Basic insurance benefits - overview of benefits

Basic insurance in Switzerland, also known as compulsory health insurance (OKP), forms the backbone of the Swiss healthcare system. Basic insurance ensures that all residents have access to necessary medical benefits. In this blog, we take a detailed look at the various services covered by basic insurance.

Basic insurance benefits
23.05.2024  |  Reading time: 0 Minute

What does basic insurance cover?

Basic insurance covers the costs of a wide range of medical services required for the diagnosis and treatment of illnesses and injuries. These include

  1. General practitioner visits: Consultations with general practitioners and internists.
  2. Specialist visits: Referrals to specialists such as cardiologists, dermatologists and orthopaedists.
  3. Medication: Prescription medication that is on the list of compulsory health insurance (LOK).
  4. Lab tests: Blood tests, urine tests and other diagnostic tests.
  5. Vaccinations: Recommended and mandatory vaccinations.

What benefits are included in basic insurance?

The benefits of basic insurance are set out in the Health Insurance Act (KVG). Basic insurance therefore offers the same benefits with every health insurance company.

The benefits of basic insurance are listed below:

Requirements for cost coverage by basic insurance

The requirements for cost coverage by basic insurance are listed below:

  1. Insurance status: The patient must be insured with a recognised health insurance company.
  2. Medical necessity: The treatment must be medically necessary and appropriate. This means that it is necessary for the diagnosis or treatment of an illness or injury.
  3. Doctor's prescription: The services must be prescribed by a doctor. This includes physiotherapeutic measures, psychotherapies and medical aids.
  4. Recognition and authorisation: The service providers (e.g. doctors, hospitals) must be recognised and authorised by the health insurance company.

Differences in basic insurance benefits depending on the canton

Basic insurance in Switzerland is regulated nationwide, meaning that the basic services it covers are the same in all cantons. Although basic insurance is largely uniformly regulated in Switzerland, there are cantonal differences with regard to hospital lists, access to specialists, regional prevention programmes and administrative processes. These differences can have an impact on the actual utilisation and availability of services.

Which benefits are not included in basic insurance?

The benefits that are not included in basic insurance are listed below:

1. Dental treatments

  • Routine dental treatments: Regular dental check-ups, dental cleanings, fillings and root canal treatments.
  • Orthodontics: Braces and other orthodontic treatments for children and adults.
  • Dental prostheses: crowns, bridges, implants and dentures.

2. Alternative and complementary medicine

  • Alternative healing methods: homeopathy, acupuncture, osteopathy and other alternative treatment methods, unless they are covered by supplementary insurance.
  • Non-recognised therapies: Experimental treatments and therapies that are not scientifically recognised.

3. Cosmetic treatments

  • Plastic surgery: Aesthetic procedures such as facelifts, breast augmentation and liposuction that are not medically necessary.
  • Cosmetic dermatology: Treatments to improve the external appearance, such as laser therapies to remove age spots or wrinkles.

4. Certain medications and treatments

  • Non-prescription medicines: Over-the-counter medicines and dietary supplements.
  • Non-listed medicines: Medicines that are not on the list of compulsory health insurance (LOK).
  • New and expensive treatment methods: Treatments and medicines that are not yet recognised as mandatory benefits.

5. Visual aids

  • Glasses and contact lenses: Costs for glasses and contact lenses, with a few exceptions for children and in special medical cases.
  • Laser eye surgery: Laser treatments to correct visual defects.

6. Care services and long-term care

  • Non-medical care: Long-term care and support at home or in care homes that is not medically necessary.
  • Care for the elderly: Costs for care and support for elderly people in care homes.

7. Health and wellness services

  • Fitness and wellness: Gym memberships, wellness and spa treatments.
  • Nutritional advice: Non-medically prescribed nutritional advice and diet programmes.

8. Travel vaccinations and special preventive measures

  • Travel vaccinations: Vaccinations that are required for travelling to certain countries are generally not covered.
  • Special medical check-ups: Medical check-ups that are not part of compulsory care.

9. Transport costs

  • Non-medically necessary transport: Costs for transport that is not classified as medically necessary, such as non-urgent ambulance or transport costs for private convenience.

What types of treatment are covered by basic insurance?

Basic insurance covers the following types of treatment:

1. General medical care

  • General practitioner visits: Consultations with general practitioners and internists.
  • Specialist visits: referrals to specialists such as cardiologists, dermatologists, orthopaedists, etc.
  • Medication: Prescription medication that is on the list of compulsory health insurance (LOK).
  • Lab tests: Blood tests, urine tests and other diagnostic tests.
  • Vaccinations: Recommended and mandatory vaccinations.
  • Preventive check-ups: Regular health check-ups and early detection examinations.

2. Inpatient treatments

  • Hospitalisation: Costs for accommodation and meals in a shared room in the general ward.
  • Operations: Necessary surgical procedures and post-operative care.
  • Rehabilitation measures: Aftercare and rehabilitation programmes following operations and serious illnesses.

3. Pregnancy and birth

  • Pregnancy care: Regular examinations during pregnancy.
  • Birth preparation: Birth preparation courses.
  • Delivery: Costs for the birth in a hospital or birthing centre.
  • Follow-up care: Follow-up examinations for mother and child.

4. Psychiatric and psychological care

  • Psychiatric treatments: Treatments for mental illnesses.
  • Psychotherapy: Outpatient and inpatient psychotherapy if prescribed by a doctor.

5 Therapeutic measures

  • Physiotherapy: Physiotherapy treatments if prescribed by a doctor.
  • Ergotherapy: Occupational therapy treatments if required.
  • Logotherapy: Speech therapy, if prescribed by a doctor.

6. Emergency care and transport

  • Emergency treatment: Acute care in hospital emergency departments.
  • Rescue services: Costs for transport by ambulance or helicopter in life-threatening situations.
  • Ambulance services: Medically necessary transport.

7. Aids and devices

  • Medical aids: Wheelchairs, walking aids, hearing aids and other necessary aids prescribed by a doctor.
  • Prostheses and orthoses: Artificial limbs and other orthopaedic aids.

8. Special treatments

  • Dialysis: Renal replacement therapy for kidney failure.
  • Oncology: Treatments for cancer, including chemotherapy and radiotherapy.
  • Cardiology: Treatments for cardiovascular diseases, including heart surgery.
  • Diabetes management: Training and care for diabetics, including insulin pumps.

9. Paediatrics and adolescent medicine

  • Paediatrician visits: Regular check-ups and treatments.
  • Vaccinations and prevention: Vaccinations and preventive measures for children and adolescents.

10. Geriatric care

  • Age medicine: Treatments specifically aimed at older people, including geriatric rehabilitation programmes.
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