Swiss Health Insurance

Do I have to have insurance?

 

Yes. Health insurance is compulsory in Switzerland. 

 

You need health insurance:

 

  • if you are resident in Switzerland, irrespective of your nationality. All the members of your family, both adults and children, require insurance;
  • if you are a national of another country and have a Swiss residence permit valid for three months or longer;
  • if you are a national of another country, are working in Switzerland for less than three months and do not have comparable insurance cover from another country which is valid in Switzerland;
  • if you have come to Switzerland intending to take up residence;
  • if you are a Swiss national or a national of an EU/EFTA country, are working in Switzerland and are resident in a member state of the EU, in Iceland or in Norway. This also applies to any members of your family who are not employed;
  • if you are a Swiss national or a national of an EU/EFTA country whose only source of income is a Swiss pension and are resident in a member state of the EU, in Iceland or in Norway. This also applies to any members of your family who are not employed.

But there are certain exceptions?

 

You do not need health insurance if: 

 

 

  • you have health insurance in a member country of the EU, in Iceland or in Norway
  • you are a member of a diplomatic or consular mission or employed by an international organization (including your family) unless you wish to take out voluntary health insurance in Switzerland.

 

Is my health insurance policy also valid in other countries?

 

Yes:

 

  • in an emergency if you are temporarily in another country;
  • if you are insured in Switzerland and resident in an EU/EFTA country 
  • if your employer sends you to work in another country for a limited period
  • if you live abroad for an extended period in order to study or for other purposes. Please contact the canton in which you live for further information
 

Where can I obtain insurance?

 

Compulsory health insurance can be obtained from any branch of the approximately 80 health insurance funds operating in Switzerland. Not all of these health insurance funds are able to offer insurance to people who live in an EU country.

 

What services and benefits does my health insurance cover?

 

Services provided by a doctor:

 

Before a doctor examines or treats a patient, he/she should inform the patient whether the procedures that he/she is about to perform will be covered by the patient's compulsory health insurance. The health insurance fund will normally pay for all treatments carried out by a doctor.  In addition, your health insurance covers other services (physiotherapy, nursing care at home (SPITEX) or in a nursing home, nutritional advice, advice for diabetic patients, speech therapy, occupational therapy) provided by health care professionals at a doctor’s request. It also covers examinations (e.g. analyses, X­rays) requested by a doctor. Psychotherapy is covered subject to certain conditions. Please ask your doctor or health insurance fund for more information about the level of reimbursement provided by your insurance. You should also talk to your doctor or health insurance fund if you are in any doubt about whether your insurance covers a particular form of medical treatment. Basic insurance does not cover treatment methods whose efficacy or suitability is questionable or whose cost far exceeds any benefit that may be expected or will only cover them under certain conditions.

 

In hospital:

 

Basic health insurance covers stays in and treatment provided in general wards at hospitals on a special list kept by the canton in which you live. You will be required to pay any additional costs for treatment or stays in private or semi-private wards; however, you can obtain top-up insurance to cover such costs. 

Choice of hospital: The hospital list can be obtained from your health insurance fund or the Health Department of the canton in which you live. If it is imperative for you to receive hospital treatment outside the canton in which you live, e.g. in an emergency or because you require special treatment, your health insurance will also cover the costs as long as the hospital appears either on the list kept by the canton in which you live or the canton in which you are treated. If you wish to be treated at a hospital outside the canton in which you live, please contact your health insurance fund beforehand to find out which costs are covered by your basic insurance.

 

Medicines:

 

Your basic insurance covers the cost of all medicines which are prescribed by a doctor and which appear in the “List of pharmaceutical specialities”. Around 2400 medicines are currently covered by the compulsory health insurance system, and the list is constantly being revised in the light of medical progress. Pharmacists have been permitted to dispense generic products instead of proprietary medicines unless the doctor specifically prescribes a branded product. Generics are “copies” of branded products which are of the same quality but are considerably less expensive; they contain the same active ingredients.

 

Preventive healthcare:

 

Your basic insurance covers the cost of various procedures and examinations designed to protect your health (preventive healthcare), such as in particular:

 

Vaccinations as listed in the Swiss vaccination schedule issued by the Swiss Federal Office of Public Health like tetanus, diphtheria, whooping cough, rubella, measles, mumps, poliomyelitis, etc. For children and adolescents up to the age of 16 as well as for non immune adults. The vaccination against diphasic meningoencephalitis (FSME). The vaccination against human papilloma virus (HPV) for girls and young women aged between 11 and 19, if it is carried out under a cantonal vaccination programme. Vaccinations against influenza are covered for individuals over 65 years of age and for individuals suffering from serious medical conditions in which infection with influenza could have grave consequences. Your insurance does not cover special travel-related vaccinations or prophylactic medicines required for travel, such as yellow fever vaccinations or malaria prophylaxis.

 

Eight examinations to monitor the health and normal development of children of pre-school age.

Gynaecological screening examinations (including pap smears): once every three years if the two preceding annual check-ups were normal, otherwise as required.

 

Mammography to detect breast cancer: one examination per year if your mother, daughter or sister has or has had breast cancer. Otherwise once every two years for women from their 50th birthday, when the examination is carried out under a cantonal or regional screening programme that meets certain quality assurance requirements. At the moment, these programmes are operating only in the cantons of Bern (only the Bernese Jura region), Fribourg, Geneva, Jura, Neuchâtel, Ticino, Vaud and Valais (your doctor can give you more information about this).

 

Maternity:

 

Pregnancy: Your basic insurance covers the cost of seven outine antenatal examinations carried out by a doctor or a midwife and two ultrasound examinations (one between the 11th and 14th weeks of pregnancy and one between the 20th and 23rd weeks). In high-risk pregnancies your insurance will cover as many examinations and ultrasound examinations as necessary.

 

Your basic insurance pays CHF 100 towards the cost of group antenatal classes held by midwives.

Your basic insurance pays for the birth of your baby, as long as it is attended by a doctor or a midwife in a hospital, at home or at a birthing centre.

 

After the birth, your basic insurance covers one post-natal examination between the 6th and 10th weeks after the baby is born and up to three breast-feeding advice sessions provided by midwives or specially trained hospital staff.



Hospital care for your newborn baby:

 

The hospital and nursing costs incurred for a healthy newborn baby while its mother is still in hospital are part of the mother’s maternity benefits, i.e. they are covered by the mother’s health insurance (there is no cost-sharing ). However, if the baby is or becomes ill, the associated costs are covered by the baby’s insurance (with cost-sharing).

 

Physiotherapy:

 

Your basic insurance covers physiotherapy if it is prescribed by a doctor and carried out by a registered physiotherapist. Your doctor can prescribe up to 9 sessions, wherein the first treatment must be carried out within five weeks of the doctor’s order. If necessary, your doctor can write a prescription for the therapy to be continued. In contrast to physiotherapy, the cost of treatment provided by a chiropractor is covered even if it is not prescribed by a doctor.

 

Spectacles and contact lenses:

 

The compulsory health insurance programme covers spectacle lenses and contact lenses up to CHF 180 per year for children and adolescents up to the age of 18 (if prescribed by an opthalmologist in both cases); the maximum amount covered from the 19th birthday is CHF 180 every 5 years – the first time you obtain glasses or contact lenses you require a doctor’s prescription, on subsequent occasions an optician can carry out your eye test. For patients with very defective vision and for patients with certain medical conditions, the basic insurance programme covers a higher level of costs for spectacle lenses and contact lenses and for patients of all ages (your health insurance fund or ophthalmologist can provide more information about this). Like the other benefits provided by your health insurance, the patient is required to pay a contribution towards the cost of spectacle lenses and contact lenses.

 

Medical aids and devices:

 

Under certain circumstances your health insurance covers aids and appliances such as fixed dressings, inhalers and prosthetics which appear in the published list of aids and devices.

 

 

Dental treatment:

 

The compulsory health insurance programme only covers dental treatment for patients who develop a serious mouth or jaw disorder or in connection with a severe generalized disorder (e.g. leukaemia, heart-valve replacement) if this treatment is necessary to support and ensure he success of medical treatment being given, or if dental treatment is required after an accident and the patient has no other insurance that will cover the costs. The insurance does not cover the cost of conventional fillings in decayed teeth or the correction of misaligned teeth (braces for children). 

 

Accident:

 

If you work at least 8 hours per week, you are insured through your employer against work-related and non-work-related accidents under the Accident Insurance Law. If you have an accident, this insurance will provide benefits.

If you do not have compulsory accident insurance, you will need to take out accident insurance with the company that provides your health insurance. This will increase your insurance premium slightly. If you have an accident, your health insurance must then provide the same benefits as it would if you were ill.

 

Spa treatments:

 

Your health insurance fund pays CHF 10 per day (for up to 21 days per year) if the spa treatment is prescribed by a doctor and is carried out at a registered medicinal spa centre (ask your health insurance fund for more information). Additional costs for medical treatment, physiotherapy or medication, for example, are reimbursed separately.

 

Nursing care at home (Spitex) or in a nursing home:

 

If you need nursing care at home or in a nursing home after an operation or because of a medical condition, your basic health insurance covers the cost of this care as long as it is requested by a doctor (e.g. injections, changing dressings). However, the basic insurance does not cover the cost of home helps (who cook, clean or shop for you, for example), nor does it cover board and accommodation in a nursing home; these costs are the responsibility of the insured person.  Pensioners on a low income can apply for supplementary benefits.

 

 

Necessary treatment in an EU/EFTA country:

 

If you are temporarily in an EU/EFTA country, e.g. on holiday, you can obtain benefits from the health insurance system in that country if your medical condition makes this necessary. In order to obtain such benefits, you must show your European insurance card issued from your health insurance fund to the person providing the benefits (doctor) or the local health insurance fund in the EU/EFTA country where you receive treatment. The person requiring treatment will receive the same treatment from doctors and hospitals in that country as people who are insured there.

 

 

Depending on the country, the treatment costs will either be paid by the local organization and then invoiced to your health insurer in Switzerland for reimbursement, or you will be asked to pay for the treatment and can later request reimbursement from your health insurance fund.

 

 

Emergency treatment in a country outside the EU/EFTA:

 

If you require emergency treatment in a country that is not a member of the EU or EFTA, for example if you become ill while on holiday, your health insurance fund will cover costs up to twice the amount that the same treatment would have cost in Switzerland. Additional travel insurance may be necessary for certain countries (e.g. the USA) in which treatment and medical transport are more expensive. Ask your health insurance fund for more details.

 

 

Medical transport and rescue:

 

Special transport may be needed to take you for treatment (e.g. an ambulance). Your basic health insurance covers half the cost of this kind of transport up to a maximum amount of CHF 500 per year. This also applies to medical transport in other countries. 

 

Basic health insurance also covers half the cost of rescuing you if you are in mortal danger (e.g. after a mountaineering accident or a heart attack) up to an annual maximum amount of CHF 5,000 (applies only in Switzerland).

 

Premiums

 

Each person pays his or her own premium, known as a “capitation premium”. The health insurance funds offer reduced premiums for children and adolescents (from 0 to 18 years) and young adults (19 to 25). The premiums are not dependent on a person’s income, but they do vary from one health insurance fund to another, from canton to canton, and from country to country for people living in an EU country, in Iceland or in Norway. The health insurance funds can employ a maximum of three regional premium levels within a single canton or a single EU/EFTA country. All insurance providers are bound by the standardized definition of cantonal premium regions determined by the Swiss Federal Office of Public Health.  Individuals on a low income are entitled to reduced health insurance premiums.

 

Cost-sharing

 

A proportion of treatment costs is paid by the policy-holder. This proportion consists of:

 

a standard deductible of CHF 300 per year; children and adolescents up to18 years of age do not pay a standard deductible;

 

a retention fee of 10 percent of the remaining invoiced amount up to a maximum of CHF 700 per year (CHF 350 for children and adolescents). Exception (medicines): the retention fee is 20 % for proprietary medicines if an interchangeable generic exists. Your doctor or pharmacist can inform you on this matter. 

 

The standard direct contribution to costs is therefore a maximum of CHF 1,000 per year for adults and CHF 350 for children and adolescents.

 

Example

 

The cost of the treatment you receive in the course of a year (doctor, hospital, etc.) is CHF 2,000 in total. You pay a deductible of CHF 300 and 10 percent of the remaining amount, i.e. a total of CHF 470 (CHF 300 + 10% of CHF 1,700 = CHF 470). Your health insurance covers the remaining CHF 1,530.

 

Maternity

 

You are not required to pay a direct contribution to the cost of benefits associated with a normal pregnancy. However, the Swiss Insurance Court has decided that the standard level of cost-sharing applies to benefits required because of medical conditions related to pregnancy or conditions not related to pregnancy.

 

Mammography

 

No deductible is payable for mammography carried out for the early detection of breast cancer as part of a cantonal or regional programme. Ask your doctor or health insurance fund for more details.

 

Hospital stays

 

Individuals who do not live in a household with another member of their family for whom they have an obligation to pay maintenance or for assistance, also pay CHF 10 per day during a stay in hospital.

 

Important: Benefits provided in an EU country, in Iceland or in Norway are subject to the cost-sharing regulations in effect in those countries.

 

 

How can I save on insurance premiums?

 

 

Compare health insurance funds

 

You will not incur any penalty if you change from one health insurance fund to another that is better suited to your needs. The range of benefits provided under the compulsory health insurance programme is the same everywhere; the only difference between the health insurance funds is the level of service they provide. Some are faster at reimbursing costs, for example, or provide more comprehensive advice. All health insurance funds are obliged to accept you as a member.

 

 

Important: Some health insurance providers add an administration surcharge to top-up insurance policies if basic health insurance is provided by a different company (ask your health insurance fund). However, this surcharge must not be more than 50 percent of the gross premium charged for the top-up insurance policy.

 

Overview of premiums

 

Every October the SFOPH publishes a list of the premiums for basic health insurance in each of the cantons, for the EU countries and for Iceland and Norway. The list is available to everybody and can be obtained free of charge from the SFOPH or downloaded from the Internet.

 

 

Cancellation periods 
 

If you have a basic insurance policy with the standard deductible of CHF 300, you can cancel this policy with three months’ notice at the end of June or December in any year. This means that your notice of cancellation must reach your health insurance fund by 31 March or 30 September in order to be effective.

 

If you have a health insurance policy with a higher deductible or with a restricted choice of doctors/hospitals, you can only cancel it at the end of the year, usually with three months’ notice, i.e. your notice of cancellation must reach the health insurance fund by 30 September to be effective. 

 

 

If your health insurance fund notifies you a new premium, you can change to another insurance provider by giving just one month’s notice to the end of the month preceding the month in which the new premium will start. This applies no matter whether the new premium approved by the SFOPH has been increased or whether you have an insurance policy with an HMO/general practitioner model, model with prior telephonic advice or an optional deductible. Your health insurance provider must inform you of the new premium at least two months in advance. The health insurance provider is also required to inform you of your cancellation rights when notifying you of the new premium.

 

 

You can only change to a different deductible rate or to a different form of insurance (HMO/general practicioner model, model with prior telephonic advice)at the start of the year.

 

Example:

 

If you want to change your basic health insurance to a different insurance provider from 1 January, you can give your notice of cancellation to your existing insurance provider by 30 November irrespective of whether the insurer has increased your premium or whether you have an insurance policy with an HMO/general practitioner model, model with prior telephonic advice or an optional deductible rate. The decisive factor is that your health insurance provider must have informed you by 31 October that a new premium approved by the SFOPH will be coming into effect. 

 

Important: Make sure you cancel your existing insurance in good time. Your insurance provider must receive your notice of cancellation before the cancellation period expires. Complete all the necessary paperwork before you join the new health insurance fund. Your insurance will not be transferred until the month in which the new insurer informs the previous insurer that the continuity of your insurance cover will not be interrupted. Without this information, the change will not be effective.

 

Take a critical look at top-up insurance.

 

The basic health insurance programme ensures comprehensive, high-quality medical care for everyone. Look carefully at what top-up insurance offers compared with the benefits to which you are automatically entitled under the basic insurance programme.

 

Choose a special form of insurance

 

If you choose one of the following special forms of insurance your premium will be lower.

 

Restricted choice of doctors and hospitals

 

You can save up to 20 percent by opting for HMO (Health Maintenance Organization)  insurance or a general practitioner model. In return, you give up the right to choose your doctors and hospitals freely and receive treatment at an HMO centre (e.g. a group practice). In the general practitioner model you undertake always to consult your GP first; he or she will then decide whether you need treatment from a specialist. This restriction does not apply in an emergency. Look at the insurance conditions for more information.  The discounts are granted on the premium for standard insurance with accident cover. If you combine this form of insurance with an optional deductible rate, you may not be able to take full advantage of these discounts because of the regulations governing the minimum premium.

 

Choose a higher deductible rate

 

The health insurance fund will offer you a lower premium if you raise the deductible rate, i.e. the fixed annual sum that you pay towards the cost of your treatment, above the compulsory minimum level of CHF 300. The size of the discount is determined by the deductible rate. The optional deductible can only be increased with effect from 1 January in any year and remains in effect for at least one year. The discount depends on the deductible rate, but the maximum discount is regulated by law. The optional deductible rates for adults are CHF 500, 1,000, 1,500, 2,000 and 2,500; for children they are CHF 100, 200, 300, 400, 500 and 600. The health insurance funds are not obliged to offer all deductible rates. They may offer different deductibles for adults and young adults (from the 18th birthday to the 25th birthday). Premium discounts for optional deductibles: The health insurance fund must charge a minimum premium of 50 percent of thestandard premium with accident insurance cover applicable to the age group and premium region of the individual in question. The premium must not be less than this amount, not even if the insurance does not provide accident cover or is combined with a policy that restricts the individual’s choice of service provider.

 

In addition, the discount must not exceed 70 percent of the additional risk accepted by the insuredindividual. The corresponding amounts (in CHF) are shown in the table below. The first line shows the deductible; the second line shows the maximum annual discount. However, the maximum discount can only be offered if the resulting premium is at least equal to the minimum statutory premium.

 

Further forms of insurance 

 

Several insurance providers offer new forms of insurance (e.g. model with prior telephonic advice or combined insurance models). Ask your health insurance provider for further details.

 

Join a bonus insurance programme Your premium is reduced gradually for every year that you do not submit any invoices to the health insurance fund for reimbursement. The starting premium is 10 percent higher than the standard premium. It can then fall to 50 percent of the starting premium within 5 years. 

 

Important: The special forms of insurance are not available to individuals resident in an EU country, in Iceland or in Norway.

 

Exclude accident insurance cover

 

... if you work at least 8 hours per week; in this case you are covered against work­related and non-work-related accidents through your employer under the Accident Insurance Law.