Health Insurance in Switzerland - Detailed explanation

What is a health insurance?

Health insurance is an essential part of the healthcare system in Switzerland and is required by law, which means that all residents are obliged to take out health insurance. Health insurance, also known as compulsory health insurance (OKP), is designed to ensure that everyone has access to basic medical services and is protected against financial risks arising from medical costs.

What does health insurance cover?

Health insurance covers a wide range of standard treatments, including visits to the doctor, hospitalisation, certain medications and diagnostics. All health insurances must accept every applicant for basic insurance, regardless of age or state of health, and the benefits are defined by law and are the same for all health insurances.

What are the features of health insurance?

The features of the health insurance are as listed below:

• Premiums: The health insurance has a premium that insured persons must pay regularly (e.g. monthly or annually) to maintain their insurance cover. The amount of the premium varies depending on the health insurance, age and place of residence.
• Deductible: The health insurance has a deductible, which is the amount that the insured person must pay before the insurance covers medical costs. Health insurance offer a choice of deductibles ranging from CHF 300 to CHF 2500 for adults.
• Health insurance model: The health insurance offers 4 models that allow policyholders to organise their insurance cover according to their needs and preferences. The health insurances offer health insurance models such as the standard model, family doctor model, HMO model and the Telmed model.
• Accident insurance: Health insurance offer accident insurance as part of the compulsory basic insurance to ensure that children, housewives, pensioners and the self-employed have accident cover through their health insurance. With accident insurance, the health insurance ensures that all residents of Switzerland, regardless of their employment status, have basic protection in the event of an accident.

Who can take out health insurance in Switzerland?

Anyone who is resident in Switzerland can take out health insurance. Here are the specific groups that must or can take out health insurance.

• Swiss citizens
• Foreign nationals
• Newborns
• Persons without gainful employment
• Employed persons

Can the health insurances accept the family members?

Yes, family members can be included in the health insurance, but in Switzerland each family member must be insured individually. The health insurances require that a separate policy must be taken out for each family member. The health insurance can create a standardised policy for families as family health insurance. Here are the steps and information on how health insurances can cover family members:

• Newborns: The health insurance must be informed by the parents of the registration of the newborn within 3 months of the birth of a child. The health insurances have no waiting periods or risk assessments for prenatal registration.
• Spouses: It is necessary for spouses to take out their own insurance with a health insurance of their choice, as joint policies are not offered. Spouses are free to choose any health insurance.
• Children: Children must also be insured with a health insurance, with health insurances offering parents different providers and policies to provide cover that meets the family's needs and budget.
  Students and young adults: Students and young adults who are still in education and may be living with their parents must be listed by health insurances as individual policyholders.

How do health insurances set their premiums?

Health insurances set their premiums based on various factors, including the risk profile of the insured person, the cost of medical services and administrative expenses as well as legal requirements. Health insurances calculate health insurance premiums according to the insured person's age, place of residence, deductible and chosen insurance model. In addition, health insurances take into account expectations of future healthcare expenditure and the need to build up financial reserves in order to calculate premiums.

What strategies do health insurances use to reduce premiums for their policyholders?

Health insurances in Switzerland offer several strategies that individuals can use to reduce their premiums. Here are some effective methods.

• Choosing the deductible: The offer of a higher deductible by health insurances usually results in lower monthly premiums for the insured. For people in good health who rarely need medical services, choosing a higher health insurance deductible can be advantageous.
• Choosing an insurance model: Health insurances enable their policyholders to save on health insurance premiums by offering alternative models such as the family doctor model, HMO model or Telmed model. In these models, the health insurances oblige policyholders to consult a specific provider or contact centre first if they have a health problem.
• Health insurance comparison: Health insurances have different premiums despite the statutory basic insurance benefits. The health insurances enable insured persons to find a more favourable premium by comparing health insurances.
• Review supplementary insurance policies: Health insurances recommend that policyholders review the supplementary insurance policies they have taken out to determine whether all the benefits included are actually required. It can happen that supplementary insurance policies contain components that are not absolutely necessary for the insured person.
• Annual payment method: Some health insurances offer a discount if the premium is paid annually instead of monthly.
• Premium reduction: Depending on the income and assets of the insured person, health insurances can offer premium reductions in cooperation with the local authorities. Insured persons are therefore encouraged to enquire with their local authority about possible support programmes.
• Family discounts: Some health insurances offer discounts for families or for insuring children. It is worth considering such discounts when choosing a health insurance.

Why is health insurance important in Switzerland?

Health insurance in Switzerland is important for several reasons.

• Legal obligation: In Switzerland, it is a legal requirement that every person resident in the country has health insurance. This ensures that everyone has access to necessary medical care, regardless of their income or state of health.
• Access to medical care: With health insurance, people in Switzerland have access to high-quality medical care. This includes visits to the doctor, hospitalisation, medication, therapeutic services and much more. Without health insurance, the cost of such services would be prohibitively high.
• Financial protection: Health insurance protects against financially burdensome expenses in the event of illness. Medical treatment can be very expensive, and without insurance many people would not be able to afford necessary treatment, which could lead to deteriorating health and potentially long-term financial difficulties.
• Prevention and early detection: Health insurances often also cover preventive measures such as vaccinations and regular check-ups in Switzerland. These preventive measures contribute to the early detection and treatment of illnesses before they become more serious and expensive to treat.
• Solidarity: The Swiss healthcare system is based on the principle of solidarity. Young and healthy people pay into the same system as older and possibly sicker people. This principle ensures that everyone receives medical services regardless of age and state of health.
• Quality assurance: The health insurance fund also contributes to quality assurance and improvement in the healthcare system in Switzerland. As the health insurances demand certain quality standards, this contributes to the general improvement of medical care.
• Psychological aspect: Having health insurance can also provide psychological reassurance, as you know that in the event of illness or an accident, the financial burden will be alleviated and you will have access to the medical help you need.

Is health insurance compulsory in Switzerland?

Yes, health insurance is compulsory in Switzerland. Every person living in Switzerland must register with a health insurance for basic health insurance within a certain period of time, usually within three months of taking up residence in the country. This obligation applies to all residents regardless of age, gender or state of health.

What should I bear in mind when choosing a health insurance?

When choosing a health insurance in Switzerland, you should consider various aspects to ensure that you receive the right insurance cover for your needs and circumstances. Here are some important factors you should consider.

• Insurance model: Check the different models available, such as the standard model, family doctor model, HMO model or Telmed model. Each model has its own advantages, restrictions and premium structures.
• Deductible: The amount of the deductible directly influences your premiums. A higher deductible leads to lower monthly premiums, but also means that you have to pay more out of your own pocket in the event of illness before the insurance takes effect.
• Premium amount: Compare the premiums of different providers, taking into account your chosen model and franchise. Use online comparison portals to find the best offers.
• Catalogue of benefits: Make sure you understand what medical services are covered and whether they meet your needs.
• Health insurance ratings and service quality: Find out about the service quality and customer satisfaction of various health insurances. Ratings and testimonials from other policyholders can be helpful.
• Supplementary insurance: Consider whether you need supplementary insurance that goes beyond basic insurance, e.g. for alternative medicine, dental treatment or better accommodation in hospital.
• Free choice of doctor: If the free choice of doctor or hospital is particularly important to you, you should take this into account when choosing your insurance model.
• Geographical cover: Check whether the insurance also covers benefits abroad if you are a frequent traveller or plan to spend time abroad.
• Deductible and cost sharing: Understand the rules regarding deductibles and cost sharing that may apply in addition to the deductible.
• Switching options: Remember that you have the option of switching health insurers once a year. Check the cancellation periods and conditions.

What benefits do health insurances in Switzerland offer their policyholders?

Health insurances offer their policyholders a wide range of health insurance benefits as part of compulsory basic insurance and these are listed below.

• Medical treatment: The health insurance fund covers the costs of treatment by authorised doctors both on an outpatient basis and in hospital.
• Hospitalisation: The health insurance fund covers the costs of a stay in the general ward of a hospital in your canton of residence. If you opt for treatment in another canton or for a higher ward (semi-private or private), additional costs may be incurred that are not fully covered.
• Medication: Prescription medication on the so-called speciality list is paid for by the health insurance.
• Pregnancy and birth: Health insurance covers examinations during pregnancy, birth costs and examinations of the newborn.
• Physiotherapy and occupational therapy: The health insurance fund covers certain physiotherapy and occupational therapy services, provided they are prescribed by a doctor.
• Psychotherapy: The health insurance covers psychotherapeutic treatments if they are carried out or delegated and supervised by a doctor.
• Preventive measures: The health insurance fund covers certain preventive check-ups and vaccinations.
• Assistive products: Certain medical aids that are prescribed by a doctor are also covered by health insurance.
• Emergency treatment: Necessary medical treatment abroad is covered by health insurance to a certain extent, but it is advisable to take out additional travel insurance for this.

What services are covered by health insurance during labour and childbirth?

In Switzerland, compulsory health insurance covers various benefits in the area of maternity and during the postnatal period. These benefits are designed to support the health of mother and child during and after pregnancy. Here are some of the main benefits covered by health insurance in the context of childbirth and the puerperium:

• Preventive check-ups: During pregnancy, all necessary medical check-ups and the recommended ultrasound examinations are covered by your health insurance.
• Birth: The costs of giving birth in hospital, in a birthing centre or at home are covered by health insurance. This also includes the care provided by midwives.
• Puerperal care: After the birth, health insurance covers midwife visits at home to monitor and support the health and well-being of mother and child.
• Breastfeeding counselling: Counselling services by a midwife or breastfeeding counsellor are also covered to provide support with breastfeeding.
• Medical aftercare: Any necessary medical aftercare for the mother after the birth is also covered.
• Gynaecological follow-up examination: A gynaecological follow-up examination after the birth is covered by health insurance.
• Newborn examinations: The obligatory examinations for the newborn, including hearing screenings and other necessary tests, are covered by the health insurance.

How can I take out health insurance for children?

Health insurance is compulsory for children as it is for adults. The scope of insurance cover for children is similar to that for adults and includes the basic care stipulated by law.

Parents are free to choose their own health insurance for children, regardless of which insurer they are insured with. It is worth comparing the premiums and offers of different insurers, as these can vary for children.
Health insurers offer optional supplementary insurance for children that covers benefits over and above the basic insurance, such as free choice of hospital, alternative medicine or dental treatment.

How do health insurances organise the treatment process for their policyholders?

The health insurances organise the treatment process for their policyholders as follows.

• Choice of doctor and treatment: Depending on the insurance model chosen by the insured person, health insurances allow direct access to a doctor or specialist in the standard model or require that a family doctor under the family doctor model or a centre specifically provided for by the HMO or Telmed model be contacted first if medical assistance is required.
• Use of medical services: After the consultation, the health insurances organise the necessary medical treatment for their insured persons, which includes visits to the doctor, diagnostic tests, medication, therapies and, if necessary, hospital stays.
• Billing: Health insurance funds cover the costs of treatment for their insured persons by either paying the service provider directly (direct billing) or reimbursing the amounts advanced by the patient after submission for reimbursement.
• Cost reimbursement: Health insurances allow invoices to be submitted for reimbursement if insured persons have advanced the costs. Health insurances reimburse the corresponding amount after deduction of the deductible and the excess, which is 10% of the costs above the deductible up to a maximum of CHF 700 per year for adults and CHF 350 for children.
• Review of benefits: The health insurance checks whether the benefits claimed are covered by the compulsory basic insurance. Benefits that go beyond the basic insurance are only reimbursed if there is corresponding supplementary insurance.

What terms does the health insurance have in the policy?

In health insurance, especially in the context of Switzerland, you will come across numerous technical terms that are essential for understanding the system. Here are some important health insurance terms that are used in the policy.

• Premium: The amount that the insured person pays regularly (usually monthly) to the health insurance fund in order to obtain insurance cover.
• Franchise: An annual amount that the insured person must pay for their own medical costs before the health insurance fund begins to reimburse benefits.
• Deductible: Once the deductible has been reached, the insured person pays a certain percentage of the additional costs themselves. In Switzerland, this deductible is 10% of the costs over and above the deductible up to a maximum annual amount.
• Basic insurance: The compulsory health insurance that every person resident in Switzerland must take out. It covers basic care as defined by law.
• Supplementary insurance: A voluntary insurance policy that covers benefits that go beyond basic care. This can include, for example, comfort services in hospital or alternative treatments.
• KVG: The Health Insurance Act (KVG) regulates compulsory healthcare in Switzerland and determines which services are covered by basic insurance.
• VVG: The Insurance Contract Act (VVG) regulates private supplementary insurance in Switzerland.
• Service providers: Providers of medical services, such as doctors, therapists, hospitals and pharmacies.
• Cost sharing: The share of the costs of medical services borne by the insured person, consisting of the deductible, excess and any non-refundable costs.

How do you assess your current state of health before taking out health insurance?

Assessing your current state of health before taking out health insurance is essential, as it can influence the conditions and costs of the insurance cover. In Switzerland, however, the situation is somewhat different from many other countries because basic insurance (compulsory health insurance) must cover everyone, regardless of their state of health. Here, there is no risk assessment or health check that could affect your premiums or your access to insurance.

For basic insurance:

• The health insurances do not take the state of health of the insured person into account when setting premiums and deciding whether to accept them for basic insurance. Health insurers are obliged to accept every resident and charge the same premium to all insured persons in the same age group and region, regardless of their state of health.

For supplementary insurance:

• Health insurances can request a health check for supplementary insurance and decide whether or not to insure someone based on their state of health, and under what conditions.
• Health insurances can charge higher premiums, exclude certain benefits or reject the application for supplementary insurance completely if there are pre-existing conditions or higher health risks.

What are the advantages of health insurance?

Health insurance offers numerous benefits that encompass both individual and social aspects.

• Financial security: Health insurance protects against high medical costs that can arise from accidents, illnesses or regular medical care. Without health insurance, medical costs can quickly become a considerable financial burden.
• Access to medical care: Health insurance provides access to a wide range of healthcare services. Health insurance covers visits to the doctor, hospitalisation, medication, preventive measures and specialist treatments.
• Prevention and early detection: Health insurances cover preventive measures such as regular check-ups, vaccinations and health screenings. Preventive check-ups can help to recognise and treat illnesses at an early stage, which not only promotes health but also reduces long-term costs.
• Better health outcomes: With regular access to healthcare services, illnesses can be recognised and treated earlier with health insurance. These healthcare services improve health outcomes and quality of life.
• Right to free choice of doctor: Health insurances offer a free choice of doctor in Switzerland, allowing patients to choose their preferred medical provider.
• Mental comfort: Knowing that you are financially covered by your health insurance in the event of illness and have access to necessary medical services provides a reassuring feeling and mental security.
• Societal stability: A universally accessible healthcare system, supported by health insurance, contributes to social stability and productivity by improving overall health and enabling people to return to work more quickly.
• Risk spreading: Health insurances work on the principle of risk spreading, with many policyholders bearing the costs for the few who need serious healthcare. This principle helps to reduce costs for individuals.

What are the disadvantages of health insurance?

The disadvantages of health insurance are listed below.

• Costs: The premiums set by health insurances can represent a considerable financial burden for insured persons, especially in countries with high healthcare costs such as Switzerland. In addition, the costs of deductibles and co-payments can further increase the financial burden, especially if medical services are frequently utilised.
• Complexity: The complexity of the different policies, cover options and schemes that health insurers offer can make it difficult to understand. For many people, it is a challenge to compare the different offers and conditions in order to choose the most suitable health insurance for their needs.
• Overinsurance: Health insurers sometimes find that people take out more insurance cover than they actually need, which leads to unnecessarily high premiums without the insured person benefiting from this.
• Administrative burden: The processing of insurance claims, paperwork and administrative matters by health insurances can be time-consuming and frustrating for insured persons.

Can health insurance policies be cancelled in Switzerland?

Yes, health insurance policies can be cancelled in Switzerland. Health insurances allow policyholders to cancel their insurance within the cancellation periods. Health insurances have different cancellation periods, which vary depending on the type of insurance (basic insurance or supplementary insurance). The health insurance requires a health insurance cancellation letter for the cancellation.

You should prepare a health insurance cancellation letter to cancel your health insurance. The cancellation should always be made in writing, either by letter or, if offered, by e-mail. The cancellation should clearly state your name, address, policy number and the desired cancellation date. Upon receipt of a cancellation, health insurances issue a confirmation of cancellation to the insured person. It is recommended that insured persons keep this confirmation carefully.

What additional benefits are included in health insurance in Switzerland?

In addition to the compulsory basic insurance, health insurances also offer various supplementary insurances in Switzerland that go beyond the basic medical benefits.
Health insurances offer various supplementary insurances to meet the needs of their policyholders, including.

• Supplementary hospitalisation insurance: Enables insured persons to be accommodated in a general, semi-private or private ward in hospital, including the freedom to choose the doctor or clinic.
• Supplementary outpatient insurance: Provides cover for additional outpatient services such as alternative therapies, extended physiotherapy, psychology, occupational therapy, speech therapy or nutritional counselling that go beyond the basic insurance.
• Supplementary dental insurance: Covers costs for dental treatment, orthodontic measures or dental prophylaxis that exceed the minimum basic insurance cover.
• Glasses and contact lens insurance: Covers the costs of visual aids that are not or only partially covered by basic insurance.
• Travel insurance: Protects against medical emergencies abroad, including repatriation costs.
• Daily allowance insurance: Pays a daily allowance in the event of incapacity for work due to illness or accident.
• Supplementary complementary medical insurance: Reimburses costs for treatments by recognised therapists in areas such as homeopathy, acupuncture, chiropractic or anthroposophic medicine that are not or only partially covered by basic insurance.
• Fitness and prevention: Some policies reimburse contributions for fitness subscriptions, prevention courses or health checks.

Is every health insurance in Switzerland equally expensive?

No, not all health insurances are equally expensive. Health insurances have different monthly costs in Switzerland. You can find out how expensive the health insurances are by using the health insurance comparison.