It’s health insurance season. Average premiums are increasing in 2018. Compulsory basic Swiss health insurance can generally only be changed once a year. To change you must notify your current provider by 30 November. This article explains the basics of Swiss health insurance.
1. How does Swiss healthcare work?
Basic health insurance is compulsory in Switzerland and governed by federal law called LAMal. This law aims to ensure high quality health care for everyone, subsidise those who cannot afford it and control costs. LAMal defines compulsory basic universal cover, ensures providers are financially robust and imposes risk sharing by limiting premium discounts and requiring insurers to accept all-comers regardless of their health.
2. How does Swiss healthcare compare to other countries?
Swiss healthcare is of a high standard but comes at a high cost. Switzerland sits in second place behind the United States on share of national income spent on health. In 2013, spending on health was 11.1% of Swiss GDP compared to 16.4% in the US. The OECD average was 8.9%.
Costs continue to climb despite federal government attempts to control them. In 2012 costs rose by 3.5%. In 2013 Switzerland’s health costs increased 1.9%, twice the pace of the OECD average, to reach an average annual cost of CHF 6,200 per person, including premiums and government spending – 66% of the total. The OECD average was CHF 3,384.
Health insurance premiums are rising in line with costs. 2016 saw average health insurance premium increases of 4% nationally with some rising by over 20%. The average increase in 2017 was 4.5%. The chart above shows average Swiss health insurance premium increases since 2006. The average premium has risen by 40% over this ten-year period.
3. Who pays for healthcare in Switzerland?
Costs are covered by the government via taxes, and by individuals via health insurance premiums.
In 2016 the Swiss canton of Vaud spent 15.6% of its total budget on healthcare – a total of CHF 1.4 billion or around CHF 1,900 per person.
4. What does Swiss health insurance cover?
There are two types of cover. The first is basic compulsory cover. This breaks down into cover for illness and accidents. Standard policies cover both. Those with accident insurance as part of their employment are able to opt out the accident element and reduce their premium.
The second type is complementary or supplementary cover. This is optional and includes optional coverage for range of treatments not covered by basic insurance. It can also cover risks not covered by basic policies.
- Basic cover
Basic healthcare covers basic healthcare and hospitalisation in your canton of residence.
- Complementary insurance cover
Complementary insurance covers a wide range of care not covered by basic insurance, including dentistry, alternative medicine, prenatal care, travel insurance, enhanced hospital care, loss of earnings and lump sum payments if you are unable to work. Complementary insurance is separate from basic insurance even when bought with basic cover.
5. Is health insurance compulsory?
You and every member of your family must have his or her own basic cover. Click here for detailed information.
If you fail to insure yourself within three months, the canton will chose a provider for you and you will be sent a premium bill by the provider. Cover and premiums are backdated to the beginning of your residence.
There are some exceptions. For example if you have alternative cover that provides better coverage than any Swiss insurance you can be exempted upon approval. Click here for further exemptions.
6. Are insurance plans and prices the same across all of Switzerland?
No. Prices and plans vary depending on your canton of residence. This is because cantons have different health infrastructure and levels of cantonal government funding. Cantons can also be divided into zones with different premiums. Swiss cantons with mountains are reputed to have more active and healthier residents and sometimes have lower premiums.
7. Does basic insurance cover all medical expenses?
No. You are charged 10% of the costs. This can rise to 20% at the pharmacy if you choose a branded drug when a cheaper generic alternative is available. Click here for a list of these drugs.
Above a certain level of annual expenses, the 10% contribution does not apply. The maximum amount of this contribution is CHF 700 for adults and CHF 350 for children. Once annual medical expenses exceed the deductible by CHF 7,000 for adults and CHF 3,500 for children the 10% contribution stops.
An exception is made for expectant mothers who are not required to pay this 10% from the 13th week of pregnancy until eight weeks after birth. In addition, there is no 10% contribution requirement for normal pregnancy specific costs covered by basic insurance at any time.
Some treatments are not covered. The government decides what must be covered by basic health insurance.
8. How does medical expense payment work?
It depends. If your insurance provider has set up a direct payment process with the medical provider then the insurance company will pay directly and send you a bill for 10% of the cost. If no such arrangement exists then you will be required to pay yourself and claim 90% of the cost back from your insurance company.
9. Can I choose any insurance company?
You can choose any approved Swiss health insurance company. A list of approved insurers can be found here.
10. Do I need to fill out a health questionnaire? Can my application be rejected?
Not for basic cover. There is no questionnaire and your application must be accepted. Applications cannot be rejected based on age or state of health. Complementary cover is different. Insurers can request health information and reject your application.
11. Can I change basic health insurance provider?
Every insured person has the right to change the provider of his or her basic compulsory health insurance at specific times every year. Insurers must tell their members what next year’s premiums will be by 31 October. Members then have until 30 November to cancel their insurance contract. If an existing contract is not cancelled it automatically continues. Some get the opportunity to change on 1 July every year. Click here for more information on how to change.
12. Who provides health insurance and how can I compare?
13. What can I do to reduce the cost of Swiss health insurance?
- Pay in advance. Most companies offer a discount for this, typically 2% if you pay the full year up front instead of monthly.
- Increase the deductible. You can choose deductibles of CHF 300 and CHF 2,500 on an adult policy – a minimum deductible of 300 must be selected. Deductibles for children range from zero to CHF 600. The deductible is the amount you’ll need to pay before insurance payments kick in. If you think you are unlikely to visit your doctor you might want to risk paying a deductible in return for a lower premium. If you are certain you’ll need treatment it might make sense to pay a higher premium instead.
- Choose a lower cost model. There are a number of models, which vary by provider. Some offer discounts for requiring you to always go to you family doctor or a multidisciplinary group of doctors under the same roof – known as a HMO (Health Maintenance Organisation), as a first step rather than allowing you to go directly to a specialist. Others require you to start with health advice by telephone or to only buy medication in certain pharmacies.
14. Does Swiss health insurance include mountain rescue?
It depends on your policy. It should not be assumed that it does. Two notable organisations in Switzerland provide discretionary cover for mountain rescue services. Click here for more information.
15. Does basic cover pay for treatments outside Switzerland?
If you are abroad temporarily in an EU or EFTA country and present your European health insurance card (credit card sized and provided by your insurance company) you will normally be entitled to a reimbursement. Click here for more information – in French.
Outside these countries emergency care is reimbursed however the cost of hospitalisation is only partially covered up to a maximum of 90% of what the same care would have cost in Switzerland. The percentage reimbursed depends on your policy.
If you have any questions let us know in the comment box below on our website and we will try to answer.