Swiss health insurance in a nutshell

Which health insurer is best for me and how can I obtain optimal cover in the event of illness? When should I opt for a high deductible? And when for a low one? Which insurance model is right for me? Swiss Life gives you the most important health insurance information easily and conveniently.

Health insurance in Switzerland

The health insurance system in Switzerland consists of two parts: basic insurance and various supplementary insurance policies. You can adapt your health insurance to your individual needs.
 

What do I need to know about basic insurance?

• If you live or work in Switzerland, you must take out basic insurance.
• Health insurance is freely selectable – you can decide which provider is the right one for you. 
• The premium calculator provided by the Federal Office of Public Health (FOPH) can help you compare the basic insurance policies available from different health insurers.
• Health insurers cannot refuse to offer people basic insurance.
• You can change your basic insurance provider in any year until the end of November. Here it is important that the notice of termination has been received on the last working day in November.
• Premiums vary among providers, however the benefits under basic insurance are the same for all basic insurance providers. The amount of your premium depends on where you live, your age, the insurance model and deductible.
• Illness, accident and maternity are covered by basic insurance. If you work more than eight hours a week for the same employer, you are also insured for occupational and non-occupational accidents. Additional accident cover via basic insurance is then not necessary.
  

What’s a deductible?

The deductible is part of the cost-sharing amount that every adult in Switzerland must pay towards their treatment costs each calendar year. People can choose a deductible of CHF 300, 500, 1000, 1500, 2000 or 2500. That means insured persons take care of at least the first CHF 300 up to a maximum of the first CHF 2500 of their treatment costs per calendar year.

What is the benefit of a high deductible?

The higher the deductible, the lower the insurance premium. Do you feel as fit as a fiddle and expect not to need much medical care? If so, you should choose a higher deductible and save on your monthly premiums.

But be careful: always keep something in reserve just in case. If you unexpectedly find yourself going to the doctor more often, you need to be able to comfortably cover the deductible.
 

What is the excess?

The excess is the second part of the cost-sharing amount and becomes due as soon as you reach the deductible limit you have selected during a calendar year. From then on, you will only pay 10% of your treatment costs, up to a maximum of CHF 700 per calendar year. This excess is the same for everyone – regardless of their deductible.

How can I change my health insurer?

To change your health insurer (basic health insurance), you must terminate your current insurance by no later than 30 November of the current calendar year. Here it is important that your insurer receives the notice of termination by the last working day in November. The best way to do this is by registered letter or A-Post Plus (priority) so that you have proof that you have met the legally stipulated deadline. Some health insurers also accept a notice of termination by e-mail. Contact your current insurer for more information on this.

In addition to changing health insurers, it is also possible to change your deductible or insurance model. An adjustment or reduction of the deductible must be reported by 30 November, an increase in the deductible by 31 December. Again, the notice of any change must be received by the last working day of the month. Any changes in insurance model, for example from the family doctor model to the Telmed model with an existing insurer, can generally be made as of 1 January. Here, too, notice must be given by the last working day of the month. Some insurers also allow changes to be made during the year; you should check your insurance conditions for more information on this.
 

What is the right insurance model for me?

There are different types of mandatory basic insurance:

Free choice of doctor (outpatient)

As the name suggests, with a free choice of doctor, you can choose which doctor you would like to go to. This is only the case for outpatient treatment, not inpatient treatment. For example, if you have acute headaches, you can go straight to a specialist.

Advantage: no other insurance model is more flexible. With a free choice of doctor, you have free access to any doctor for outpatient treatment.
Disadvantage: the free choice of doctor is the most expensive option.

HMO model

HMO stands for “Health Maintenance Organisation”. With this insurance model, you must always first consult a specific HMO practice if you are ill. Exceptions include emergencies, annual gynaecological screening and check-ups by the eye doctor.

Advantage: you benefit from a high premium discount.
Disadvantage: your choice of doctor is limited.

Family doctor model

Do you like your family doctor and always want to visit them first before you go to another specialist? If so, the family doctor model is the right choice for you. Here, too, treatment when abroad, emergencies, annual gynaecological screening as well as check-ups by an eye doctor are exceptional cases – otherwise you are obliged to always first consult your family doctor if you are ill.

Advantage: you benefit from a high premium discount and have a fixed point of contact who you can trust.
Disadvantage: not all family doctors may be eligible – the health insurance company also has a say.

Telmed model

Do you value flexibility and would like to receive help quickly regardless of a doctor’s opening hours? Then the Telmed model is the right one for you. If you have any problems, the first thing you do is to call a medical hotline. They will give you advice and recommend what to do next. If your condition does not improve, you can go to a doctor or seek emergency treatment in hospital.

Advantage: this is another way of saving on premiums. And you can be flexible and request a medical consultation around the clock.
Disadvantage: remote diagnosis is often difficult. There is no fixed medical point of contact and no fixed family doctor.

Our advice:

Insurance providers allow you to consider other models; take the opportunity to find out more about this in a personal consultation.
 

What should I know about supplementary insurance?

In addition to mandatory basic insurance, you can supplement your health insurance with a range of supplementary insurance policies designed to suit your lifestyle and needs.

The most important points to consider:

• Supplementary insurance offers complete coverage with outpatient and supplementary hospital insurance.
• Supplementary insurance is voluntary.
• A medical examination is performed prior to the conclusion of supplementary insurance.
• Take out supplementary insurance when you’re fit and free of ailments – otherwise you may have difficulty being accepted.
• Supplementary insurance providers are allowed to reject you: if you are already ill, you may be rejected or there may be exclusions for your specific illness.
• You don’t have to take out supplementary insurance with your basic insurance provider. It makes sense to compare the supplementary insurance offered by different health insurers.
• Supplementary insurance complements basic insurance by insuring benefits that are not paid at all or only partly paid by basic insurance. Attractive supplementary insurance includes, for example, contributions to gym membership, visual aids, travel and protective vaccinations and much more besides.
• The notice periods vary depending on the health insurer and the insurance contract, but as a rule they are three months. Notices of termination should always be received by the health insurer by registered post and on time.
• Before terminating your supplementary insurance, you must make sure that you have been accepted without reservation with another insurer. Only then are you guaranteed the insurance cover you require. In this regard, please take note of the notice period. In most cases, supplementary insurance must be terminated by the last calendar day in September.

The Swiss healthcare system offers many options for adapting health insurance to your needs and lifestyle in a financially self-determined manner. Find out what type of basic insurance and what supplementary insurance is best for you.