Understanding the Ins and Outs of the Swiss Health Insurance System

Jörg Jörg
May 02, 2023
, 3 mins
Understanding the Ins and Outs of the Swiss Health Insurance System

Switzerland’s healthcare system is excellent, but the costs are pretty high. It is mandatory to have minimal health insurance. The Swiss Health insurance act (KVG) governs it. Healthcare administration is left in the hands of private insurers, each of which imposes a different rate based on the canton, under the direction of the Federal Office of Public Health (FOPH). Supplemental insurance that complies with the Insurance Contracts Act (VVG) may supplement mandatory health insurance advantages. They are under the direction of the Swiss Financial Market Supervisory Authority (FINMA).

Basic and Supplementary Health Insurance

Basic Insurance

Basic insurance is mandatory for all Swiss residents. It provides basic medical care in cases of illness and maternity. Accidents are covered separately by the accident insurance act and often insured with your employer.

In some cases (i.e. if you are unemployed, a child or retired) you are covered by the health insurance law.

Coverage

It covers essential medical needs such as doctors appointments, medication, therapies, etc. and guarantees your in-patient stays in a shared room in the hospital when you need them.

It also covers dental care and alternative medicine to a small certain extent. But supplementary insurance is recommended to get a solid cover in this matter.

Subordination

The cantonal authorities will automatically select your health insurance company if you don't make a decision within the three months prior to your arrival in Switzerland. This should be avoided as much as possible. A so-called forced subordination is associated with premium surcharges, and often you will not be assigned to a favourable insurance company. It will therefore be expensive in two ways.

The insured person is free to select any of the 44 insurers who are authorised to sell basic health insurance. A health questionnaire is not necessary for basic insurance, and insurers are not allowed to reject an application.

Cost

Please keep in mind that insurance premiums vary depending on the risks and expenses, which change from canton to canton. The premiums are therefore as high as the health care costs of the canton of residence. For instance, premiums in Geneva are higher than in Valais.

Termination / Changes

The basic insurance can be terminated and changed as of 01 January of each year with a notice of termination as of 30 November (1 month before expiry).

Supplementary Insurance

This insurance is personal. As a matter of fact, insurers can provide a variety of services to supplement the fundamental insurance benefits (KVG). For instance, they pay for dental work, hospital stays in double or single rooms, alternative or natural medical services, as well as the choice to receive treatment in the Swiss hospital of your choice or from the Doctor of your choice.

The insurer has the right to reject an application because this is a private contract under the Insurance Contract Act (VVG). Additionally, in order to sign up for supplemental health insurance, it is typically necessary to complete a thorough health questionnaire. Every insurance company has their particular own set of rules (underwriting guidelines) on who to accept and who to decline.

We recommend that you fill out the health questionnaire truthfully; in the event of medical treatment, the health insurance company will have access to the invoices, expert opinions, and other information. Their medically trained staff will quickly determine if you have concealed any pre-existing conditions and deny your benefits.

In the worst case, you could end up with a large unpaid bill and be charged with insurance fraud, and that's not worth it.

Coverage

You receive some benefits from supplemental insurance that are either not covered at all by mandatory health insurance or are only partially covered by it. This covers additional medical care, rest and recuperation, dental care, and preventative health measures.

Your additional health-related needs are covered by supplemental insurance. the ability to choose from a variety of insurance plans to meet different needs, the requirement in some circumstances for a health declaration, and the premium amount based on factors such as location, gender, and age.

Termination / Changes

The supplementary insurance can also be terminated or changed as of 01 January of a year. In most cases, the cancellation period runs until September 30 of the year. Some providers also use June 30.

Here it is worth taking a look at the general conditions of the provider to ensure that you have the cancellation period under control.

Do I have to have both my basic and supplementary insurance through the same insurer?

No, you are not required to purchase both your primary and secondary insurance from the same insurer. In fact, having separate insurers for primary and secondary insurance is quite common.

This is advantageous because you can freely choose your products more individually and buy them with the desired insurer for each product.

The insurers exchange information with each other and with the treating doctors, hospitals and pharmacies and are therefore very well able to coordinate their various services if you want to have separate insurance.

The advantage of an insurance for basic and additional insurance is certainly that you receive a single and clear premium and benefit statement and the company has a holistic customer image of you. This usually ensures the best possible individual customer service.

Related articles

The tax System in Switzerland - An introduction

The tax System in Switzerland - An introduction

Switzerland has one of the most complex tax systems in the world, but it's also one of the most efficient. If you're an individual living or planning to move to Switzerland, it's essential to understand how the tax system works to avoid any surprises when it comes to paying taxes.

Sandra Sandra
Apr 28, 2023
, 2 mins
Navigating the Swiss Electricity Market: Monopolies, Regulations, and What They Mean for You

Navigating the Swiss Electricity Market: Monopolies, Regulations, and What They Mean for You

Switzerland's electricity market is known for its unique mix of hydro, nuclear, and renewable energy sources. While the market is liberalised for large consumers, the residential sector is still highly regulated and operates as a monopoly. In this post, we will explore the intricacies of the Swiss electricity market for individuals, including the roles of key players, regulatory framework, and the potential opening of the residential electricity market. We will also share essential tips for individuals to make the most of their electricity needs in Switzerland.

Sandra Sandra
Apr 10, 2023
, 3 mins
View more