Getting health insurance in Switzerland: A complete guide

Switzerland has far more to offer than just charming Alpine slopes and delicious chocolate. The universal healthcare system in Switzerland has a world-class reputation. They have well-trained doctors and an extensive network of healthcare centres and hospitals. This is a major draw for many people looking to relocate abroad permanently or simply those taking an extended holiday. Anyone living or working in Switzerland must purchase health insurance and just like many things in this beautiful country, it can be costly.

This guide helps you navigate the Swiss healthcare and health insurance system, including the types of plans offered and what’s required of you to get the coverage you need.

What kind of healthcare system does Switzerland have?

Switzerland has a universal healthcare system, but the government requires all individuals to have insurance. There are over 60 government-approved non-profit insurance providers that offer the basic mandatory coverage set by the government. Insurance premiums vary by provider, type, and depend on the policyholder’s place of residence.

Switzerland ensures that companies don’t take too much advantage of customers by regulating insurance through the Swiss Federal Law on Health Insurance. The system aims to keep costs reasonable for individuals, while also holding them accountable for paying into the system.

Individuals are able to choose which provider and plan they want, but plans in Switzerland impose relatively high cost-sharing, including deductibles and coinsurance. The policyholder will have to pay the set deductible before the insurance kicks in. After the deductible, the individual will pay a coinsurance of 10% of the costs exceeding the deductible. There’s a maximum set on the coinsurance of 700 Fr. per year. Each insurance plan also usually sets an annual maximum out-of-pocket amount.

If you reside or work in Switzerland, you’re required to have health insurance, no matter where your home country is. While you technically have up to three months to apply for health insurance upon your arrival, the government actually wants you to apply as soon as possible. You will need to have basic health insurance even if you'll only be working in Switzerland for less than three months. If you’re from an EU/EEA country, your European Health Insurance Card (EHIC) provides you access to healthcare in Switzerland.

Who needs to be covered by health insurance, by how much, and what’s actually covered?

All Swiss residents are required to be covered by health insurance. You’re free to choose whichever health insurance company you want on the list of government-authorised companies. The only exception is if you’re an international civil servant or diplomat, whom can request exemption from coverage in their canton.

Basic coverage in Switzerland is still pretty extensive. Insurance must cover treatment in the case of illness, accidents, and pregnancy. As well as your stay in hospital, should you get hospitalised. Home visits by doctors, nurses, or specialists are also covered by insurance in most cases. Coverage extends to prescribed services, like physiotherapy, nursing care, occupational therapy, speech therapy, and nutritional counseling.

The public health system doesn’t usually extend to the dentist (zahnarzt / dentiste / dentista).

How long can I be uncovered by health insurance?

The Swiss government mandates that every individual intending to reside in the country be covered by health insurance within three months of their arrival in the country. The insurance policy will be retroactively applied to the individual’s arrival date.

Are there any penalties for not being covered by medical insurance?

If you miss the three month deadline to sign up for health insurance the government will assign you a plan, which might charge higher premiums than you’d like to pay.

Private or public health insurance, which should I choose?

Private insurance

It’s very popular for people to look for private supplemental insurance to cover things not under the basic insurance plan- outpatient services like orthodontic or osteopathic treatment, for example. More than 80% of people do this. Private supplemental insurance isn't mandatory and isn’t regulated by the government- premiums are set by the provider. When seeking private supplemental insurance you may come across the abbreviation VVG. This stands for versicherungsvertragsgesetz, which is the legal basis for insurance policies under private law.

Premium plans allow you to go to private hospitals, which means you might be able to get a single room or get treated by senior, more experienced doctors. However, the law in Switzerland ensures that even if you don’t choose private insurance, you’ll still be well taken care of.

Public insurance

The government dictates that every resident have basic health insurance coverage. You might come across the abbreviation KVG (krankenversicherungsgesetz), which stands for Health Insurance Act- the law that determines the basic health insurance benefits. This law ensures that all providers offer identical basic health coverage, which covers illness, maternity care, and accidents and emergencies. Individuals are allowed to choose their insurance from one of over 60 Swiss government approved providers.

The Swiss don’t spend that much on their healthcare, even though the coverage is outstanding. According to the World Health Organisation, they spend 10.8% of their GDP on healthcare, whereas the United States spends 17.2%, for example.

HMOs and Physician Networks

One type of insurance plan is an HMO plan where the policyholder is required to visit a specific healthcare centre or group of centres, although some exceptions may apply. Gynecologist and paediatrician visits are most likely to be exempt from this rule. In exchange for adhering to these restrictions on location and doctors, HMO plans have discounted monthly premiums. Together, there are 86 physician and HMO networks in Switzerland.

HMOs usually fall into two categories in Switzerland. In one model, physicians work for the insurance company that manages the HMO. In the other model, all physicians are considered part-owners of the HMO, which can also be known as a ‘physician network.’ In both models, the insured person makes a promise to use the healthcare system through these networks if they have any health related problems. Specialist treatment is generally referred by an in-network care manager.

Flexcare

Because of flexible monthly premiums, people may be incentivised to try a Flexcare insurance plan, such as the Telmed model. In this model, policyholders receive medical advice for illnesses over the phone before visiting a doctor in person. Should you not call the hotline before you go in, your insurance may not cover your visit. The exceptions to this rule include emergencies, gynecology and pregnancy related visits, vaccinations, dental surgery and treatment of children below the age of 6.

There are special provisions to this type of plan, including a combination with the HMO model, allowing policyholders to choose to get care over the phone or by visiting a specific medical centre.

What’s the average cost of health insurance?

Health insurance premiums can be costly and each year companies can increase their prices by a small percentage. The cost will vary depending on where you live, your personal details, whether you have a family plan or an individual plan, and which provider and plan type you choose. The places with the highest monthly premiums are cities like Basel, Zurich and Geneva. The average monthly premium in 2017 is 447 Fr. per month. Here are some examples of what it would cost a 30 year old living in Zurich for health insurance per month:

Every time you receive treatment, you’ll have to pay:

• A share of the costs
• A deductible, or ‘franchise’ - maximum of 300 Fr. for adults, free for minors
• A retention fee - 10% of treatment costs at a maximum of 700 Fr. per year for adults and 350 Fr. per year for children
• A hospital fee of 15 Fr. per day for a hospital stay

Children, young adults in education or training, and women whose maternity benefits are fully covered don't pay any hospital contribution.

If you're relocating to Switzerland and thinking of purchasing insurance, you might want to consider getting a Wise borderless multi-currency account. It’ll help you receive and organise your money in tens of different currencies, as well as convert and transfer your money without the often marked-up unfair exchange rates of banks and their sometimes obscure fees. Wise fees are small, upfront, and transparent and they always use the real mid-market rate - the one you’d find on Google.

Do I need to choose a family doctor / GP?

Basic insurance holders are free to choose their own doctor. Sometimes, depending on your plan, your insurance policy may restrict your choices, particularly if you have a cheaper policy. Like in many places, you need to book your own appointments and call within 24 hours if you need to cancel. Many people find doctors based on personal recommendations from friends or colleagues. Here are some good sites for finding doctors:

• www.doktor.ch
• www.doctorfmh.ch
• Swiss Yellow Pages

A GP will refer you to a specialist or outpatient clinic if the need arises. You can also consult specialists without that referral, as long as they’re covered by your insurance.

Are pre-existing conditions covered?

Healthcare companies can’t deny coverage based on pre-existing conditions. It’s illegal. They’re also not allowed to make profits off of basic plans that are offered at a wide scale. Instead, they’re supposed to incentivise positively, by providing perks to individuals that buy supplementary, more comprehensive plans. These plans usually cost more but will also cover more treatments.

Are there any deductions I can make for medical expenses in my Swiss taxes?

Depending on where you live, some medical expenses are tax-deductible. Insurance premiums may be deductible up to a certain amount. Across the country, medical costs that exceed 10% of your income are tax-deductible. As an example, in the canton of Berne, if you’re married and employed you can deduct 4,800 Fr. maximum. To make sure you can claim your payments and expenses, request a tax confirmation from your insurance provider. Keep in mind that these deductions don’t extend to elective treatments, like cosmetic surgeries or eyesight corrections.

How do I sign up for medical insurance?

You should apply for insurance directly with the company of your choice. All applications for the basic coverage will be accepted, but providers have discretion over the cost of private supplementary plans. You have three months to sign up for compulsory healthcare from the time you arrive in Switzerland, no matter your age or nationality.

To sign up:

• You can choose the insurance company you like, online or by visiting their office
• They’ll send you an application form to complete by post or email
• Once you’re enrolled, you have to pay a monthly premium to the insurance company, which will vary depending on your company and canton; low-income residents might get a premium reduction

The health card

Each health insurance provider should supply you with a health insurance card. It will be issued to you in the post as soon as you’re approved for a plan. You should bring this card with you on all of your medical visits. As an EU citizen, you’re eligible for healthcare through your EHIC, but if you become an official resident or find a job, you’ll need to switch to a Swiss insurance scheme.

Which Insurance company should I choose?

These are a few popular Swiss health insurance providers you might want to consider:

• Swica
• Agrisano
• Concordia
• ÖKK
• Atupri
• Assura

The Federal Office of Public Health is a good starting place for more information about Swiss health insurance. This site has a directory of approved health insurers for you to choose from.

These sites can also help you learn about the insurance policies and compare plans:

• Swiss Authorities Online - Health Insurance
• Comparis.ch

With its world-class universal healthcare, Switzerland is a great choice if you're considering a relocation abroad. This guide will help you navigate Switzerland’s health insurance policies so that you can get the healthcare coverage you need when you're there.