5 Important Facts Most Expats Do Not Know About Swiss Health Insurance

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5 Important Facts Most Expats Do Not Know About Swiss Health Insurance

When making the decision to move to Switzerland, the healthcare system ranks high on the list of positives for expats looking into the pros and cons of their new adoptive country. And although health in general is one of the most important things in life for most of us, only few of us really know what our health insurance policies cover us for.

This article looks at some important facts that should not be overlooked when choosing the level of your Swiss health insurance cover.


1.    Compulsory health insurance cover – what are the options?

There are 4 main different options that you can look at when choosing the compulsory health cover, listed below in an approximate order of premium cost, from highest to lowest; the last 3 are generally referred to as special forms of compulsory insurance and they are more restrictive compared to the standard model.

  • Standard model – you have free choice of doctor across Switzerland
  • Family doctor – you must choose a GP from a list recognized by your insurer and any treatment must first be discussed and agreed with your GP.
  • HMO (Health Maintenance Organisation) – only available in large cities, you must first consult a doctor in a Health Centre
  • Telmed – people insured under this form must ensure that before seeing a doctor or going to a hospital, they obtain health advice from the insurer’s medical call centre

  2. Basic health care insurance – covered for all eventualities?

Not quite.  There is no doubt that the basic health insurance in Switzerland is of very high standard. When illness strikes however, we all want the best level of care there is.

So, what are you not covered for on the basic health insurance?

  • Medical transport – the basic insurance only offers a contribution towards medical transport such as ambulance or helicopter of 50% and only up to CHF 500. To put things into perspective when it comes to medical transport, it costs approx. CHF 2,500 for a helicopter to start  and CHF 180 per minute thereafter.
  • Drugs – the basic insurance covers only drugs recognised by Swissmedic and because the approval process generally takes a long time it is unlikely the latest drugs make it on this list.
  • No free choice of hospital and doctor – the basic insurance only covers hospitalization costs in the canton of residence, in a general ward and with no free choice of doctor.

These are just a few examples of gaps in the basic health insurance however insurance companies do offer supplementary products that help address these gaps and can vary from covering the basics to providing the best health care options there are.

 3.    Do higher basic insurance premiums translate into better health cover?

Myth. The basic insurance provides the same cover for everyone, regardless of the insurance provider. And yet, premiums for basic insurance can differ quite significantly from one insurer to another. Although it’s no secret, very few people know the reason for this: by law, all insurance companies must balance their books when it comes to the basic health insurance, meaning they can not make a profit or a loss; the premiums received must balance the claims paid out and of course some companies may have higher claims than others, hence having to charge higher premiums for the basic cover. It’s as simple as that.

Based on the above, you may draw the conclusion that going with the cheapest provider for your basic insurance may be the most advantageous option but a lot of expats look at other important factors as well, such as the level of service the insurance company provides, whether they provide information and support in English or whether their supplementary health insurance products tick all the relevant boxes in terms of comprehensive health cover.

 4.    Frequent travel abroad – adequately covered?

The basic health insurance does cover costs for medical treatment abroad but only in case of an emergency, and as per bilateral agreements in place with the EU and EFTA.  If you and your family travel frequently outside of the EU, whether for work or holidays, it is highly unlikely you are adequately covered by your basic insurance. To address this gap, most Swiss insurers do offer supplementary insurance with various degrees of worldwide cover, some not only covering emergency situations but also elective treatment abroad with free choice of doctors and hospitals.

5.    Rewarded for keeping fit?

Not on the basic health insurance. However, some health insurance providers do offer supplementary insurance that contributes various percentages towards alternative medicine as well as preventative measures, amongst them being contributions towards gym memberships. Before taking out such insurance, make sure you check first that your gym is on the list recognized by your insurer (the larger fitness centres are generally included in this scheme). You are required to submit the gym contract and proof of membership payment as well as a specific form provided by the gym.

If you would like to know more about Swiss health insurance and supplementary cover options, get in touch and we will be happy to help.