance (OKP – obligatorische Krankenpflegeversicherung)
Everyone living in Switzerland must subscribe to an OKP policy. It covers essential healthcare services linked to illness, maternity, or accident. However, for any service to be reimbursed under OKP, it must fulfill the WZW criteria:- Wirksamkeit (effectiveness)
- Zweckmässigkeit (appropriateness)
- Wirtschaftlichkeit (cost-effectiveness)
These criteria are strictly evaluated, and only services listed in official benefit catalogues (like KLV Annexes or MiGeL) are reimbursed.
- Supplementary insurance (VVG – Versicherungsvertragsgesetz)
Optional and privately negotiated, VVG insurance covers services beyond the OKP catalogue, such as alternative medicine, dental care, or digital therapeutics. It offers more flexibility for startups to negotiate reimbursement, but addresses a smaller, segmented market.
What this means for startups
- Supplementary insurance is faster and more flexible but fragmented.
- OKP inclusion provides national scale and long-term sustainability—but is slow, rigorous, and administratively heavy.
- Some solutions might never fit into OKP, while others can gradually evolve from self-pay to supplementary, and eventually into OKP reimbursement.
Moreover, there is no dedicated reimbursement pathway for digital health applications (dGA) in Switzerland (unlike Germany’s DiGA directory or France’s PECAN). Instead, dGA must fit into existing reimbursement categories, such as:
- Medical services (KLV Annex 1)
- Aids and appliances (MiGeL – KLV Annex 2)
- Lab analyses (AL – KLV Annex 3)
This lack of a “digital-specific” process means startups must be creative and rigorous in navigating the system—and ideally, not do it alone.
To navigate reimbursement successfully in Switzerland, you must first answer a seemingly simple—but strategically crucial—question: what exactly does your digital solution do, medically speaking?
This definition isn’t just a branding exercise. It determines:
- Whether your product qualifies as a medical device
- What regulatory path it must follow (e.g., Swissmedic compliance)
- And which reimbursement route is even possible
What counts as a digital health application (dGA)?
Switzerland doesn’t have a dedicated legal framework for digital health applications. But the Federal Office of Public Health (FOPH) defines a dGA as: “A product that promotes health, supports patients, or serves a medical purpose through digital technologies.”
This includes:
- Apps and software
- AI-based tools
- Connected devices (e.g., sensors, wearables)
- Hybrid systems that combine hardware and digital layers
If your solution is used for diagnosis, treatment, monitoring, prevention, or care and generates actionable medical insights, it likely qualifies as a medical device software under the Swiss Therapeutic Products Act (TPA) and Medical Devices Ordinance (MedDO). That means you need:
- Proper classification (risk class I, IIa, IIb…)
- A conformity assessment
- Technical documentation proving safety and performance
⚠️ If your app just provides general wellness advice or tracks steps without a medical claim, it won’t qualify—and therefore won’t be eligible for OKP reimbursement.
Why this matters for reimbursement
Only digital solutions with a clear medical purpose can be considered for reimbursement under:
- Compulsory health insurance (OKP) — if they meet WZW criteria and are integrated into a KLV annex
- Supplementary insurance (VVG) — many insurers prefer to cover medical-purpose tools that improve outcomes or reduce costs
Clarity on your medical purpose also simplifies the path toward:
- Selecting the right reimbursement category (e.g. MiGeL vs KLV Annex 1)
- Building the clinical evidence needed for approval
- Convincing physicians and insurers that your product is not just “nice-to-have”, but must-have
Trying to enter the Swiss reimbursement system in one big leap is rarely realistic—especially for early-stage startups. A smarter approach is to build traction in phases, aligning product maturity with regulatory requirements and insurer expectations along the way.
This phased strategy is not just theoretical—it reflects the real journeys of Swiss startups that have successfully moved from self-pay to supplementary insurance to OKP reimbursement.
Phase 1: Start with self-pay (B2C or B2B2C)
Launching with a direct-to-consumer or provider-paid model is often the quickest way to test your product in the market.
✅ Advantages
⚠️ Challenges
💡 Tip
Embed your product into clinical care pathways early. Provider
recommendation greatly increases uptake—even in a self-pay context.
Phase 2: Negotiate with supplementary insurers (VVG)
Once you’ve demonstrated value and usage, you can approach supplementary health insurers to include your solution in their offerings.
✅ Advantages
- Faster and more flexible than OKP
- Opens access to a broader user base
- Acts as a credibility milestone for future OKP inclusion
⚠️ Challenges
- Market is fragmented—negotiations happen one insurer at a time
- Not all patients have supplementary insurance
- Coverage is tied to specific policies, often not well-known by patients or prescribers
💡 Tip
Highlight how your solution supports the insurer’s strategic goals (e.g., cost savings, customer satisfaction, preventive care).
Phase 3: Apply for reimbursement under compulsory health insurance (OKP)
This is the gold standard of reimbursement: if your solution is approved under OKP, it becomes broadly accessible to the entire Swiss population.
✅ Advantages
- Maximum scalability
- Trusted legitimacy in the market
- Long-term commercial viability
⚠️ Challenges
- Long and demanding application process (≥ 1 year)
- Must meet strict WZW criteria (effectiveness, appropriateness, cost-efficiency)
- Requires inclusion in one of the official benefit catalogues (e.g. KLV Annexes, MiGeL, AL)
💡 Tip
Highlight how your solution supports the insurer’s strategic goals (e.g., cost savings, customer satisfaction, preventive care).
A proven startup path
From Carity to KSM-SOMNET or Akina Cloud (other successfully reimbursed startups) the most successful startups in Switzerland didn’t rush into OKP. They started lean, validated their models, and built momentum across the stages.
This approach reduces risk, maximizes learning—and earns you the trust of the healthcare ecosystem along the way.
In Switzerland, reimbursement decisions are not just about the product—they’re about trust. That trust is built through robust clinical evidence, demonstrated cost-effectiveness, and long-term relationships with key stakeholders. For startups, this means that success is rarely achieved alone.
🎯 Why evidence matters
Whether you’re applying for inclusion under OKP or negotiating with a supplementary insurer, your product needs to prove:
- That it works (effectiveness)
- That it is relevant in clinical workflows (appropriateness)
- That it is worth the cost (cost-effectiveness)
These are the WZW criteria, and they form the legal backbone of all OKP reimbursements. To meet them, startups must:
- Run clinical studies or real-world pilots in Switzerland or comparable health systems
- Use validated endpoints—standardized clinical measures (like PHQ-9 for depression or 6-minute walk test for cardio rehab)—that align with physician expectations and payer metrics
- Prepare a health economic analysis that quantifies potential savings or efficiency gains
⚠️ The FOPH increasingly expects startups to follow Health Technology Assessment (HTA) methodology, even for digital solutions.
🤝 Why relationships matter just as much
Evidence alone won’t get you there. The Swiss health system is relationship-driven, and startups need to proactively engage with:
- Health insurers (OKP and VVG): To co-design pilots, explore reimbursement pathways, and build trust through pilots
- Hospitals and care providers: To run studies, demonstrate integration into care workflows, and gain prescriber buy-in
- Research institutions: To validate efficacy and support your HTA file
- Support programs: Like the Future of Health Grant (FoHG), Innosuisse, or Swiss Healthcare Startups, which can open doors and provide guidance
🚀 Your action plan
- Run a pilot study as early as possible—even small-scale, if well-designed, it’s gold.
- Document outcomes and user experience (clinical, economic, human).
- Build your evidence pipeline aligned with WZW and HTA principles.
- Start conversations with insurers and care providers before you “feel ready.”
- Leverage platforms like FoHG, Innosuisse, or SHS to access expertise and funding.
No two startups take exactly the same road to reimbursement—but patterns emerge. Below, we explore the experiences of Carity, Ocumeda, and YLAH, three digital health ventures that worked closely with CSS and the Future of Health Grant. Their stories offer invaluable lessons for anyone looking to turn an idea into a reimbursed solution.
🧭 Three startups, three paths
| Startup | Focus | First CSS Contact | VVG Approval | OKP Status |
|---|---|---|---|---|
| Carity | Blended care for cardiac rehab (Class I → IIa) | Sep 2022 | Jun 2024 (effective 2025) |
In preparation |
| Ocumeda | Telemedical eye check-up (no certification needed) | Early 2022 | Mid 2023 | Not started |
| YLAH AG | Blended psychotherapy for depression (Class I) | Early 2024 | Aug 2024 (effective mid-2025) |
Planned for 2027–28 |
Carity
Ocumeda
YLAH AG
(effective mid-2025)
Each followed a similar phased approach:
- Early contact with CSS via the Future of Health Grant
- VVG reimbursement secured (or close to)
- OKP preparation as the long-term objective
💬 Voices from the field
Carity: design with reimbursement in mind
Carity built its regulatory and business model with reimbursement as a core objective from day one. Discussions with CSS began before their clinical trial even launched. Still, uncertainty was a major challenge:
“The hardest part was wondering if our documentation and economic evaluations were aligned with what CSS actually needed.”
— Aliaksei Tsitovich, Carity co-founder
Their advice? Integrate health economics early, and be ready to adapt your pitch and invoicing models to each insurer’s internal systems.
Ocumeda: fast traction, but opaque process
Ocumeda’s solution didn’t require medical device certification, which helped accelerate time to market. Through the Future of Health Grant, they secured reimbursement via CSS’s Gesundheitskonto—a flexible supplementary benefits model.
“Initially, we focused on building traction through a self-paid service only. Now we working to get coverage through supplementary insurances – CSS was of great help in that process. Yet for OKP, even today we’re still not 100% sure about the right path for us to get fully reimbursed”
— Dr. Benedikt Wiechers, Ocumeda co-founder
Despite these ambiguities, CSS’s backing helped boost their credibility across Switzerland, Germany, and Austria.
YLAH AG: early-stage, but structured
YLAH AG is still in the early stages, planning to submit its OKP reimbursement dossier end of 2025. Their solution was declared as a Class I medical device in June 2024. Their engagement with CSS was catalyzed via mentorship during the Future of Health Accelerator:
“CSS’s approval was a strong signal that helped us build trust with other insurers and partners.”
— Florence von Gunten, YLAH AG Founder and CEO
While still pre-reimbursement, YLAH AG is clear about what’s holding them back: until health professionals can bill for ylah®’s use, wide adoption will remain difficult.
🔍 Key takeaways
What works ✅
- Engaging insurers early and informally during product development
- Using VVG as a credibility booster toward OKP
- Building regulatory and economic readiness in parallel
- Leveraging pilot programs like FoHG for visibility and structure
What doesn’t ⚠️
Getting your digital health application reimbursed in Switzerland is rarely fast, never linear—but entirely feasible. If there’s one takeaway from those who’ve done it, it’s this: plan smart, start early, and don’t go it alone. Here are six final tips to help you move from uncertainty to reimbursement ready.
✅ 1. Adopt a phased approach
Start with what you control: self-pay or pilot projects. Use them to prove real-world value. Then move into VVG, and finally OKP once your product and evidence are mature.
Think of it as a staircase, not a jump.
💡 2. Anchor your strategy in clinical and economic evidence
Reimbursement isn’t just about health—it’s about costs. Invest early in:
- Clinical trials or real-world studies
- Health economics modeling
- Usability and integration feedback from providers
Good science builds trust. Good economics opens budgets.
🤝 3. Build your ecosystem
You won’t succeed alone. Create partnerships with:
- Insurers (we recommend CSS…)
- Hospitals and care networks
- Research institutions (e.g. universities of applied sciences)
- Support programs (Future of Health Grant, Innosuisse, Swiss Healthcare Startups,…)
Every ally adds momentum—and insight.
⏳ 4. Be ready for a marathon, not a sprint
Especially with OKP reimbursement, timelines are long (12–24 months minimum). Keep a parallel track running: commercial pilots, B2B deals, VVG discussions. This buys you time and keeps traction going.
📣 5. Educate and activate healthcare providers
Even the best digital solution won’t be used if doctors don’t see the point. Make it easy for them:
- Provide training or onboarding
- Show how your product fits into care routines
- Demonstrate value to their patients (and to their own workflows)
🧭 6. Stay agile, stay aligned
The Swiss system is evolving. Be ready to adapt—regulatory frameworks, payer strategies, and public attitudes toward digital health are all moving targets.
At each stage, ask yourself: “Does my strategy still fit the system—and do I have the right people at the table?”
✋ In Short:
- Start early
- Think in stages
- Build evidence
- Nurture partnerships
- Educate the ecosystem
- Keep adapting
Bringing a digital health solution to market in Switzerland is a challenge—but one worth taking. The landscape is opening up. Insurers are more curious. Clinicians are more open. Patients are ready.
Yes, the path to reimbursement is demanding—but you don’t have to walk it alone.
If you’re building something meaningful in digital health, now is the time to connect with programs designed to help you succeed:
- Future of Health Grant and its Pilot Factory offer direct access to insurers, experts, and healthcare partners who can help you validate and scale your solution through real-world pilots.
- Innosuisse supports startups with funding, coaching, and access to clinical research networks—especially helpful when preparing for OKP inclusion.
- And if you want to go deeper into the details, don’t miss the comprehensive guide: Remuneration of Digital Health Applications in Switzerland (2025)— A must-read if you’re serious about making your product reimbursable.
The opportunity is there. The tools are there. And the support is growing.
Your innovation could be what transforms care for thousands. Let’s make it happen—step by step.