Health insurance: Benefits and treatments of basic insurance

Health insurance benefits under the Health Insurance Act (KVG) cover many areas such as treatment, hospitalisation, illness, maternity, accidents, medication, glasses and contact lenses, treatment abroad, transport, rescue, complementary medicine, vaccinations and dental treatment. Compulsory basic insurance provides coverage for necessary medical measures and treatments. A distinction is made between inpatient and outpatient treatment, while in the case of a hospital stay, medical services, treatment, medication and accommodation are covered. Basic insurance also covers treatment costs for illnesses and offers special benefits for maternity. Supplementary insurance can cover additional areas such as private hospitalisation, medication, glasses, and dental treatment.

health insurance benefits
08.09.2023  |  Reading time:  4  Minute

Health insurance benefits

The benefits provided by health insurance funds are laid down in the Health Insurance Act (KVG) and therefore the benefits are the same for every health insurance fund. You can receive benefits from health insurance companies in the event of an accident, illness or maternity. The compulsory basic health insurance only pays for treatments that really help, make sense and do not involve unnecessary expense. If the doctor carries out treatments that are not included in the health insurance benefits, he or she must inform the patient of this. Otherwise, the patient has to pay the bills himself.

The health insurance benefits are as listed below:

Benefits for treatments

The health insurance funds provide benefits for treatments. Treatments in medicine can be divided into two types: outpatient and inpatient. Outpatient treatment means that you can go home within 24 hours. Inpatient treatments mean that you stay overnight for further care.

Benefits during a hospital stay

The health insurance funds cover the costs during a hospital stay. The benefits include medical examinations, treatment, medication and accommodation in hospital. The compulsory basic insurance only covers costs in the general ward of the hospital. For additional hospital insurance, you must take out supplementary insurance such as Spital Halbprivat or Spital Privat.

Benefits in case of illness

Basic insurance covers the costs of treatment in the event of illness. An illness is a disorder or impairment of the physical, mental or psychological health of a person according to federal law.

Maternity benefits

For maternity benefits, the insured woman does not pay any cost sharing such as a deductible or excess. In addition, from the 13th week of pregnancy and until eight weeks after the birth, women no longer have to contribute to the costs of general medical services and nursing services in the event of illness. Find out about maternity benefits as early as possible.

Accident benefits

The health insurance funds provide benefits in the event of accidents. Insured persons do not have to include accident coverage with their health insurance if they work for an employer for more than 8 hours per week. See the article Accident coverage for more information.

Benefits for medicines

Basic health insurance covers the cost of prescription medicines that are on one of the following lists:

  • List of specialities (SL)
  • List of medicines with tariff (ALT)

For "non-payable medicines", you need supplementary insurance.

You can find out more about this in the article: Medicines.

Benefits for glasses and contact lenses

The basic insurance pays CHF 180 per year for glasses and contact lenses for children. Adults only receive benefits for glasses and contact lenses in the case of certain illnesses. You can find more information in the article Glasses and contact lenses.

Benefits abroad

The basic insurance only pays abroad in case of illness or emergency. If you are temporarily staying outside the EU, the EFTA area or the United Kingdom, the basic insurance covers emergency treatment (both illnesses and accidents) up to twice the costs that would be incurred for comparable treatment in Switzerland. In the case of hospitalisation, a maximum of 90% of the costs that would be incurred for similar treatment in Switzerland are reimbursed. The background to this is that the cantons cover at least 55% of the costs for hospital treatment in Switzerland, which is not the case for hospital stays abroad. Medical services provided abroad outside of emergencies are generally not covered by basic insurance.

Transport and rescue benefits

Basic insurance pays 50% up to CHF 500 per year for transport and 50% up to CHF 5000 per year for rescue in Switzerland. Supplementary insurance covers up to 100% of the costs incurred. You can find more information about transport and rescue in this article.

Benefits in complementary medicine

Services in complementary medicine (such as homeopathy, acupuncture, etc.) are usually not included in the scope of the Swiss basic insurance. However, some supplementary insurances might cover these types of treatments.

Benefits for vaccinations

Vaccinations recommended by the Federal Office of Public Health (FOPH) are covered by basic insurance. These may include, for example, vaccinations against measles, mumps and rubella (MMR), flu vaccinations for risk groups and travel vaccinations.

Benefits for dental treatment

  • Supplementary dental insurance

Basic insurance does not cover dental treatment. You must take out supplementary dental insurance for dental treatment. Supplementary dental insurance is particularly worthwhile for children.

  • Braces

Basic insurance only pays for braces in certain cases. Supplementary insurance can cover the costs of braces up to CHF 10,000.

  • Removal of wisdom teeth

Basic insurance only pays for wisdom teeth in certain cases.

Benefits for fitness and fitness membership

The basic insurance does not provide benefits for fitness and fitness subscriptions. You can take out supplementary insurance for fitness and fitness membership. For more information on the topic of fitness and fitness membership, see this article.

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