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April, 2004 Newsletter

Health Insurance
in Switzerland

General principles

Your health, in Switzerland just like in the rest of the world, has no price!
In accordance with the Federal Law on Sickness Insurance, of March 18, 1994, insurance is compulsory for medical and pharmaceutical care.
The Law also creates an obligation to take out insurance cover. If you move to Switzerland, you must take out health insurance within three months of arrival. This deadline also applies to newborn children.

The Law on Sickness Insurance regulates social sickness insurance. It contains two parts: insurance for medical and pharmaceutical care, known as "basic insurance" and daily allowance insurance.

The Law on Sickness Insurance maintains the system of individual insurance, which means that in practice a premium is paid for each member of a family. In addition, sickness insurance premiums are not proportional to the income of insured persons.

What does mandatory "basic insurance" cover?

In the event of sickness, maternity or accident (not covered by special accident insurance), congenital illness or defect (not covered by the invalidity insurance) and legal abortion, the following cost of the benefits is covered:

examination and treatment carried out by a doctor

cost of hospital treatment in the general (public) ward
(the hospital or clinic must be listed by your canton of residence)

analyses, medicaments, diagnostic, therapeutic services & equipment
prescribed by a doctor, included in the "Specialty List"

participation in the cost of spa treatment prescribed by a doctor

rehabilitation measures carried out or prescribed by a doctor

contribution to medically necessary transport and rescue costs

services subject to conditions regarding prevention & other healthcare:
vaccinations, maternity care, optical care, home nursing, etc.
(information is available from your health insurer)

However, please note that you are responsible for 10% of the expenses not included in the franchise amount.
You can take out additional or supplementary health insurance, only provided that you hold basic health cover from the same insurer.

Daily allowance insurance

In accordance with the Federal Law on Sickness Insurance, daily allowance insurance is optional. Any person between the ages of 15 and 65, who is domiciled or engaged in paid employment in Switzerland, may take out insurance cover for daily allowances.

Daily allowance cover may also take the form of a collective insurance contract. Such contracts may be concluded by employers (either for their employees or for themselves), by employers' organizations or by professional associations (for their members and the employees of their members) and by trades unions (for their members).

Insurers may exclude from cover, by making a reservation, illnesses, from which an insured person is suffering at the time of admission. The same is true for previous illnesses, if experience shows that recurrence is possible.

Participation by insured persons in the cost of insurance

Insured persons participate in the cost of the benefits which they receive. This participation includes a fixed amount per year, known as the "franchise", plus 10% of the cost, exceeding the amount of the franchise known as the "share".

In cases of hospitalization insured persons also pay a contribution to the cost of their hospital stay. This may be reduced according to family expenses.

In some cases a higher participation in the cost of certain benefits may be required, when a benefit has been provided for a specific duration or has reached a specific volume.
In other cases the participation in costs for long-term treatment and/or treatment of serious illnesses may be reduced or cancelled.

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DEFINITIONS

Health insurers

provide mandatory basic health
insurance. They are non-profit
organizations recognized by the
Swiss Federal Department of
Home Affairs. They also offer
supplementary insurance cover.

Basic health insurance

guarantees access to high-quality
healthcare and a broad range of
services, identical for all
insurance holders. All persons
insured by one insurer must pay
the same premium. This means
that premiums may not be
graded according to selected
parameters (e.g. age, gender,
etc.) nor according to the income
of the insured person.
Obviously, equality of premiums
corresponds to equality of
benefits.

Supplementary insurance

is optional. It covers specific
needs (private or semi-private
rooms) and services (dentists,
naturopaths, etc.). In general,
the premium corresponds to the
risk that the insurance holder
represents for the insurer. The
insurer can refuse to cover an
applicant or make reservations,
based on the applicant's existing
state of health.

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Health Insurance
in Switzerland