basic swiss health insurance overview

Swiss Health Insurance: 16 Costs Covered by Your Compulsory Policy

Find out exactly what your basic Swiss health insurance policy covers in this moneyland.ch guide.

Every person residing in Switzerland is required to take out a basic health insurance policy, and health insurance poses a significant expense. But aside from those two facts, many residents do not know what they are actually getting in exchange for their sizeable premiums.

Does basic health insurance cover you outside of Switzerland, or even outside of the canton you live in? What about specialist treatments? Are medicines you buy at pharmacies covered or do you pay for these out of your own pocket? Are accidents covered? Do you need supplementary insurance coverage?

To help answer these questions, moneyland.ch has listed 16 coverages you get from a basic compulsory health insurance policy in Switzerland.

1. Doctors

Visits to a doctor for the purpose of diagnosing or treating an illness are covered by your basic policy. If you use a family doctor policy or an HMO policy, your general practitioner or HMO center respectively will have to refer you to a doctor in order for that doctor’s fees to be covered. If you use the telmed insurance model, you will have to contact the telemedicine center ahead of your doctor visit.

2. Specialists

Treatment by both conventional specialists is covered by your basic policy, although you will need to get a referral if you use the family doctor, HMO or Telmed policy models. A number of additional specialized treatments are also covered, when they are prescribed by a doctor and performed by an accredited medical specialist. These include physiotherapy, ergotherapy, speech therapy, dietary coaching and consultation for diabetics. Additionally, a number of “alternative” treatments are also covered (under evaluation through December 31, 2017), when prescribed by a doctor and performed by certified doctors with recognized qualifications in the relevant field. These include homeopathy, traditional Chinese medicine (including acupuncture), anthroposophical medicine and neural therapy.

3. Hospitals

Because many insurance companies offer additional hospital insurance as a supplemental policy, newcomers to Switzerland often wrongly assume that hospital stays are not covered by the basic policy. But as a matter of fact, stays at hospitals in your canton of residence are covered by your basic, compulsory health insurance policy.

Additionally, hospital stays resulting from an emergency are covered right across Switzerland, so if an unexpected medical emergency lands you in a hospital on the other side of the country, your hospital stays will still be covered. Hospital stays in other cantons are also covered if the hospitals in your canton of residence do not have the facilities required for the treatment you need.

If, on the other hand, you choose to stay at a hospital in another canton because it is more conveniently located in relation to your residence, or because you prefer the vibe, your stays will still be covered, but only up to a limit set by your canton of residence. If that limit is not adequate, you should consider getting additional hospital insurance coverage.

You can easily find the best offers for your needs using the unbiased moneyland.ch hospital insurance comparison tool. Note that not all hospitals and private clinics are covered by all policies. Many private clinics in particular may not have partnerships with your insurance provider. However, public hospitals and many private healthcare providers are covered by most policies.

4. Medicine

Many people end up paying for pharmaceuticals out of their own pocket, without realizing that they could be reimbursed for prescribed medicines. Your Swiss obligatory health insurance policy covers any medicine prescribed by a doctor as long as it is listed in the List of Pharmaceutical Specialties maintained by the Federal Office of Public Health. Most medicines are. However, when a generic alternative is available but you choose the brand-name medicine instead, you will have to cover 20% of the cost out-of-pocket, up to a maximum copayment of 700 francs every year (350 francs for children).

5. Medical treatment outside of Switzerland

Many travelers buy extra travel or health insurance to cover medical situations that may arise while traveling. Getting supplemental outpatient insurance can be a good idea if you frequently visit countries where healthcare costs are very high (the United States, for example).

But what many basic policyholders do not know is that their basic insurance policy already covers them internationally. In the case of a medical emergency abroad, your basic insurance covers treatment in foreign countries up to a limit of twice the estimated cost of getting the same treatment in Switzerland. In most countries, this coverage is more than adequate.

When traveling in European Union (EU) or European Free Trade Agreement (EFTA) member countries, you are entitled to the same healthcare services which people insured in those countries enjoy, as long as you present your European health insurance card. You get this card from your health insurer, and you should take it with you when traveling outside of Switzerland.

Depending on the country in question and your insurance provider, you may have to pay costs upfront and then apply for reimbursement, or the costs may be paid directly from the insurer. Because medical costs can be very high, it’s a good idea to check how payment to your proposed destination is handled by your insurance provider before you travel.

6. Maternity

In many countries, maternity-related costs or hospital stays are not covered by basic health insurance. But in Switzerland, your basic policy covers the cost of up to 7 prenatal examinations, 1 postnatal examination, delivery and 3 breast-feeding consultation sessions. Maternity-related hospital stays in your canton of residence are covered by the general ward insurance included in your basic policy.

Stays in a private ward are only covered by supplementary private ward hospital insurance. If you want to be able to which doctor or gynaecologist supervises your case, you get that option with optional semi-private ward coverage or private ward coverage, but not with your basic policy. Your baby will be covered by your policy for up to 3 months from the date of birth, and this includes any care the baby may need shortly after birth. After 3 months, your baby will need their own insurance policy.

7. Ambulance transportation

It’s easy to assume that getting chauffeured to the hospital in an ambulance or helicopter in a medical emergency would be covered by your basic policy, but you need to be careful here.

Your basic insurance policy only covers 50% of the costs of transportation by ambulance within Switzerland or abroad. If the evacuation is necessary to save you from a life-threatening situation (a heart-attack, for example), the basic insurance covers half the cost, up to a limit of 5000 francs (but only in the case of transports within Switzerland).

If the situation is not life-threatening, the insurance only covers up to a maximum of 500 francs. Another limitation is that, in the case of non-life-threatening illness, if your insurance company decides that you could have made your way to the doctor or hospital using your own car or public transport, they may not pay the costs of ambulance transportation at all.

If you prefer to be fully covered for the cost of medical evacuations, consider getting a supplementary outpatient insurance policy with extended ambulatory coverage.

8. Psychiatric treatment

If you feel the need to visit a shrink, convincing your doctor that doing so is important to your mental health could save you a lot of money. Treatment by a psychologist is covered by your Swiss obligatory health insurance policy when it is recommended by a doctor. Additionally, all treatment by qualified psychiatrists (medical doctors specialized in mental health) is covered.

9. Inoculations

A number of standard vaccinations are covered by your basic policy. These include all of the inoculations which are typically recommended for children and several of those recommended for travelers and seniors.

10. Paediatric examinations

Under obligatory health insurance laws, children living in Switzerland are entitled to 8 routine medical examinations over the course of their childhood. These examinations are covered by their basic health insurance policy.

11. Gynaecological examinations

Your basic health insurance covers 1 preventative gynaecological examination every 3 years. If treatment is required, it will be covered by your insurance just like any other specialized treatment. An added benefit is that an exception is made for gynaecological visits in the case of family doctor, telmed, and HMO policy types by which you will not need to contact your general practitioner, HMO or telmed center ahead of visiting a gynaecologist.

12. Preventative mammography

If you are a woman and are at least 50 years old, your basic policy will cover 1 mammogram every 2 years. Women whose mother, sister or daughter have been affected by breast cancer are entitled to 1 covered mammogram every year.

13. Dental emergencies

Although dental care is not covered by your basic policy, dental emergencies which can potentially impact your health are covered. This may include serious infections, dental damage caused by illnesses (cancer, for example), and even damages caused by accidents, when no alternative insurance coverage is available. Braces, cavity care, plaque cleaning, wisdom-tooth pulling and cosmetic dental care are not covered, but a number of insurers bundle dental insurance in their optional outpatient insurance policies.

14. Children’s eyecare

Until the age of 18, your child’s basic policy covers up to 180 francs of the cost of eyeglasses or contact lenses, as long as these have been prescribed by a doctor.

15. Outpatient coverage

A portion of the cost of treatment in your home or at a care center, as prescribed by a doctor, is covered by your basic insurance policy. However, the exact out-of-pocket payments you have to make are not dictated by national obligatory health insurance laws and can vary between cantons, municipalities and care centers. Getting supplemental outpatient insurance is the best way to insure yourself against the costs of outpatient medical care.

16. Spa treatments

This is probably one of the most pleasant treatments covered (at least partially) by your basic health insurance policy. If a visit to a thermal bath is prescribed by your doctor, your basic policy will contribute 10 francs per day towards the entrance fees, for up to 21 days per year. The only catch here is that not all thermal baths are eligible on all insurance policies, so you will have to check into which spas your insurer lets you choose from.

What part of the costs are covered?

Unless otherwise specified (as in the case of ambulance transportation), your obligatory insurance policy covers all costs minus your annual deductible and co-payments.

In Switzerland, the lowest annual deductible you can choose for a basic policy is 300 francs, and the highest is 2500 francs. You will pay that amount out of your own pocket before the insurance company takes over.

After you’ve reached your deductible, you will still pay 10% of all medical expenses as a copayment until you reach the annual copayment limit of 700 francs (350 francs for children up to 18 years old).

That means that the absolute maximum amount of fully covered healthcare expenses you can be made to pay out of your own pocket every year is 3200 francs (if you have the maximum deductible of 2500 francs).

You can easily find the optimum deductible based on your average medical expenses using the unbiased moneyland.ch health insurance comparison tool.

Are accidents covered by the obligatory health insurance policy?

Accident insurance is a point of confusion for many Swiss residents. If you work for an employer at least 8 hours per week, then your employer is required to provide you with accident insurance coverage. This accident insurance covers work-related (occupational) accidents and accidents that occur in your leisure time. If you have an accident while away from work (during a weekend ski trip, for example), the costs should be covered by your accident insurance. Typically, your employer will pay for the occupational accident insurance premiums, while the (more expensive) non-occupational coverage premiums are deducted from your salary.

Like compulsory health insurance, this compulsory accident insurance provided by your employer also covers the costs of accidents you have outside of Switzerland up to a limit of twice the estimated cost of treatment in Switzerland. If you frequently travel to the US or to another country with very high healthcare costs, you may want to consider taking on additional accident insurance coverage.

If you are unemployed and are registered for unemployment benefits, your unemployment insurance provides accident insurance. If you are employed less than 8 hours per week, or are not employed at all (as a retiree, housewife/husband, student or child, for example), you are required to take out accident insurance as a rider on your obligatory health insurance policy.

The accident coverage rider on your obligatory health insurance policy gives you the same benefits you receive for illness, including coverage for doctors, specialists, hospitals, medicines and therapy in Switzerland and abroad (up to double the cost of treatment in Switzerland).

Things to watch out for

Choosing the family doctor, telmed or HMO models for your obligatory health insurance policy can save you money on premium payments. But make sure that you follow the course of action stipulated by your policy, such as visiting your general practitioner or HMO center, or calling your telemedicine center before you purchase any medicines or receive medical care.

More information:
Basic health insurance comparison tool
Outpatient health insurance comparison tool
Supplemental hospital insurance comparison tool

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The moneyland.ch magazine provides accurate, unbiased information on topics related to finance and money. In addition to research and expert interviews, the magazine contains numerous financial guides.