Choosing the right health insurance model

The most beautiful mountains, clear lakes and cities with the highest quality of life in the world - Switzerland offers countless reasons why emigrants are drawn to this country. But there are many aspects to consider. One of them is the right health insurance - because this is compulsory in Switzerland. The following lines explain which models are available, what to look out for and what differs from other countries.

The decisive factor for compulsory health insurance is the place of residence

You need health insurance in your new home country - this is mandatory, even if you still have insurance cover in your old country. This is because the Swiss Health Insurance Act (KVG) stipulates that residence is decisive: anyone who has a place of residence in Switzerland therefore needs health insurance. The law also stipulates that health insurance companies must accept every applicant.

However, the choice of health insurance company is up to you. There are around 160 different health insurance companies in Switzerland. In the basic model, they all cover the same benefits. However, when it comes to additional insurance and premiums, the benefits often differ significantly. Emigrants should therefore compare Swiss health insurance companies carefully. This is the easiest way to get an overview of the various basic insurance premiums, additional benefits and so on. There are also different models for basic health insurance (e.g. standard model, General practitioner model (GP), HMO model, Telmed model), which are worth comparing!

Note: Emigrants have three months after entering and registering in Switzerland to take out health insurance. They are then insured retroactively from the date of entry.

The Swiss health insurance model: basic insurance and supplements

Emigrants should be aware that the Swiss health insurance model includes basic health insurance but also allows for supplementary insurance. The benefits of basic insurance are relatively straightforward, so it is always worth looking beyond the end of your nose.

Basic health insurance in Switzerland

All health insurance companies in Switzerland cover the same benefits with basic insurance. In general, the benefits are similar to those of German statutory health insurance. The law stipulates that costs for illness, accidents and maternity are covered. However, basic insurance only covers accidents if no other insurance cover is available. Costs for certain preventive medical measures are also covered. As a general rule, benefits must be "effective, appropriate and economical".

This also includes, for example:

• Services in the field of anthroposophic medicine, drug therapy and traditional Chinese medicine, homeopathy, phytotherapy and acupuncture treatments
• Psychotherapy carried out by medical practitioners
• Treatments at the dentist only in an emergency
• Treatment and hospitalisation if the hospital is on the hospital list of the canton of residence
• Preventive measures only if they are carried out by a doctor and are on the list of the Nursing Benefits Ordinance (KLV)
• All medically prescribed check-ups during and after pregnancy
• Entitlement to the same benefits in EU/EFTA states

However, the amount of the insurance premium can vary from health insurance fund to health insurance fund. This is because, in addition to the standard model, there are other basic insurance models that can offer price advantages, for example by waiving the choice of doctor.

General practitioner model (GP)

• Waiver of free choice of doctor
• Except in emergencies, the family doctor must be consulted first
• Up to 20 per cent discount possible compared to the standard model

HMO model

• Obligation to first select a practice of the Health Maintenance Organisation (HMO)
• Except for emergencies, gynaecological check-ups or eye examinations
• Up to 25 per cent discount possible compared to the standard model

Telmed model

• First a telephone consultation, then a selected visit to the doctor following a decision by the medical staff
• Works very cost-efficiently
• Up to 20 per cent discount compared to the standard model

Note: The services must be provided in the same canton as your place of residence. Otherwise the health insurance company may not cover the costs - emergencies are exceptions!

When it is possible to change basic insurance

However, once you have decided on a health insurance company, you do not have to stay there. It is possible to change basic insurance at the end of a calendar year. However, a cancellation period of one month must be observed. In some cases, it is also possible to switch on 1 July, but then a notice period of three months applies!

Supplementary insurance in Switzerland

If you would like more benefits in Switzerland, you can take out supplementary insurance. This includes, for example, dental services, alternative medicine, glasses and contact lenses as well as the desire for a single room during hospitalisation. The benefits offered by the various insurers differ considerably here - so it is essential to compare them carefully beforehand.

In contrast to basic insurance, there is no obligation to accept an applicant for supplementary insurance. Swiss health insurers scrutinise applicants carefully, particularly with regard to their state of health. It is therefore advisable to take out supplementary insurance as early as possible. Only expectant mothers do not have to undergo a health check at the time of prenatal registration.

Costs and co: excess and deductible

One major difference to German insurance is the cost model. In Switzerland, employees and employers do not share the costs. Every insured person has to pay the premiums themselves. In addition, insured persons must contribute to their own healthcare costs. This cost sharing is called a deductible in Switzerland. The amount of the deductible is between CHF 300 and CHF 2,500 and determines up to what point the insured person pays themselves and from what point the health insurance company takes over.

This means that anyone who agrees a deductible of CHF 300 and has annual costs of CHF 800 will only be reimbursed benefits worth CHF 500. There is also a deductible of 10 per cent for treatment and medication costs - but this is capped at a maximum of CHF 700 (CHF 350 for children). A contribution towards hospitalisation costs may also be possible (CHF 15 per day).

The amount of the deductible varies according to place of residence, doctor model and age. Salary, on the other hand, plays no role in the Alpine country. In addition, there is no family insurance - everyone has to take out health insurance individually. However, lower contribution rates apply for children and young people.

Please note: The various insurers also differ in their billing systems and repayment times.

Summary: Comparison is important!

If you live in Switzerland, you must take out health insurance there. Although the basic benefits are the same, it is worth making a comparison. This is because different models, different franchise limits and also supplementary insurance can result in different costs. However, thanks to the different offers, customised cover is also possible in Switzerland.

How informative was this text?