Mandatory basic insurance
Health insurance is mandatory in Switzerland. Employees are required to take out health insurance themselves as quickly as possible (starting date: date of taking residence), covering basic outpatient and inpatient medical care in the event of illness, accident, and maternity. This also includes foreign nationals with residence permits of at least 3 months.
Cross-border commuters residing in Germany, Austria, Italy or France have the right to choose whether they want to be insured in Switzerland or in their home country. This right of choice also applies to non-employed family members. Within 3 months from the validity of the cross-border commuter permit, the persons concerned must decide in which country they wish to join a health insurance scheme.
Cost sharing basic insurance
Services are subject to co-payment by policyholders. This comprises:
- Standard deductible: CHF 300 per year. Children and adolescents under 18 are exempt.
- Retention fee: 10% of the costs exceeding the deductible, up to a maximum of CHF 700 per year (CHF 350 for children and adolescents under 18).
- Contribution to the costs of a hospital stay: CHF 15 per day. Children and adolescents under 18, young adults up to the age of 25 in education/training, and women receiving maternity-related services are exempt.
The benefits of the basic insurance
- Examinations, treatment and care provided by physicians, chiropractors, midwives and persons acting on a physician's orders (for example, physical therapists, nurses).
- Medically prescribed medications (according to the list of specialties) and laboratory tests.
- Unlimited stay in the general ward of a hospital according to the cantonal hospital list (max. cost coverage at the tariff of the canton of residence).
- Maximum of double the costs of what the same treatment would have cost in Switzerland.
- Contributions to medically necessary transport (50% of the costs, max. CHF 500 per year) and rescue measures (50% of the costs, max. CHF 5000 per year).
- Seven check-ups during pregnancy, two ultrasound examinations and one follow-up examination, birth preparation course (150 francs) and three breastfeeding consultations.
- Contributions, for example, for vaccinations (no travel vaccinations) and gynecological examinations (once every three years) as well as, under certain conditions, for mammograms.
- Treatments carried out by a doctor which the legislator considers to be effective, expedient and economical.
- The basic insurance covers the costs of psychotherapies according to methods whose effectiveness has been scientifically proven, if ordered by a doctor.
Spitex, nursing home
- Cantonally varying contributions to care services at home (Spitex) or in a nursing home, no coverage of costs for household help (for cooking, cleaning, etc.) and for accommodation in a nursing home.
- Coverage for dental accidents, severe diseases of the masticatory system (if these were unavoidable), dental damage as a result of a severe general illness, no coverage for caries damage and wisdom teeth ; coverage of costs for corrections of tooth position only in case of severe disfigurement.
- Contributions to means and objects used for examination or treatment (for example, contentation devices, blood glucose meters).
- Full assumption of costs in the general ward of a rehabilitation clinic in the canton of residence, if prescribed by a doctor and if the need for hospitalization is proven (obtaining a cost approval prior to admission to the clinic is strongly recommended).
- Contribution of CHF 10 per day for a maximum of 21 days to medically prescribed spa treatments.
Employees and members benefit from collective discounts on additional insurances, these include interesting sports allowances (fitness, yoga, dancing, tennis, massage, nutritional counseling, swimming) of up to CHF 500. The offer also includes other insurances such as personal liability, household, car and life insurances, as well as discounts up to 25%.
Supplementary insurances can be divided into two categories: outpatient supplementary insurances and hospital supplementary insurances.
Outpatient supplementary insurances
- The outpatient supplementary insurances are, for example, supplements for alternative medicine, non-mandatory medication and psychotherapy by psychologists without medical training. Furthermore, insurances are offered for:
- Preventive health measures such as subscriptions to fitness centers, indoor swimming pools, etc.
- protective and travel vaccinations
- spa and recreational cures
- Home health care and home help
- eyeglasses and contact lenses
- Emergency and transfer transport as well as rescue and recovery costs
- Dental treatment costs, corrections of the position of teeth and measures of oral surgery
- Treatment abroad (also temporary for vacation stays)
- All these benefits are usually limited to a maximum amount per calendar year.
Supplementary hospital insurance
- Supplementary hospital insurance covers inpatient services. With some insurance models, the choice of hospital is limited to a list provided by the insurance company, which leads to lower premiums.
- With the supplementary insurance semi-private ward whole Switzerland, the insured person is entitled to the payment of a two-bed room. In the hospitals, the senior physician is usually responsible for the treatment of the semi-private insured.
- In the case of supplementary insurance private ward all Switzerland, the insured person is entitled to payment of a single-bed room. In hospitals, the head physician is usually responsible for the treatment of the privately insured.
- Flex models: Variant of the supplementary hospital insurance. The choice of hospital ward is made only upon admission to the hospital. For the general ward of the whole of Switzerland, this supplementary insurance covers the full costs. For the semi-private or private ward, the insured shares in the additional costs to the extent determined by the health insurance company.
- Hotel models offer the comfort of a 1- or 2-bed room without free choice of doctor.
- The supplementary insurance general ward whole Switzerland covers any additional costs in the event of a hospital stay outside the canton of residence. The new hospital financing system has been in effect since January 1, 2012. Since then, hospital stays outside the canton are fully covered by the basic insurance and the canton of residence if the hospital is on a hospital list and the costs (flat rate per case) are not higher than in the canton of residence. If the flat rate per case is higher than in the canton of residence, they are borne by the patient or his supplementary insurance. Especially for residents of cantons with low hospital costs who want to be treated outside the canton, the supplement can still be worthwhile. As before, treatments that cannot be carried out in the canton of residence (e.g. transplants) or if it is an emergency will be paid for by the basic insurance.
The premiums are tiered according to the age of the insured person and their place of residence.