Health insurance in Switzerland
Everyone living in Switzerland must have health and accident insurance. This basic insurance coverage is compulsory for everyone, regardless of their age, origin or residence status. After you have moved to Switzerland you get up to three months to obtain health insurance from the company of your choice. The same three-month period applies to new-born babies. Partners and children should be insured individually, as they are not necessarily covered by one person’s plan. You need a reliable provider and plan that comprehensively covers you and your family for any unforeseen health issues that come up.
There are more than 80 health insurance companies in Switzerland. Every health insurance company offers the same benefits in the basic health insurance policy. These are laid out by the Health Insurance Act (KVG).
Health insurance policies are administered by the canton in which the individual resides or works. There are usually two insurance providers (known as ‘sickness funds’) in each canton and approximately 80 in Switzerland in total. Sickness funds are not allowed to profit from the sale of national insurance scheme policies: they can however make a profit on supplemental/complimentary plans to cover expenses which are not met or not fully met through the national insurance scheme.
However several companies have different levels of service with many of them offering documents only in German, French and Italian. Researching policies and companies is very critical. However it is usually the case that you may spend hours researching different providers trying to find the right health insurance package, pick one which seems reasonably priced but still not understand what you are covered for.
Premiums vary from one insurer to another, and from one canton to another; the insurance company must offer exactly the same premiums for all its policyholders who are in the same age group and live in the same region, regardless of their gender or state of health. And in common with the rest of Europe, premiums tend to increase every year.
Accident insurance and Compulsory Health Insurance
Accident insurance covers emergency situations that occur unexpectedly as opposed to health insurance which covers illnesses, from colds to cancer.
In Switzerland all employees are automatically insured for work-related accidents. Anyone who is in employment for more than eight hours a week is also insured for non-work-related accidents. The accident insurance is paid by the employer. You don’t get a say in the provider of this accident insurance.
Accident insurance covers accidents both during and outside of working hours. The coverage includes reimbursement for care services, other accident-related expenses, and provides a daily allowance, if you are temporarily unable to work. The same insurance provides a pension, in case you are permanently incapacitated. If you decide to become self-employed, you can get accident insurance from your health insurance provider.
Deductibles and Excess for Swiss Medical Insurance
The policyholder must pay medical expenses up to at least CHF 300 per year for doctors, hospital and medicines for themselves. This contribution is termed as an ‘excess’ and is not applicable for children.
The insurance company will pay the amount of doctor’s bills that go beyond the excess. However, you are required to pay 10% of this amount as well. This amount is termed as the deductible and is limited to a maximum of CHF 700 per year for adults or CHF 350 per year for children.
Choosing an Expatriate Medical Insurance Provider
Choosing your Swiss health insurance provider depends on what you want out of your coverage, and how often you generally go to the doctor. If you rarely see a physician, and are not prone to frequent illness, you might consider a low cost insurance, with a high deductible. If you have a chronic illness, you might consider a plan that has a lower deductible. The health care options available to you in Switzerland are as laid out below. Depending on your choice of treatment you may choose a policy that covers you and your family.
▪ Standard Basic Health Insurance
Standard basic health insurance is the compulsory health insurance provided by all Swiss health insurance companies as laid out by Health Insurance Act (KVG). The benefits are identical irrespective of the health insurance company. It is possible to consult the doctor of your choice on this plan.
▪ The GP and HMO (Health Maintenance Organisation)
This type of treatment plan involves contacting your GP or HMO health center first when you fall ill. They will refer you to a specialist if necessary. This means you cannot choose a specialist for yourself. Your doctor will decide that for you. However, this option enables you to pay lower premiums.
This type of treatment plan involves use of the telephone advice line for medical consultations, so that you can pay lower premiums. With the TELMED model, you first need to ring a telephone counseling service before seeing a doctor for illness. The call center is run by medical professionals who will give you information and recommendations for your health condition. If necessary you will be referred to a doctor, a hospital or a therapist.
Compulsory basic health insurance includes Sickness Insurance, Maternity Insurance and Accident Insurance and pays for expenses such as:
- Hospital stay and outpatient care in any general ward of the canton of residency
- Nursing care, of up to 60 hours per week at home or in a nursing home
- Examination, treatment and nursing in a patient’s home by a physician or chiropractor
- Rehabilitation ordered by a physician, including health resorts
- Emergency treatment abroad
- Maternity costs, including 7 routine examinations, post-natal examination, childbirth and 3 breast-feeding consultations
- Serious and inevitable dental treatment
- Complementary medicines
Treatment must be administered in the individual’s canton of residency and only in a hospital which is accredited to receive reimbursement for providing ‘basic treatment.’
Students, Researchers, Interns and Au pairs
Some insurance providers cater specifically to students, researchers, interns, trainees and au pairs. The insurance is generally cost-efficient and meets the minimum legal requirements. To obtain such a policy individuals need to produce evidence of eligibility.
- Individuals drawing a pension exclusively in an EU or EFTA state
- People who are working in an EU or EFTA state
- Students and researchers who are temporarily resident in Switzerland — providing they have alternative and acceptable cover
Foreign civil servants, NGO staff and members of permanent missions who are based in Switzerland are only required to join the state health system after six months residency. Individuals living in a neighbouring country but working in Switzerland, can choose to take out insurance in Switzerland or in their country of residence.
In the event of an emergency if you call an ambulance the health insurance company only bears half the cost and up to CHF 500 per year.
Supplementary Insurance / Top-ups
In addition to the basic health insurance you can also take out optional supplementary insurance policies. The costs for these are over and above the usual cost for a basic health insurance.
For example, you can take out supplementary insurance or top-ups for instances such as orthodontics (corrective dentistry), spectacles, or for inpatient treatment in a semi-private or private ward, or for choice of doctor at the hospital. The more benefits in your insurance coverage, the more expensive your insurance premium becomes.
The benefits covered by supplementary policies vary from company to company. You are also not obliged to take out supplementary policies with the same insurance company that provides your basic health insurance.
If you are unhappy with your insurance provider or type of policy, for any reason other than a cost increase, there are specific dates when you can switch to a new provider or type of policy. This must be done usually in December or June and you are required to provide at least 3 months’ notice in writing prior to this date.
If you are unhappy with the increasing costs of your policy you can switch to a new provider or obtain a new policy in December or June by providing one month notice prior to this date.
Terminating Your Policy Upon Leaving Switzerland for Good
If you are planning to leave Switzerland you can terminate your insurance policy at any time of the year by providing proof of your deregistration (which you will be able to receive from your local Resident’s Office).
If you have just arrived in Switzerland or are not happy with your current health insurance arrangements we can help you find the best health insurance provider to suit your family’s and your needs. We are dedicated to providing expert advice with excellent customer service. We are able to provide all documents in the language of your choice i.e. English, German, French and Italian. Please send us your details and one of our health insurance experts will soon be in touch with you.
Utilising a combination of public, subsidised private and wholly private healthcare providers, the Swiss healthcare system aims to
- Provide substantial minimum benefits for all
- Foster competition between the insurers
- encourage citizens to be judicious in their use of healthcare facilities
There’s very little waiting for treatment in Switzerland and the quality of medical and nursing care – whether administered in hospital or at home – is second to none. Furthermore, the elderly, the infirm and those in ill-health, cannot be discriminated against, i.e. insurers are legally obliged to insure them and without any form of penalty.
Irrespective of their nationality, almost anyone and everyone who lives and/or works in Switzerland is required, by law, to establish and maintain a basic health insurance policy.