The Health Insurance System in Switzerland
Understand which medical costs are covered by insurers and patients, and how to pay for medical care in Switzerland...
It is compulsory to have health insurance in Switzerland. Individuals may choose their insurance provider; prices vary between companies and also between different cantons. Compulsory health insurance provides cover for illness, maternity and accident. s and offers the same range of services and benefits to all insured people.
The Federal Office of Public Health (FOPH) provides a list of insurance providers that are registered to provide basic health insurance, as is legally required by the state. There are around 90 companies that fall under this category. Insurers must ensure equal treatment for everyone.
- For information and to search for the insurance section of the BAG website
It is necessary to register for health insurance within three months of arriving in Switzerland. If medical care is needed during this initial three month period, any costs which are covered under basic health insurance will be reimbursed once the individual has taken out a medical insurance policy.
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Note: in this case, in order to qualify for reimbursement, the patient must have applied for basic health insurance within their first three months of residency in Switzerland.
All state-registered insurance companies are legally required to accept any applications, regardless of a person's age, financial situation or existing health.
All persons must be insured in their own right, irrespective of their age and family situation. Any dependants, such as spouses or children, must have their own insurance policy.
All insurers are required by the FOPH to provide the same benefits within their compulsory insurance coverage. These include:
- medical treatment
- hospital treatment
- supplementary treatment
- dental treatment
Note: restrictions and limitations to the extent of coverage apply to several of these categories.
A specific list of treatments which are covered by basic medical insurance does not exist under the Swiss healthcare system. Instead, the system operates according to the “effectiveness, appropriateness and efficiency” of each individual proposed treatment. In general, most routine treatments, as well as any treatment prescribed by a physician or received in an emergency situation, is included in the basic health insurance cover.
- maternity benefits (including prenatal scans, antenatal classes, delivery, postnatal check-ups, breastfeeding assistance and midwife provision)
- preventative medicine, such as basic recommended vaccinations
- routine checks (for example, mammograms and smear/pap tests), which are always provided for through compulsory health insurance
Wherever possible, it is a legal requirement that the patient be informed if they are required to personally finance any part of their medical treatment.
All disputes over the coverage of medical care under basic health insurance will be investigated by an external commission.
- For detailed information on what is included in the compulsory basic health insurance scheme, from the Federal Administration
Patients are reimbursed for their stay in hospital, provided that the hospital features on the list specified by their particular insurer. If there is an urgent reason why a patient must visit a hospital not on their prescribed list, the costs will still be covered through basic insurance. If no such reason exists and the patient chooses to receive treatment in a different hospital, they are required to cover any costs exceeding those which would ordinarily be paid by the insurance company themselves.
Basic medical insurance covers a patient’s stay and treatment in a general ward only. Again, if the treatment exceeds that which is included under the compulsory insurance, or if the patient requires a semi-private or private room, additional insurance cover is required.
Coverage for hospital care lasts for an unlimited duration, however, patients who do not live with any other member of their family will be required to pay a set fee each day for their accommodation (this excludes patients receiving maternity care).
If an ambulance is required, the insurance company is liable for half the cost of the transport under basic health cover and the patient is responsible for the remaining half. Reimbursement is only valid up to CHF 500 each year. A similar policy applies if a patient needs emergency rescue, for example if an accident occurs in the mountains (or similar). In this case, reimbursement is valid for up to CHF 5,000 per year.
Some supplementary treatments, such as chiropractic consultation, diabetes counselling and speech therapy, are covered by compulsory health insurance. Reimbursement for supplementary treatment is only available to a limited extent and following certain requirements, such as referral by a general practitioner.
The cost of certain medicines, prescribed by a healthcare professional, is reimbursed according to the compulsory health insurance scheme. Others are chargeable to the individual.
- Visit BAG for a list of the medications for which separate tariffs are applied (PDF in French, German and Italian)
Dental treatment, such as orthodontics and fillings, is not covered under compulsory health insurance. Only where dental intervention is seen as vital to the overall health of the patient, and where the ailment can be described as unavoidable on the patient's part, is treatment reimbursed through basic insurance. All other treatment requires additional insurance or private consultation and is funded by the patient themselves.
There are provisions to help people fund compulsory health insurance, which can prove very expensive. For situations where the cost of health insurance makes up over 8 percent of the individual's income, cash subsidies are available. It is estimated that more than a third of all families in Switzerland receive help with the payment of their health cover.
- For more information about assistance with healthcare costs, specifically the reduction of insurance premiums for certain individuals, visit KVG
Only basic cover is compulsory by law, however there are several options for those who desire supplementary health insurance. Any extra insurance that the patient wishes to take out will be entirely funded by the patient themselves.
In the case of additional medical insurance, patients are free to choose an insurance company that is not registered with the Federal Office of Public Health (FOPH), although most of those acknowledged by the government as providing the required basic health cover also offer supplementary insurance.
- CH have more information