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Health Insurance is mandatory in Switzerland and highly regulated by the Federal Law on compulsory Health Care (KVG). Any person residing in Switzerland is obliged to have health insurance within 3 months of birth, or when taking up residence in Switzerland. Health insurance covers the cost of treatment in case of sickness, accidents and maternity. The aim of the law is to guarantee comprehensive health care for all, and subsidise its cost for those who cannot afford it.

The KVG law sets out the rules and parameters for basic universal cover and ensures that the insurance providers are financially sound. It also limits premium discounts and requires insurers to accept everyone – regardless of their financial status, health condition or age.

In this post, we answer the most frequently asked questions regarding health insurance.

 

1. What are typical costs?

Swiss residents typically pay a monthly fee for health insurance. This varies depending on which health insurance company is used, and varies considerably according to where the insured person lives. The Federal Office of Public Health (FOPH) has announced that the average health insurance premium for 2023 will cost CHF315.30 per month, which is the lowest price in the last 14 years. A comparison of current premiums is available on Comparis. Premiums are lower if a higher excess is agreed. The individual has to pay all costs up to the annual excess before the insurance starts to cover them. Premiums are also reduced if a more restrictive policy is selected, for example always firstly calling the insurance “netmed” hotline or visiting an elected general practitioner who then refers the patient to a given specialist if required. Note that there is always free choice of gynecologists and eye doctors, or if the patient needs to visit A&E.

Premiums are also subsidised for children, students in full time education or apprenticeships, and for families with low salaries.

2. Who pays for Health Care in Switzerland?

Costs for health insurance are covered partly by the Swiss government, and directly by individuals via their mandatory health insurance premiums. Many employers cover loss of earnings due to sickness  with a salary insurance (German – Krankentagesgeld or KTG). This is not be confused with Personal Health Insurance (German – Krankenkasse  or KVG) which is a separate insurance covering treatment.

3. What is covered by Swiss Health Insurance?

From the two types of cover possible, the following conditions apply:

  • Basic healthcare – as the name says, this insurance covers basic healthcare and hospitalisation in the canton where the worker lives. Basic healthcare is of a high standard and is often all that is needed.
  • Complementary insurance cover
    This insurance covers a wide range of care not covered by basic insurance. This can include dentistry, novel psychotherapy, alternative medicine, prenatal care, travel insurance, alternative medecine, enhanced hospital care and private rooms, loss of earnings and lump sum payments if the insured person is unable to work. Note: Unlike basic healthcare the insurance company will often insist on a doctor’s health report before offering anyone such a policy.

 

4. Is Health Insurance compulsory for each family member?

Every member of the family has to have at least the basic cover. For detailed information please visit the bag admin website .

Individuals who fail to purchase a health insurance policy for themselves and family members will automatically be given an insurance provider by the Canton where they live, and then sent an invoice for the insurance premium by the insurance provider. This will be backdated to the start of the residence in Switzerland.

There are however some possible exceptions. For instance if the contractor has an alternative insurance cover that can provide the same, or better coverage than the Swiss insurance requirements, an exemption might be possible. There are other situations which may apply, and these are described on the bag admin website.

 

5. Does the basic healthcare insurance cover all medical expenses?

The simple answer here is “no”.  Firstly, the insured individual has to pay all of the medical costs up to an annual “excess”. This excess can be selected from CHF300 – 2’500 for adults, the premiums varying according to the excess agreed. For minors under the age of 18 the excess is usually zero. Thereafter a charge for 10% of the total costs up to an annual limit of CHF700 (CHF350 for minors) has to be paid. Rarely this can rise to 20% where the worker selects a “branded” drug at the pharmacy. One exception is for pregnant mothers, who are not required to pay the 10% contribution from the 13th week of the pregnancy until eight weeks after birth.

 

6. How are medical bills paid?

This depends on the insurance provider. Many insurance providers set up a direct payment process, where the insurance company pays the medical bill directly. If there is not such an agreement in place, the insured individual will pay the invoice themselves and claim the payment back (less any required contribution) from the insurance company. In this case the insurance cover is usually settled by reputable insurance companies promptly, and often before the payment due date. For a list of approved medical insurance providers click here.

 

7.  Can I change provider?

  • Basic Compulsory Insurance – Insurers must inform their members of next year’s premiums by 31 October. Contractors and other insured persons then have until the end of November to cancel their insurance policy so they can switch to another supplier. Some insurers even offer the opportunity to change on 01 July each year with similar notice periods.
  • Complementary cover – This is optional and as discussed, can cover a range of treatments and risks not covered by basic insurance. Here there is no automatic right to change these policies annually. The notice periods vary with these policies and a switch to a new complementary policy may require a new medical check and result in further exclusions for existing health issues.

The Federal Office of Public Health (OFSP) recommends starting the process to find a suitable insurance provider in good time when looking to change provider. It is important to note that the date of cancellation is the date the letter arrives at the insurance company and not the date it was sent. Always send the cancellation notice by registered post (currently costs CHF6.50).

Once the cancellation letter has been received, the switch to a new insurer only becomes final when the existing insurance company receives a confirmation letter from the new one. This must happen before the end of the year to ensure uninterrupted coverage.

 

Accurity was established over 20 years ago by contractors searching for a personalised and trustworthy payroll service provider. Since that time the Swiss market has witnessed several waves of companies looking to gain market share quickly using disruptive tactics only for these to fail. This strengthens the case for a personalised and trustworthy service. 

Accurity – we make Switzerland easy!