Can the Swiss health insurance company refuse me?
No, every health insurance company is obliged to accept you, regardless of your state of health.
Health insurance, also known as basic insurance, is compulsory for everyone living in Switzerland. For immigrants, proof of insurance must be provided within a certain period of time after registration - so don't put off choosing a suitable insurance for too long. On this page we offer you a comprehensive insight into the health insurance system in Switzerland as well as free, personal advice - tailored to you.
![[Translate to English:] Preiskurve Grafik](fileadmin/user_upload/content/lp/kv_graph.jpg)
The decision to immigrate to Switzerland involves significant changes. In the stress of trains and paperwork, the conclusion of health insurance must not be forgotten. You have 3 months after the change of residence to join one of the almost 55 health insurance companies in Switzerland. This applies both to you and your family members, including children. It is not relevant whether your family is self-employed or living on a pension or unemployment benefit. As soon as you transfer your residence to Switzerland, you have no other option than to take out insurance in Switzerland - the residence principle applies. Exceptions apply to employees working in an EU or EFTA state or to members of diplomatic or consular missions and international organizations' employees.
The health insurance system in Switzerland is different than in Germany. While the mandatory basic insurance with all providers includes the same benefits, some of these insurances offer various voluntary supplementary insurances with other benefits. Depending on your needs and budget, you can choose your modules from the additional services catalog to put together your insurance package. You can take out basic and supplemental insurance with different providers.
| Basic insurance | Additional insurance |
|---|---|
| Obligation if resident in Switzerland | Voluntary |
| Scope of services required by law | The offer of services determines the provider himself |
| Annual determination of premiums, approval by the Federal Office of Public Health (BAG) | Annual determination of premiums, approval by the Financial Market Authority |
| Duty to admit everyone/health check not permitted | Rejection possible / health check and reservations allowed |
| Approx. 55 providers on the Swiss market | Approx. 23 suppliers on the Swiss market |
| The basis is the Health Insurance Act (KVG) and the Health Insurance Supervision Act (KVAG) | The basis is the Federal Act on Insurance Contracts (VVG) and the Insurance Supervision Act (VAG) |
| Cancellation per end of June or end of December possible, depending on franchise (according to KVG) | The provider can determine notice periods themselves |
| Not for profit | Profits allowed without restrictions |
![[Translate to English:] Familie mit Kindern](fileadmin/user_upload/content/lp/kv_grundversicherung_sparen.jpg)
Basic insurance in Switzerland is a complex structure. Learn how you can save a lot of money with simple tricks.
It is up to you to determine your health care needs. Looking back over the last few years, you know roughly what you need and the costs of the services you have used. The annually recommended preventive medical check-ups, for example, can represent a considerable cost factor. But an insurance policy is primarily there to cover the unexpected. And, unfortunately, often comes unexpectedly. It is all the more annoying when you are then confronted with costs that you cannot bear. Be realistic in your considerations, and - even if you prefer a cheap insurance option - keep in mind that your health is at stake. It can lead to considerable financial problems if you want to save too much and take too high risks.
Find the right insurance option for you. With the following tips, you can save on your primary insurance:
The basic insurance offers various alternative insurance models:
Important:
You can change your basic insurance every year. The new awards will be announced at the end of September. If you give one month's notice, you can terminate your basic insurance at the end of December. If you have decided on 300 francs (see point 3), you can even terminate your contract at the end of June. The notice must reach then; however, the health insurance already ends in March. You can change health insurance companies without hesitation because every other essential insurance company must accept you. Make the premium comparison every year and switch to the cheapest basic insurance in Switzerland. This requires some effort but can be worth it.
Participate in the medical costs up to a certain amount and save a lot on the premium. The higher the franchise, the lower the premium. The health insurance companies offer the following franchises:
Important:
Before you decide on a higher deductible rate, you should be aware of the financial risks, e.g., in case of a severe illness.
Suppose a single employer employs you for at least 8 hours per week. In that case, you are automatically insured against accidents and can safely exclude accident coverage from your health insurance. This can lead to a discount of up to 10%.
Depending on your health insurance, you have the option of paying the premium annually instead of monthly and thus benefit from a discount.
Should you have any questions regarding basic insurance, you will find answers to the most important questions here.
No, every health insurance company is obliged to accept you, regardless of your state of health.
Abroad, the mandatory basic insurance pays a maximum of twice the amount that the same treatment would have cost in Switzerland. Within Europe, this coverage is usually sufficient. In certain overseas territories, especially in the USA, Canada, Australia, New Zealand, and Japan, additional insurance cover must be provided.
You can cancel the basic insurance each year until the end of November. The letter must be sent by registered mail and must reach the insurer by November 30th at the latest. With a franchise of 300 francs, you also have the additional option of submitting your cancellation by the end of March and thus canceling your contract at the end of June.
As soon as your annual healthcare costs exceed CHF 2,000, the CHF 300 is worth it. If the prices are lower, the franchise of CHF 2,500 is the better choice. Please note, however, that you may be faced with unexpected health costs.
Some insurers focus on low premiums, which leads to savings in other places. For this reason, more expensive cash registers can, in some cases, offer a more comprehensive range of supplementary insurance, have more branches, are easier to reach, or are simply more expeditious in repaying customers. Not only the amount of the premium should be in the foreground when choosing health insurance.
No matter which model you choose - the benefits remain the same. Only the contact point changes:
The Telmed model can be worthwhile for healthy insured persons. However, the standard and family doctor models are incredibly popular.
You must declare the premiums in your tax return. They are then automatically credited to the flat-rate deduction for insurance premiums.
After your child's birth, you have 3 months to take out necessary insurance so that the insurance is valid retroactively and covers any costs. Every provider should accept a baby without reservation. Additional dental insurance is recommended for children.
People in modest financial circumstances are entitled to premium reductions. This is handled differently at the cantonal level. The compensation office of your municipality of residence can help you with this issue.
The Swiss health insurance system stands for a system in which every citizen is subject to compulsory insurance. Apart from a few exceptions, basic health insurance is mandatory for every resident in Switzerland and is regulated by the Health Insurance Act. It lists in detail all the services that every insurer must offer every citizen. The benefits are identical for all insurers. In principle, services must be subject to practicality, efficiency, and effectiveness.
The Health Insurance Act regulates the service catalog of the providers.
It provides for the assumption of the following services:
The basic insurance covers the costs of medical treatment. Suppose a specific treatment should not be paid for by the insurance company. In that case, the attending physician must inform the patient about it.
All medications that can be found on the so-called specialty list are covered by the basic insurance provided by a doctor. If a prescribed medicine is not on the list, the attending physician must inform the patient.
Up to the age of 18, health insurance will contribute CHF 180 per year to the costs. The prerequisite for this is a corresponding prescription issued by the doctor. The basic insurance does not provide financial support for adults. There are exceptions for patients who get problems with their eyes due to diseases.
The basic insurance covers the costs of vaccinations that correspond to the Swiss vaccination plan. Travel vaccinations are not covered. The flu vaccination is also excluded if the patient does not belong to the risk group.
Suppose the hospital is on the hospital list of the canton of residence. In that case, the general ward's benefits are covered by the insurer. This also applies to special and emergency treatments. However, the patient must contribute to the costs. The deductible rate and excess will be exhausted if necessary. Also, there is a daily fee of 15 francs.
In the event of an operation or illness, the nursing costs are partially covered by health insurance. However, in most cases, the insured person has to pay a significant part of the expenses himself.
The basic insurance only covers the costs of a check-up with the gynecologist every 3 years. In the case of conspicuous findings, examinations at shorter intervals are possible, covered by health insurance.
The basic insurance covers a maximum of 40 therapy sessions with a competent doctor.
In a medical emergency (heart attack, mountain accident, or similar), the necessary insurance covers up to CHF 5,000 in transport costs. For transports that are not associated with danger to life, the insurance company will cover 50% of the charges, but no more than CHF 500.
Insofar as the attending physician can demonstrate a significant title or appropriate further training, the insurer covers the costs of acupuncture, homeopathy, traditional Chinese medicine, and anthroposophic medicine.
With a corresponding medical prescription and the respective health insurance company's approval, a patient is entitled to 60 Spitex hours.
In addition to the standard model, which gives you a free choice of doctor, other models in Switzerland have restrictions but offer significant savings potential.
This model is an organization of physicians who share a group practice (HMO = Health Maintenance Organization). In the HMO center, you will find general practitioners, specialists, and therapists. When you sign a contract, you choose a doctor who is always your first contact point - regardless of your symptoms. He can then refer you to a specialist if necessary.
As an insured person, you can choose a doctor from a network of family doctors who is always the first point of contact for you in the event of complaints. You renounce the free choice of doctor. Consult this doctor for all medical matters. He then decides whether to carry out the treatment himself or refer you to another specialist.
With this model, you must always contact a telephone counseling center before your first visit to the doctor. Medical professionals can provide information, make recommendations, or refer you to a doctor, hospital, or therapist. Necessary: Emergencies are excluded from these regulations. In emergencies, you can go directly to the hospital.
Summary:
If you choose an alternative model, you can save between 15 and 25% in premiums. Depending on what is important to you or what you can do without, an alternative model may be attractive for you.
It is not easy to keep the overview - the primary insurance not only brings with it a monthly premium; every insured person must also contribute directly to the treatment costs. This is what the franchise and the deductible are for.
With the franchise, a patient contributes a fixed amount to the costs of their treatments or prescribed medication. For adults, the minimum franchise is CHF 300; for children, the contribution to costs can be CHF 0 if desired. The following franchise levels exist in Switzerland but are not offered by all insurance companies:
| Adults | 300 CHF |
| 500 CHF | |
| 1'000 CHF | |
| 1'500 CHF | |
| 2'000 CHF | |
| 2'500 CHF | |
| Children and teenagers | 0 CHF |
| 100 CHF | |
| 200 CHF | |
| 300 CHF | |
| 400 CHF | |
| 500 CHF | |
| 600 CHF |
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As soon as the selected deductible for the current year is exhausted, the deductible is applied. The patient must pay 10% of the treatment or drug costs themselves. An upper limit ensures that these costs are not immeasurable: Adults must contribute a maximum of 700 francs and children to 350 francs to the expenses. The deductible is always 10% and is not dependent on the deductible rate.
![[Translate to English:] Bild mit Spital](fileadmin/user_upload/content/lp/info_icon_spital.jpg){kind=icon}
During an inpatient hospital stay, insured persons are required by health insurance law to pay a hospital contribution of CHF 15 per day. In this way, the patient contributes to the costs of food and accommodation. Children and adults under 26 who are still in education are exempt from this obligation. So also pregnant women of the 13th week of pregnancy until 8 weeks after the birth.
Health insurance covers all medical treatment in Switzerland. Besides, services provided by other therapists on behalf of a doctor can be reimbursed. This includes physiotherapy, nursing home services, occupational therapy, speech therapy, and psychotherapy. Treatment methods whose appropriateness and effectiveness are questionable, also concerning the costs incurred, are not paid for by compulsory health insurance or only under specific conditions. In case of doubt, ask your doctor or health insurance company.
Costs for medicines are covered if they are prescribed by a doctor and are listed in the "specialty list." This includes all drugs subject to compulsory health insurance from currently around 2,500 preparations. Furthermore, extemporaneous preparations produced in the pharmacy are reimbursed. Pharmacies can dispense generics containing the same active ingredient if the treating doctor does not explicitly prescribe the original drug.
7 Routine examinations during pregnancy are covered by health insurance. Also, two ultrasound examinations are paid for and, in the case of high-risk pregnancies, all further studies. Covered are tests for trisomy, the birth itself and follow-up measures from the 6th to 10th week, 3 breastfeeding consultations, and 10 home visits by midwives after the birth. Birth preparation courses are supported by CHF 150.
You can be treated in a listed hospital. These are hospitals that appear on the list of hospitals in your canton of domicile or residence. You can obtain the list of hospitals from the cantonal health department or your health insurance company. Suppose you voluntarily seek treatment in a hospital that is not on the list of hospitals in your canton. In that case, the costs of your stay and treatment are covered by your health insurance up to the amount that would have been incurred in the listed hospital in your canton of residence. Exceptions are made for emergencies or unique treatments - here, and the costs are entirely covered. Treatments in private or semi-private departments are not paid.
Precautionary measures (prevention) are also covered by compulsory health insurance. This includes vaccinations following the recommendations in the Swiss Vaccination Plan (e.g., against tetanus, whooping cough, mumps), 8 preventive examinations for children and mammography screening for the early detection of breast cancer from the age of 50, as well as preventive examinations for colon cancer between the ages of 50 and 69.
Physiotherapy is paid for if it is prescribed by a doctor and performed by a licensed physiotherapist. Up to 9 sessions can be defined, and the doctor can order a continuation.
Up to 180 CHF per year is paid for contact lenses or glasses if a doctor prescribes them. Higher contributions are paid for severe visual defects or diseases.
The health insurance covers dental treatment costs only in case of severe illness or after accidents. Ordinary tooth fillings or the correction of malpositions are not covered.
In case of an accident, the accident insurance pays if you work at least 8 hours per week. If this is not the case, you must take out additional insurance against your health insurance company's accidents. Then all benefits are paid as in the case of illness.
The health insurance company pays half of the travel cost to treatment by ambulance or cab up to a maximum annual amount of CHF 500. A yearly maximum amount of CHF 5,000 applies for emergency rescue operations.
The primary insurance benefits are the same for all insurances, but the amount of the fees differs. Therefore you can switch to a fund that ensures you at a lower price. You can cancel your health insurance. However, you must observe the notice periods. On October 31st of each year, you will receive a letter from your health insurance company informing you of the coming year's premiums. Here providers also point out the right of termination. If you want to choose a cash register with lower premiums, now is the right time to change.
Suppose you want to cancel your health insurance by December 31st of a year. In that case, the cancellation letter must be received by the previous health insurer as a registered letter by November 30th or by the last working day of November. Suppose the termination is to apply from June 30th. In that case, the previous health insurer must receive the written message by March 31st or the last working day in March. However, only insured persons with a deductible rate of 300 francs and standard basic insurance can cancel in the middle of the year. For all others, such as those with HMO tariffs, termination is only possible at the end of the calendar year. Suppose you have agreed on bonus insurance with your health insurance company. In that case, you can only cancel it five years after taking out the policy with three months' notice. If premiums are still outstanding, you will be refused a change of health insurance company.
The basic insurance covers the costs of necessary treatments and medication. To obtain more extensive coverage, many insured persons decide to take out supplementary insurance. This offers the possibility to receive medical treatment that is not covered by the basic insurance. The services vary depending on what is provided, as do the prices. It is essential to find the insurance that best suits your needs and your wallet.
Depending on your needs and requirements, it makes sense to take out supplementary insurance. Supplementary insurance can usefully supplement the benefits of the necessary insurance.
In the following cases, the conclusion of additional insurance makes sense:
The benefit catalog of supplementary insurance plans offers many options for extending coverage from basic insurance. Depending on the provider, supplemental insurances can cover the following services:
You can move outside your canton of residence if you wish, without having to worry that the costs will not be covered by basic insurance.
You decide who will treat and operate on you.
As a supplement to basic insurance, which covers only a small portion of alternative treatment methods, supplementary insurance in this area is a good option.
What the primary insurance does not cover, you can substitute with supplementary insurance.
The additional insurance participates in costs that arise, for example, in the context of a rescue or transport at home or abroad.
Medical treatment can be expensive in countries like the USA. The coverage from the primary insurance is not sufficient. With appropriate additional insurance, you can travel without worries.
Suppose you value intimacy and peace. In that case, you should opt for supplementary insurance that offers the comfort of a single or double room.
The list of specialties from the primary insurance only covers a small part of the costs for medication. Additional insurance can extend this list.
With appropriate supplementary insurance, you can benefit from extended services that contribute to your well-being.
Home help can be of great use after an operation or treatment that physically restricts you.
The supplementary insurance covers costs for psychotherapeutic services performed by non-medical therapists.
Most Swiss people opt for supplementary hospital insurance. This means that treatment in specialized hospitals outside the canton of residence is also possible at no extra charge. People who live in rural areas or who value treatment in university hospitals opt for supplementary hospital insurance. Often the associated comfort also plays a role.
The supplementary hospital insurance covers inpatient services:
![[Translate to English:] Zeichnung Spital](fileadmin/user_upload/content/lp/illustration_spital.jpg)
The insured person is entitled to a second bedroom. As a rule, the senior physician is responsible for the treatment of semi-privately insured persons.
The insured person is entitled to a single room. As a rule, the senior physician is responsible for the treatment of semi-privately insured persons.
With the Flex model, you remain flexible. You only decide on a hospital ward when you enter the hospital. For the general neighborhood, this additional insurance covers the full costs. For the semi-private or private community, you must contribute to the additional costs to the extent determined by your health insurance.
This model offers the comfort of a single or double room, without enjoying the free choice of doctor.
When applying for supplementary insurance, the insurance company is allowed to ask questions, and you must answer them truthfully. Usually, people ask about diseases and related treatments for the last 5 years. The questionnaire looks different with every provider.
It is recommended to answer the health questions truthfully. The health insurance company is entitled to initiate sanctions, also in retrospect. These can lead to the exclusion of an insurance benefit for a specific illness or termination.
In the case of supplementary insurance, the provider determines the periods of notice himself. These vary greatly depending on the provider. Read the fine print before signing a contract. Many providers specify a term of several years.
Yes, you can. Usually, additional insurance policies are concluded for several years and cannot be terminated prematurely. However, if the following year's premiums are increased without this being stipulated in the contract, you can cancel early. Pay attention to the notice periods specified in the contract. These can differ from provider to provider.
Yes, you have the option of taking out supplementary insurance with several providers. However, suppose you have already taken out basic insurance with another provider. In that case, the insurance company may demand a surcharge for the additional administrative work. Please note that the decision to have several insurers is also associated with other expenses for you. For example, you have to make sure that service invoices are sent to the correct cash register.
You should do that so that it is fully insured from day one. Most insurance companies waive a risk assessment for prenatal registration. This means that your child is covered by supplementary insurance, even if he or she is ill or born with a disability.
For children, additional dental insurance is particularly recommended. If it should need later, e.g., a brace, very high costs can come up to you. This can be prevented with additional insurance that you take out for your child early.
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