Health insurance

Health insurance is big business in Switzerland, and one of the biggest expenses for most families. Switzerland differs from many western European countries in that there’s no state healthcare, but the system is heavily regulated and, unlike in the US, no-one is in danger of being uninsured.

There are two sides to health insurance in Switzerland: the obligatory basic insurance (known as LAMal, after the law governing health insurance), and optional, complementary insurance, which can offer fuller coverage of basic healthcare as well as alternative therapies and non-essential treatments. Here we focus on LAMal since the conditions of complementary insurance vary from one provider to the next.

Who needs health insurance?

Every single person living in Switzerland is obliged to take out basic health insurance (with the exception of legitimation card holders). Consequently, insurers are not allowed to refuse you, regardless of your state of health and any pre-existing conditions.

For the purposes of LAMal, “living in Switzerland” means from the moment you actually move here, not when you receive your residence permit. You have three months from the date of your arrival to purchase your basic health insurance, and if you miss this deadline, the cantonal authority will register you with the insurer of their choice automatically.

Our top tip: The healthcare authority won’t look for the best offer or the one that best suits your needs, and you may end up with a high deductible, so make sure you choose your own health insurance before the deadline is up.

The same goes for children born in Switzerland – you must conclude an insurance contract before your baby is three months old.

Provided you take out a contract before the three-month deadline, the coverage is retroactive to the date of your arrival in Switzerland (or your child’s birth), so you will be able to claim reimbursement for treatments received during this time.

If you are a cross-border commuter living in a neighbouring country but working in Switzerland, you can choose whether to take out health insurance in your country of residence or in Switzerland.

Which provider?

The number of health insurance providers in Switzerland is huge, and the choice is yours. You can even choose to have your basic insurance with one provider and complementary insurance from another. Note that, while insurers can’t reject your request for basic LAMal insurance, they can ask you to fill in a health questionnaire before agreeing to provide complementary insurance, and they are entitled decline or exclude certain services from your contract.

You have the right to change the conditions of your basic insurance or switch to a different provider every year. Any changes must be requested between 1 and 30 November and come into effect on 1 January the following year. (The law doesn’t stipulate any deadline for amending complementary insurance contracts, but they often have a minimum contract period of several years and a long notice period for cancellation).

We work with some of the best social insurance brokers in Switzerland who can help you to find the best deal taking into account your specific requirements – contact us for more information.

How much will treatment cost me?

First of all, you will have to pay the full cost of all treatments and medications until you exhaust your deductible. The standard deductible is 300 CHF per calendar year (not per event), but all insurers offer higher deductibles up to a maximum of 2500 CHF per year with the incentive of lower insurance premiums – it is entirely up to you which deductible you choose. Note that children have no deductible.

Once you’ve reached your deductible limit, the insurer will pay 90% of all medical expenses, so you will have to contribute 10% (the co-payment or “quote-part”) up to a ceiling of 700 CHF per year (350 CHF for children). This means that the most you will pay in total on top of your insurance premiums is 1000 CHF if you choose the lowest deductible or 3200 CHF if you choose the highest.

In the event of an overnight stay in hospital, you will have to contribute 15 CHF per day.

Our top tip: All of your medical expenses – insurance premiums, deductible, co-payments, hospital stay fees and any costs not covered by your insurance (be they for non-essential treatments, special medicines or accessories such as glasses) – are tax-deductible.

What does the basic health insurance cover?

Obligatory health insurance covers essential expenses relating to:

• Illness and congenital disorders;
• Accidents, if you are not covered by a separate accident insurance;
• Pregnancy and childbirth.

N.B.: Congenital disorders and accidents are covered on a subsidiary basis, i.e. if not covered by another specific insurance such as disability benefit or accident insurance. If you are employed, your accident insurance will be provided by your employer.