Health Matters

What you need to know before you choose your health insurance

Soziale Krankenversicherung – even harder to choose one than it is to say. If you are used to public medical care or subsidised insurance back home, you will have to accept the fact that here it is compulsory and get your medical insurance like every other good citizen in the country.

So how can you choose the best policy?

With 61 different private insurance companies, the task of choosing the right one can be over-whelming. For this, Comparis is a helpful website. It compares policies and prices according to your requirements and provides additional information in the glossary section.

Before you begin, what do you need to know?

The franchise/excess/deductible is the amount of money you select to pay before claiming on your policy and it ranges from CHF 300.-  to CHF 2,500.-  annually. Generally, the higher this is, the lower you pay per month. It can only be changed mid or end of the year.

The retention is the amount you pay towards the cost of health care after the franchise has been paid. It is usually 10 percent of the treatment or medication, up to a maximum of CHF 700.- (to encourage frugality), after which the insurance company pays the full amount.

Maternity services are fully covered and are exempt from franchise or retention costs.

What types of insurance are there?

Everyone must have basic insurance (Grundversicherung) and companies are required to accept all applicants. Policies across companies are identical but price can vary due to age, sex and the canton you live in. With basic insurance, only inpatient treatment in your canton of residence is covered, except if what you require is not locally available and for emergency situations. Outpatient hospital treatment is possible in another canton, unless insured with Telmed, HMO or the GP model. Other treatments, such as physiotherapy, ergotherapy or nutrition therapy (limited sessions), are covered with a doctor’s prescription.

There are three main types to consider:

With the HMO model, the policyholder must consult a certain doctor practising in an HMO centre for any illnesses, excluding emergencies and annual gynaecological or optometrist check-ups. The “gatekeeper” doctor coordinates a patient’s treatment and premiums are up to 25 percent lower than for the standard basic.

Under the family doctor/GP model, policyholders commit themselves to consulting their fixed family doctor (gatekeeper). The choice of doctor is defined by the insurance company with premiums up to 20 percent lower.

Telmed requires that the policyholder 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. This model is up to 15 percent cheaper.

You want more than basic insurance?

A Supplementary Insurance (Zusatzversicherung) can widen your options, enabling patients to get medical care outside their canton. Companies, however, can be selective and are free to discriminate based on pre-existing medical conditions. Unfortunately it may happen that it is too late to get supplementary cover at the time you most need it. Unlike basic insurance, benefits vary greatly and include plenty of treatments that fall under the preventative umbrella.

There are two types of supplementary insurance:

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.

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. There are many different policies.

What if you want to change your policy?

Normally, this can only happen twice a year. Policyholders must give written notice three months in advance, by the end of March or end of September. Under the HMO or GP model though, this can only be done once a year in September. If the company has increased costs, however, the policy can be changed with one month’s notice at the end of November for the following year. And if you are leaving Switzerland, you can terminate your policy any time with evidence of your deregistration.

What about accidents?

Those of you who are self-employed, unemployed or employed for less than eight hours per week are also obliged to pay for accident insurance. In all other cases, it is your employer’s responsibility to provide for coverage, even when the accident occurs outside the workplace. Make sure you find out how your insurance operates if there is an accident (some insurance companies require you call within 24 hours) and you may want to get additional coverage.