Switzerland - Social sickness insurance
In Switzerland, social sickness insurance includes compulsory health care insurance, covered in this chapter, as well as an optional insurance for daily allowances (see the Chapter on Optional insurance for daily allowances).
In what situation can I claim?
Compulsory health care insurance is in principle mandatory for anyone living in Switzerland, regardless of their nationality.
You need to insure yourself with an authorised health insurer of your choice (see the list of authorised insurers). The insurance is individual.
If you move to Switzerland, you need to take out insurance within 3 months of your arrival so that the insurance takes effect from the date of you taking up residence.
In exceptional cases, you may be excluded from compulsory insurance or you may submit a request for exemption.
What conditions do I need to meet?
You need to pay the monthly premium set by the insurer that you have chosen. Note that insurers must set a lower premium for children (<18 years of age) and for young adults (<25 years of age); the premium for children must be lower than the one for young adults.
If you are on a low income, you may under certain conditions benefit from a reduction in your premium (the system is organised at a cantonal level. See the list of competent institutions).
The sickness insurance provides cover in case of sickness, maternity or accident for people who are not, or not fully, covered by accident insurance (see the chapter on Accident insurance).
What am I entitled to and how can I claim?
The reimbursement of health care is guaranteed by law in case of sickness, maternity or accident (in the alternative). There is a catalogue of benefits and all health insurers must cover the same benefits, provided that they are effective, appropriate and economical:
- General benefits, particularly:
- examinations and treatment of out-patients, in a hospital or in a medico-social establishment, as well as care in the hospital provided by doctors or on their orders;
- analyses, medication, diagnostic and therapeutic services and equipment prescribed by a doctor;
- rehabilitation measures carried out or prescribed by a doctor;
- stays in hospital on the general ward;
- contribution to the cost of spa treatment prescribed by a doctor;
- contribution to transport or rescue costs considered medically necessary;
- contribution to out-patient care, provided on the basis of a medical prescription;
- acute and transition care after a hospital stay, for 2 weeks.
- Prevention measures: certain screening tests and preventive measures (vaccinations, examinations, etc.).
- Maternity-specific benefits: particularly, check-ups during and after pregnancy, delivery at home, in hospital or in a birth centre, and the assistance of a doctor or a midwife, care and stay of the new-born at hospital.
- Dental care due to a serious disease of the mastication system or due to another serious disease.
If in doubt regarding the reimbursement of treatment, contact your insurer if possible for further information before undergoing treatment.
It is also possible to take out supplementary private-law insurance for benefits not covered by the compulsory health care insurance.
Your insurer covers the medical costs, less a participation by you as the insured person.
This participation to the costs consists of two elements, the excess (fixed amount) and the share of costs:
|
Insured person: |
Ordinary excess: |
Share of costs: |
|
Adult |
CHF 300 per year |
- in general 10% of costs above the excess - up to CHF 700 per year |
|
Child (0-18 years) |
exempt |
- in general 10% of costs - up to CHF 350 per year; CHF 1,000 for several children in the same family |
In case of hospitalisation, insured persons aged over 25 years pay an additional daily contribution to the cost of their stay (CHF 15 per day).
No participation to the costs can be required for the specific maternity benefits, nor in case of medical treatment to women between the 13th week of pregnancy and the 8th week following delivery.
Jargon busters
- Health insurers: insurers which provide compulsory health care insurance. They do not make any profit and must be recognised by the Federal Office of Public Health. They may also provide supplementary insurance. See the list of authorised insurers.
- Premium: the premium is individual. It is not income-dependent and varies by canton and from one insurer to another. It must be paid in advance to the health insurer, in principle every month. Children (up to 18 years of age) and young adults (up to 25 years of age) benefit from lower premiums.
- Supplementary insurance: the supplementary insurance, which is optional, covers specific needs (semi-private or private ward in a hospital) or additional benefits (care provided by naturopaths, osteopaths, standard dental treatment). It is governed by private law and therefore the insurer is not compelled to insure you.
Know your rights
The following links provide additional information about your rights. They are not European Commission sites and do not represent the view of the Commission:
- Federal Office of Public Health (FOPH) website
- An overview of the compulsory health care insurance
- Premium calculator on www.priminfo.ch/
- Federal Law on Sickness Insurance (LAMal)
European Commission publications:
Who do you need to contact?
Federal Office of Public Health (FOPH)
3003 Berne
Tel. +41 584622111
Sickness insurance ombudsman (mediator)
Morgartenstrasse 9, case postale 3565
6002 Lucerne 2
Tel. +41 2261011 / 10 / 12 (telephone helpline from Monday to Friday from 9.00 to 11.30. Advice and mediation in case of a dispute, no advice given on insurance in general)