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Basic Swiss health insurance

Basic Swiss health insurance

Basic Swiss health insurance

Having Swiss basic health insurance is essential to accessing healthcare in Switzerland. Health insurance is mandatory for all residents and is required in order to obtain a Swiss residence permit. The cost of basic insurance varies by a number of factors, including your age, your county of residence, and the type of cover you choose.

Basic insurance is given out by over 50 regulated insurance providers who must give you health insurance if you apply for it. Hospitals in Switzerland are all private institutions that are regulated by the government. They receive income by treating insured patients and use the money to maintain the health service.

Who needs basic health insurance in Switzerland?

Every resident must have basic health insurance in order to keep living in Switzerland. There are no exceptions to this, and health insurance must be purchased for all members of the household. Failure to purchase health insurance in Switzerland will lead to the refusal of residence permits and could result in you paying the full cost for any medical treatment.

Who pays for Swiss basic health insurance?

Basic health insurance in Switzerland is paid for by individuals instead of a direct contribution through taxation. This type of insurance allows you to access the healthcare system without incurring the large costs associated with medical treatment.

Cost of basic health insurance in Switzerland

The idea behind basic health insurance is that all Swiss citizens deserve a minimum level of medical care, regardless of who they are. This is reflected in the fact that previous medical conditions, race, and medical records are not taken into account when calculating your insurance premium. When deciding the cost of basic health insurance, insurers consider:

  • The age of the applicant; if you are 25 or younger you may receive a discount. Seniors who claim their pension will always receive full coverage.
  • The amount you have selected as your deductible. Typically, the higher the deductible, the cheaper the premium.
  • The type of basic health insurance you choose.
  • Your county (canton) of residence.

Basic health insurance providers in Switzerland

Every health insurance company must provide a type of basic health insurance to anyone who wants it. Although prices are capped and regulated by the government, there is still a large variation in cost, which reflects the diversity of coverage being offered. Some of the most well-known insurance providers are:

  • Helsana
  • CONCORDIA
  • Groupe Mutuel
  • SWICA
  • Visana
  • Sympany
  • Vivacare
  • CSS

Guaranteed treatments under Swiss basic health insurance

Swiss basic health insurance is designed to guarantee a basic level of care that would be provided under a state system of healthcare. This entitles you to the following:

  • Visits to a doctor or general practitioner.
  • Treatment in a Swiss hospital in your county of residence using general admissions.
  • Outpatient care such as examinations, physiotherapy, psychotherapy and nursing care.
  • Full coverage of medical costs abroad, up to twice the price of a similar treatment in Switzerland.
  • Half of the transport costs from any emergency services used, up to 5.000 Swiss francs.
  • Alternative medical treatments such as acupuncture and homeopathy as provided by pharmacies in Switzerland.
  • Any medication that is on the official health ministry approved list.
  • Certain vaccinations and preventative medicine such as for hepatitis B and child immunisations.
  • Prenatal care when giving birth, and postnatal care for pregnancy.
  • Essential dental care if it is part of another medical procedure.

Types of basic health insurance in Switzerland

As of quite recently, you are now able to choose different types of basic health insurance in Switzerland. The different types change the way you access Swiss healthcare, particularly in the first stage of seeking medical attention.

Alternate models of cover are usually up to 20 percent cheaper than the standard form of insurance but do provide barriers that, for instance, prevent you from accessing your doctor immediately. Some insurance providers offer different combinations, with some using a hybrid system of basic health insurance that includes different parts of each system.

Standard basic insurance

Standard basic insurance is designed for those who want easy access to their general practitioner or to a specialist. With this system, you can access your GP freely and independently seek a specialist with the consent of your doctor. This is the simplest system and is the same regardless of insurance provider.

Family doctor model

If you have a doctor in mind that you would like to be your GP, the family doctor model allows you to retain your previous physician without any extra cost. Under this system, you must always in the first instance seek the advice of the GP you have selected. You are unable to look for a specialist independently, but must first be referred to a specialist by your GP.

Additionally, your GP might not be available on certain insurance providers, so do check with the insurer you are applying to as to whether your preferred GP is available. This system is usually 10 to 20 percent cheaper than standard insurance.

Health centre model (HMO)

The Health Maintenance Organisation or HMO is where you select a specific facility to go to should you need medical help. This can be a hospital, pharmacy or GP’s office. If you have signed up for HMO, you must attend your chosen facility to receive medical help. HMOs traditionally have a wider range of doctors available to consult and, if a hospital is chosen, you can access a wider range of specialists, provided you are given a referral. This system can be up to 25 percent cheaper than the standard model.

Medical helpline model (Telmed, CallMed)

The medical helpline model is a system whereby you consult a medical phone line as your first point of contact if you become unwell. This system only allows for appointments with your GP after a consultation with a helpline.

During this call, they will assess your condition and determine whether you require any medical assistance. The helpline is free, open 24 hours a day and can be accessed via mobile phone or phone line. Should you require immediate medical assistance, you will be referred to a specialist. Typically, medical helpline models allow for a free choice of doctor after your phone consultation and can be up to 25 percent cheaper than the standard model.

Switching Swiss basic health insurance

Changing basic health insurance is designed to be as user-friendly as possible in order to make sure you are always getting the best deal. It is recommended to check annually whether you can get a better deal with a different provider. The process of switching basic health insurance can be done in under two months.

What you need to change basic health insurance in Switzerland

In order to change basic health insurance, you will need to sign a contract with your new provider and let your previous insurer know before November 30. This allows you to switch suppliers for the next year. For this you will require :

  • A signed contract as provided when you applied for your new health insurance
  • A cancellation form from your previous insurer or from a price comparison website
  • Your previous social security number

As long as you submit your cancellation form before the November deadline, your insurer will change from January 1 of the new year and you will be charged the new rate from then.

Do children need Swiss basic health insurance?

It is mandatory for children to have at least basic health insurance. If you have had a child in Switzerland, you will need to take out health insurance on their behalf. Basic health insurance for children is typically much cheaper than adult health insurance and can cover dentistry treatments such as orthodontist appointments.

Health insurance while on Swiss social security

If you are claiming social security in Switzerland, you will still be required to pay for health insurance yourself. If you are on unemployment benefits or on welfare, you will be ordered to request a lower premium from your insurance provider and remove any excess benefits deemed to be unessential. 

Access to more benefits than Swiss basic health insurance

If you would like to receive more benefits than those covered by Swiss basic health insurance, such as gym discounts, access to all hospitals in Switzerland and domestic help, you should apply for supplemental health insurance. This insurance is taken alongside basic health insurance and can provide lots of additional benefits. It can also give you greater coverage and compensation should you be injured abroad or in a different canton.

Health insurance cards in Switzerland

As part of all health insurance packages, you will receive a health insurance card. This is the card that you must provide to your doctor and hospital whenever you receive medical help. The card is chipped so that hospitals can easily charge your insurer for medical expenses. It also shows your AHV number that is used to claim social security.

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