Brief Review

Private Healthcare System

As there is no state-funded health care in Switzerland, anyone taking up residence in the country has to acquire health insurance within three months of their arrival. You will be asked for proof that you are insured when dealing with various Swiss authorities. If you’re employed in Switzerland for more than three months and you can’t provide proof that insurance from your home country covers you, you will be required to get Swiss insurance.

There are some cases in which you may be exempted from taking out health insurance in Switzerland, for example:

• if you hold an obligatory health insurance plan in your home country that covers the same medical cost as the basic insurance plan that would cover your stay in Switzerland.
• if you’re in Switzerland due to an exchange or other international program, (i.e. for students, interns and scientists). In this case, your institution or employer has to guarantee that all medical costs during your stay in Switzerland are reimbursed, and has to pay all expenses not covered by an insurance plan.
• if you’ve been sent to Switzerland for a limited time by a foreign company.
• if you’re a diplomat or employed by an international organization.

As of spring 2008, the average monthly premium for a family of four was EUR 750. Low-income families are eligible for subsidies from the government to help cover the cost of insurance.

The “basic package” of health insurance, covering illness, accident and maternity, is actually quite extensive, and covers:

• Hospital stays in any general ward of the canton of residency;
• Semi-inpatient treatment, e.g. eye or psychiatric clinic;
• Outpatient care;
• Nursing care, of up to 60 hours per week at home or in a nursing home;
• Examination, treatment and nursing in a patient’s home by a physician or chiropractor;
• Rehabilitation ordered by a physician, including health resorts (of up to CH 10 per day);
• Physiotherapy and ergotherapy (max. 9 sessions)*;
• Nutritionist consultation (max. 6 sessions)*;
• Diabetic consultation (max. 6 sessions)*;
• Psychiatric consultation*;
• Emergency treatment abroad;
• Transportation and rescue costs (50% of emergency transport costs up to CHF 5,000 per year and 50% of non-life threatening transport up to CHF 500 per year);
• Legal abortion;
• Maternity costs, including 7 routine examinations, post-natal examination, childbirth and 3 breast-feeding consultations;
• Serious and inevitable dental treatment;
• Contribution to spectacles and contact lenses of CHF180 per year for children and CHF 180 over 5 years for adults.

*After physician referral.

Each individual gets to choose the level of franchise (excess or deductible) they would like to pay on their plan. The more franchise you pay, the lower your monthly premiums. This is an annual amount, so if your accident or illness spans across two financial years, you will still have to pay both years’ franchise. So, for instance, if you are in the middle of having treatments that are being covered 100 percent by your insurance company due to the previous year’s franchise having been met, and the next financial year arrives, you will have to then pay all of the treatment costs until the current year’s franchise amount has been met. Upon meeting this amount, the insurance company will then pay 90 percent of treatment costs, with you paying the remaining 10 percent, up to a maximum of 700 CHF, at which point the insurance company pays 100 percent. As of 1 January 2005, the government has set a minimum annual franchise of 300 CHF and maximum of 2.500 CHF per policy.

Basic insurance requires that you be treated in your canton of residence, which limits treatment options to some extent. Exceptions are made if it is an emergency situation while you are away from home, or one requiring urgent medical treatment that cannot be carried out in the canton of residence (organ transplants, etc.) Coverage is identical, no matter which insurance company you get the policy from, as the government sets the scope of treatment. The difference in price is due to varying levels of customer service, such as the steps necessary in order to have claims paid, etc. No insurance company is allowed to refuse payment for claims from treatment covered by the basic insurance plan.

Supplementary insurance is available for those who would like greater choice in doctors and hospitals, with more comprehensive coverage for things such as in-home care, eyeglasses, etc., and it allows for treatments in cantons outside the canton of residence. Unlike basic insurance, however, individuals can be turned down for a policy based on their age, previous illness, etc. Basic health insurance does not cover dental care, but it can be included in supplemental coverage, though it is very expensive.

Health insurance cost comparisons can be found on the Comparis web site.