Swiss Health Insurance: Covered Costs

Every person residing in Switzerland is required to take out basic compulsory health insurance. But many residents do not understand what they are actually getting in exchange for the high insurance premiums. What treatments are covered? Does basic health insurance cover you outside of Switzerland? Are medicines you buy at pharmacies covered or do you pay for these out of your own pocket? Are accidents covered?

Here is a list of the costs covered by compulsory Swiss health insurance:

• Accidents

Mandatory health insurance covers the treatment of injuries which result from accidents as well as illnesses. However, if you work and receive accident insurance from your Swiss employer, you can put the accident coverage of your mandatory health insurance on hold. For more information, refer to the guide to accident insurance in Switzerland.

• Alternative treatments

Swiss mandatory health insurance covers these alternative treatments: anthroposophical medicine; chiropractic; homeopathy; phytotherapy (herbal medicine); and traditional Chinese medicine (including acupuncture). For more on this topic, read the guide to Swiss health insurance coverage for alternative medicine.

• Ambulance transportation

Ambulance transportation – both within Switzerland and abroad – is partially covered by compulsory health insurance. Ambulance transportation: 50 percent up to a maximum sum insured of 500 francs per year, when you are incapable of traveling to the hospital using other forms of transportation. Emergency medical evacuations (rescue) in Switzerland: 50 percent of costs, up to a maximum sum insured of 5000 francs per year. You can learn how else you may be covered in the guide to Swiss insurance for search and rescue, ambulances, and repatriation.

• Approved medicines

Your Swiss obligatory health insurance 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 (FOPH). If you prefer a brand-name medicine when significantly cheaper generic alternatives are available, you may have to cover 40 percent yourself as a copayment (instead of the standard 10 percent). For more information, see the guide to covered medicines.

• Dental repair

Compulsory health insurance covers dental repair when the condition is caused by illness or by medical treatment. Treatment of serious infections of the jaw and dental system is also covered. The cost of repairing dental damage caused by accidents is covered when accident coverage is active (otherwise your employer’s accident insurance covers this). This basic coverage can be extended with supplementary dental insurance. Read the guide to Swiss dental insurance for more information.

• Doctors

Visits to a doctor for the purpose of diagnosing or treating an illness are covered by your mandatory insurance. Purely preventative medical check-ups are not covered, with the exception of allowances for gynecological and pediatric check-ups, colonoscopies, mammograms, and vaccinations (more about these exceptions further down).

• Eyecare

Until children turn 18, compulsory health insurance covers up to 180.67 francs of the cost of eyeglasses and contact lenses every year, with a prescription from an eye doctor. Glasses and contact lenses for adults are covered in clearly defined exceptional cases. Visits to eye doctors are covered. You can find more information in the guide to health insurance coverage for glasses and contact lenses.

• Gynecological check-ups

Your basic health insurance covers one preventative gynecological check-up every 3 years. If treatment is required, it is covered by your insurance just like any other specialized treatment.

• Hospitals in Switzerland

Stays in the general wards of hospitals are fully covered by your compulsory health insurance and the government of the canton you live in, but only if the hospital is included in your canton’s list of approved hospitals. Hospital stays in other cantons are only fully covered in the case of medical emergencies or if the hospitals on your canton's list do not have the facilities required for the treatment you need. You are free to get stationary treatment at hospitals that are not on the list, but insurance cover is limited to the cost of identical treatment in your canton of residence. If the cost exceeds this limit, you have to pay the difference out of your own pocket. You can get supplemental hospital insurance to close the insurance gap.

• Maternity

Your compulsory Swiss health insurance covers up to seven prenatal examinations, one postnatal examination, the delivery and three breast-feeding consultation sessions. Maternity-related hospital stays in your canton of residence are covered by the general ward insurance included in your basic health insurance. Your baby is covered by your insurance policy for up to three months from the date of birth, within which time you must take out a separate compulsory health insurance policy for them.

• Medical treatment outside of Switzerland

Basic mandatory health insurance covers medical emergencies outside of Switzerland, up to a limit of twice what the insurance would pay for the same treatment in your canton of residence. Non-emergency medical treatments outside of Switzerland are generally not covered, but there are exceptions. These are explained in the guide to health insurance coverage for treatments outside of Switzerland.

• Outpatient coverage

Temporary outpatient care at home which is prescribed by a hospital in connection with hospital stays is covered, up to a limit of 14 days per prescription. Compulsory Swiss health insurance pays out benefits for long-term care (spitex) prescribed by a doctor, up to these limits: 52.60 francs per hour for basic care; 63 francs per hour for medical examinations and treatment; 76.90 francs per hour for consultation. A copayment is required and this varies based on where in Switzerland you live, but it is never more than 15.35 francs per day.

• Pediatric check-ups

Children living in Switzerland are entitled to eight routine medical examinations over the course of their childhood – even when there is no suspicion of illness. These check-ups are covered by compulsory Swiss health insurance.

• Preventative colonoscopy

Between the ages of 50 and 74, Swiss mandatory health insurance covers one stool analysis every 2 years or one colonoscopy every 10 years. In many cantons, there is no deductible when these preventative examinations are done through the cantonal cancer prevention program. Cantons with such programs include Basel-Landschaft, Basel-Stadt, Bern, Fribourg, Geneva, Grisons, Jura, Lucerne, Neuchâtel, St. Gallen, Solothurn, Ticino, Uri, Valais, and Vaud.

• Preventative mammography

Women who are at high risk of breast cancer are entitled to one covered mammogram every year. If you are a woman aged 50 years or older, you are entitled to one covered mammogram every 2 years with no deductible if your canton operates a screening mammography program. Cantons that operate eligible screening programs include Appenzell-Ausserrhoden, Appenzell-Innerrhoden, Basel-Stadt, Bern, Fribourg, Geneva, Grisons, Jura, Neuchâtel, Solothurn, St. Gallen, Thurgau, Ticino, Valais and Vaud. In other cantons, your coinsurance payment applies.

• Psychiatric treatment

Treatment by qualified psychiatrists is covered. Visits to psychologists are covered when they are prescribed by medical doctors.

• Spa treatments

A benefit of up to 10 francs per day for a maximum of 21 days per year applies to doctor-prescribed spa treatments. Spas must be recognized by the FOPH in order for this coverage to apply.

• Specialists

Treatment by conventional medical specialists is covered by your basic, obligatory health insurance. The following specialized treatments are also covered, if they are prescribed by a doctor and performed by an accredited medical specialist: ergotherapy; consultation for diabetics; dietary coaching for certain health conditions; neuropschology; psychotherapy; physiotherapy; chiropody; and speech therapy.

• Vaccinations

A number of standard vaccinations are covered by your mandatory Swiss health insurance. These include all of the inoculations which are typically recommended for children and several of those recommended for travelers and seniors. You can find out more in the guide to Swiss health insurance cover for vaccinations.

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