Everyone who lives in Switzerland is required to have health insurance, no matter their age or employment status. By law, you have must be insured against both illness and accident from the first day of your arrival.
If you are employed and working at least eight hours a week, then your employer has the legal obligation to insure you against professional (at work) and non-professional (away from work) accidents. If you are not employed you must have accident insurance as part of your basic health insurance. This category includes children, stay-at-home parents, and those who are retired or self-employed.
Basic insurance covers you for visits to doctors (including specialists) within Switzerland, hospital treatment within the canton in which you live, contribution to some emergency care outside of Switzerland, as well as medicines and laboratory tests. It will also cover you for accidents if you don’t have a separate accident insurance policy. Your chosen insurance provider will provide you with detailed information on exactly what is covered.
There are three age categories for determining the level of premium that must be paid:
- 0 – 18 years
- 19 – 25 years
- 26 years and over
The benefits you receive through your basic insurance cover are the same, regardless of which insurer you choose. The amount of premium you must pay, depending on your age, will also vary from canton to canton, and can also vary within a canton, depending on your postcode.
There are a couple of additional things to note:
- You are free to choose an insurance provider.
- You cannot be refused basic insurance cover.
- You can change to a different provider once a year in November for the beginning of the next calendar year. It is also possible to change in March with conditions attached.
- The cancellation procedure is the same across all providers.
- Basic insurance also covers you for maternity care. Maternity bills are not included in your annual deductible.
Models of basic insurance
There are four main models of basic insurance from which you can choose. Each model has advantages and disadvantages, and your choice will also influence the amount of premium you must pay. Emergencies, annual gynaecological screening, and eye checkups are exempt from the conditions attached to each model.
- Telmed: you are required to first call a telephone medical hotline to discuss the best way forward and to access treatment.
- Family doctor: you must first consult your chosen family doctor before accessing additional treatment.
- Free choice of doctor: you can choose your doctor and can directly contact specialists.
- HMO: you are required to contact a specified HMO (Health Maintenance Organisation) practice in order to access treatment.
Basic insurance works through a system of cost sharing in which you are required to contribute to the cost of your cover. This includes:
- Deductibles, in which you pay a minimum of CHF300 annually towards the cost of your treatment. You can choose to pay a higher deductible, up to an amount of CHF2500 p.a.. The benefit of this is that it reduces the cost of your premium.
- Co-payment of 10CHF per day towards the cost of a hospital stay.
- A co-payment of 10% of the cost of treatment, once you have exceeded the amount of your deductible. This amount can increase for certain prescribed medications. It is however capped at CHF700 for adults and CHF350 for children per calendar year.
Supplementary insurance is not compulsory, but can be beneficial. It is not subject to the same conditions as basic insurance, and the benefits can vary depending on the insurance provider. It’s important to note that an insurance provider is not obliged to accept you, unlike for basic insurance. This means you could be accepted, refused cover, or accepted under certain conditions.
Supplementary insurance coverage can include:
- Hospital treatment outside your canton of residence
- Semi-private wards, and private hospitals and clinics
- Contribution towards glasses and contact lenses
- Cover abroad
- Transport (ambulance, helicopter)
- Medication not covered by basic insurance
- Alternative medicines and therapies
- Contribution towards an annual gym/fitness membership
It is possible to insure babies before their birth under a prenatal agreement. This is essentially an insurance policy for your baby taken out before their birth. It’s important to note that both the cover itself and the requirement to pay premiums begin on the day the baby is born and not before.
There are some advantages to organising insurance before the birth of your baby. Doing it before means the paperwork will be out of the way by the time your baby is born. Your baby will automatically be accepted for supplementary insurance.