Basic health insurance

Compulsory insurance in Switzerland

Basic health insurance is compulsory in Switzerland. This compulsory insurance applies to all persons who reside in Switzerland or who work in Switzerland. Special provisions apply to persons who work in Switzerland but reside abroad.

Cost sharing

The amount of the monthly premiums for basic health insurance depends on the health insurance company, deductible, insurance model, and the place of residence and age of the insured person. Persons living in modest financial circumstances can apply to the canton for a premium reduction. With a premium reduction, the canton contributes to the high insurance costs.

In addition to the premiums, the insured person must also contribute to the costs incurred by means of an excess, a deductible and a hospital contribution:

Excess

As soon as the treatment costs exceed the amount of the selected annual deductible, an excess of about 10%, up to a maximum of CHF 700 for adults and CHF 350 for children per year, becomes payable.

Deductible

In addition to the monthly premiums, you are required to contribute to the costs of hospital stays, doctor’s bills and medication with a deductible. Only if the costs exceed the deductible will the benefits be covered by the health insurance company (minus the excess).

The amount of the deductible can be freely chosen:

Children CHF 0 to CHF 600

Adults CHF 300 to CHF 2,500

The higher the chosen deductible, the lower the monthly premiums for basic health insurance.

Hospital contribution

In addition to the deductible and the excess, cost sharing in the form of a daily hospital contribution is payable in the case of hospital stays. Children, young adults in education and women during and immediately after pregnancy do not have to pay a daily hospital contribution.

Basic health insurance models

The choice of insurance model directly influences the amount of the monthly premium. Voluntary restrictions in the form of an insurance model can save additional premiums for compulsory health insurance.

The following insurance models exist for basic health insurance:

 

Standard

The standard model is the classic insurance model and is offered by all health insurance companies for basic insurance. The standard model offers a free choice of doctor and hospital throughout Switzerland.

• Advantage: A specialist can be visited without consultation with the insurance company and without restrictions.
• Disadvantage: This is the most expensive insurance model.

HMO

The HMO model is an association of doctors and specialists (group practice). HMO stands for health maintenance organisation. With the HMO model, doctors who work in an HMO practice must always be consulted first.

• Advantage: Compared to the standard model, premiums are 15% to 20% lower.
• Disadvantage: Not many health insurance companies offer this model for basic health insurance. HMO practices are scarcely available in rural areas, for example.

General practitioner (GP)

In the GP model, your GP must always be consulted first in the event of illness. The GP alone decides whether to refer you to a specialist.

• Advantage: Lower premiums than with the standard model.
• Disadvantage: You are dependent on your GP. There is no free choice of doctor.

Telmed

With the Telmed model, you are obliged to contact a consultation hotline in the event of illness. The consultation hotline then decides on the further course of action and whether a personal consultation or a referral to a doctor or specialist is appropriate. The Telmed insurance model is ideal for young and healthy adults.

• Advantage: Premiums are 14% to 25% lower than with the standard model.
• Disadvantage: Remote diagnosis may be incorrect and inaccurate. With some Telmed models, the choice of doctor is also restricted.

Cancellation and change

As long as you reside in Switzerland, you can only cancel your basic health insurance if you change to another insurance company. When changing, you must always observe the notice periods.

The following conditions must be met for a change:

• If you change your compulsory health insurance with effect from 1 January 2021, your notice of termination must reach your current health insurance company by 30 November 2020 at the latest. It is advisable to send the notice of termination by registered post as early as mid-November.
• At the same time as giving notice, you must register with the new health insurance company. CAUTION: The termination will only be accepted by the previous health insurance company if a confirmation of registration has also been received from the new one.
• If you have not settled all your debts with your previous health insurance company, you will not be able to change despite having given notice of termination in due time.

Benefits under basic health insurance

Compulsory health insurance in Switzerland generally covers the costs (minus cost sharing) incurred for examinations, diagnosis and (follow-up) treatment. The Federal Health Insurance Act (KVG) clearly defines the benefits covered by basic health insurance.

Treatment by a doctor

Basic health insurance covers all treatment provided by a doctor. However, the doctor must always inform the patient whether or not the service can be covered by basic health insurance. Basic insurance also covers therapies or care prescribed by a doctor, such as physiotherapy, home care, spa treatments, nutritional counselling, occupational therapy, speech therapy and, subject to certain restrictions, psychotherapy.

Alternative healing methods

Various alternative healing methods such as homoeopathy and traditional medicine can only be covered by basic health insurance if the complementary medical service is provided by a doctor with appropriate training.

Hospital stays

Outpatient, inpatient and emergency hospital stays in the general ward are covered by basic health insurance.

Nursing care

Costs for nursing care (e.g. home care) are only covered by basic health insurance if ordered by a doctor.

Preventive health measures

The following preventive measures are included in basic health insurance benefits:

• Vaccinations: The Swiss Vaccination Schedule from the Federal Office of Public Health is authoritative. Prophylactic travel vaccines are excluded
• Health and development check-ups for children of pre-school age
• Preliminary gynaecological examinations
• Examinations to detect breast cancer (mammography)
• Preventive examinations for colon cancer

Pregnancy and maternity

Basic health insurance covers the following maternity benefits:

Pregnancy:

• Seven routine examinations
• Two ultrasound examinations (in the case of high-risk pregnancies, the number of examinations is not limited)
• Test for trisomy 13, 18, 21
• Birth preparation course (cost sharing by health insurance is CHF 150)

Birth:

• Delivery in hospital or at home

After birth:

• One follow-up check-up between the 6th and 10th week
• Up to three breastfeeding consultations
• Postnatal care by a midwife or nurse if there were difficulties during the delivery

Visual aid (glasses/contact lenses)

Children and adolescents up to the age of 18 receive a maximum amount of CHF 180 per year for eyeglass lenses and contact lenses. A medical prescription is required.

Dental treatment

Costs for dental treatment of any kind, such as emergency treatment, braces, check-ups or corrections, are not covered by basic health insurance. Only in the case of serious illnesses (cancer/serious accidents) are the costs covered by basic health insurance if no other insurance is available. Voluntary dental insurance can effectively close the coverage gap.

Transport/rescue

If it can be proven that an ambulance is needed for transport, basic health insurance will contribute half of the transport costs up to a maximum amount of CHF 500 per year. In the case of mountain rescue, half of the costs are covered up to a maximum of CHF 5,000, but only if the person’s life is in danger. Cost sharing for rescue transport is limited to Switzerland.

Treatment abroad

Treatment in EU/EFTA countries is covered by basic health insurance if the treatment is medically necessary. Medical necessity may have to be proven. Outside the EU/EFTA, basic health insurance only covers costs in absolute emergencies. In addition, hospital stays are reimbursed at a maximum of 90% – if at all. Additional cover in the form of travel insurance or supplementary insurance is strongly recommended for stays abroad.