The In’s and Out’s of Health Insurance

Krankenversicherungsgesetz (KVG) this might be a word you have come across already – if not it’s the term for basic health insurance. Every person living in Switzerland is obliged to take out a basic health insurance policy. Even more important is that this must be done within 3 months of your arrival. Failure to do so, leaves the canton with no choice but to choose a provider for you, who will then send you the bill and it will also be backdated to the beginning of your residence.

First things first, no insurance company is allowed to reject you if you are looking for KVG. The bonus of this, is that you are free to choose from the many companies around. The best place to start is checking out Comparis website, where you can compare all the different policies available to you, including the prices. If you happen to be chatting with a friend from Zug or Bern, don’t be surprised if there is a difference between your premiums as prices and plans vary on a canton to canton basis.

With your KVG, only inpatient treatment in your canton of residence is covered, except in emergency situations or if what you require is not available locally. If you are employed for more then 8 hours a week with a single employer then you do not need to take out ‘Accident Coverage’, as your employer already has you covered.

There are three main models that you can choose from for your KVG and they are the Health Maintenance Organisation (HMO) model; Family doctor/GP model or Telmed/Callmed model.

  1. HMO model: If you choose the HMO model, then firstly you will need to choose a doctor who is practicing in a HMO. Most insurance companies will provide you with a list of the HMO’s available to you in your area. HMO policyholders must always consult their HMO doctor first. The doctor you choose is considered your “gatekeeper” and will coordinate a your treatment. The HMO docotr is paid a flat monthly rate for all treatments their registered patients might need. This flat rate covers all costs for treatment provided, by themselves, specialists or during a hospital stay. This flat rate forces the doctor to restrict the treatment, to what the patient needs, avoiding any unnecessary services. Should the doctor not be available or if the patient is away from their place of residence or work, they must seek out the nearest available emergency physician. After the emergency treatment, the patient must contact their HMO doctor to discuss further procedures. The HMO model can be up to 25% cheaper than the standard basic.
  2. Family Doctor/ GP model: Under this model, policyholders commit themselves to consulting their fixed family doctor, Hausartz first. Emergencies are exempt from this rule. Again your insurance company will give you a list of the Hausartz available in your locality. Premiums can be up to 20 percent lower.
  3. Telmed: Telmed requires you to call a hotline before consulting a health professional for the first time. Medical experts give advice or refer patients to a doctor, hospital or therapist. Exempt from this rule are emergenices; annual optometrist and gynaecological check ups. This model is up to 15 percent cheaper.

A Supplementary Insurance (Zusatzversicherung) can offer you a wide range of care not covered by KVG. However companies, can be selective and are free to discriminate based on pre-existing medical conditions. Below we have outlined the two types of supplementary insurance.

  1. Supplementary outpatient insurance may include alternative therapies, glasses and contact lenses, medicine not covered under basic, dental treatment, vaccinations for foreign travel, and even spa stays, gym membership and household care and aid.
  2. Supplementary hospital insurance covers inpatient hospital benefits, such as the right to have treatment in a general ward in any hospital nationwide, and options for semi-private or private rooms.

Take Note

  • You will have to choose your franchise/excess/deductible.
    • This is the amount of money you are willing to pay before claiming on your policy. The higher your franchise, the lower your premium.
  • The retention is the amount you pay towards the cost of your healthcare after the franchise has been paid. This is normally 10% of the costs, up to a maximum if CHF 700, after which the insurance company will pay the full amount.
  • Maternity services are fully covered and are exempt from franchise or retention costs.
  • If you were to choose a branded drug when a cheaper generic alternative is available, your insurance provider can charge you 20% of the costs instead of the normal 10%.
  • When a doctor prescribes you a treatment that is not covered by the basic insurance, they must inform you first, so as to avoid any unnecessary surprises!
  • Premiums go up every year, and insurers must tell their members what next’s year premium will be by the 31st October. You then have until the 30th November to cancel your insurance contract. If you’re looking to cancel you contract earlier, make sure to find out what the notice period is with your insurer, a good rule of thumb is to allow 3 months. However some insurers only allow policies to be cancelled twice a year.
  • Most insurance companies will be able to inform you of the languages the doctor’s speak to ensure that you can receive the best care possible.

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