Foreigners can access subsidized Swiss healthcare once they become official residents and join a scheme for health insurance in Switzerland.The Swiss healthcare system is renowned for being one of the best in Europe, although it may seem complicated at first with a range of public, subsidized private and fully private health insurance options to consider. Foreigners living in Switzerland can claim reimbursements for Swiss healthcare services once they are registered for health insurance in Switzerland. This guide explains who needs health insurance in Switzerland, health insurance costs, and how to take out Swiss health insurance. It also explains how to claim your medical reimbursements. It includes:
- The healthcare system and health insurance in Switzerland
- Who needs Swiss health insurance?
- Public health insurance in Switzerland
- Applying for health insurance in Switzerland
- Private Swiss health insurance
- Swiss health insurance costs and reimbursements
- Health insurance for the unemployed and low earners
- Useful resources
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The healthcare system and health insurance in SwitzerlandSwitzerland has the best healthcare system in Europe, currently ranked number one according to the 2018 Euro Health Consumer Index. However, the Swiss health system is one of the costliest in the world. Unlike many other European countries, however, healthcare in Switzerland isn’t charged via social security payments but is administered by local health authorities in each canton. Everyone living in Switzerland needs to take out a health insurance policy within three months of moving to the country; although exemptions apply. To continue to access Swiss healthcare, you’ll need to pay monthly health insurance premiums and pay part of the cost of your medical treatment in Switzerland.
Who needs Swiss health insurance?Any foreigner who is living or working in Switzerland will typically need to take out Swiss health insurance once they are an official resident and have received their permit; although some exemptions exist. Some of the exceptions for residents in Switzerland include:
- pensioners who draw a pension exclusively in an EU or EFTA state;
- cross-border workers who have insurance coverage in another EU or EFTA state;
- students who are temporarily resident in Switzerland and have comparable insurance;
- staff of international organisations, embassies and consulates.
What happens if I am not covered by health insurance in Switzerland?Failure to purchase health insurance in Switzerland by the three month deadline means that your local authority will sign you up to a plan, which might mean that you pay higher premiums. Anyone in Switzerland without an insurance plan, other than those exempted, will not be able to access Swiss health services other than emergency treatment which they will be billed for.
Public health insurance in SwitzerlandPrivate companies provide Swiss health insurance but the government stipulates that all residents must purchase a minimum basic health insurance package, with private top-ups available. Unless you qualify for an exemption, you will need to purchase at least the basic insurance level.
What is covered by Swiss public health insurance?State health insurance covers 80–90% of medical costs (excluding the first CHF 300 of annual treatment costs and daily fees for hospital stays). The coverage is identical across all providers, and includes:
- Accidents: If you work eight hours or more per week, you’re covered by your employer against accidents. If your employer doesn’t provide coverage, you must get additional accident coverage.
- Alternative therapy: Covers some treatments (including acupuncture, pharmacotherapy, and homeopathy) if done by an accredited specialist.
- Cancer screenings: Covers mammograms and colon cancer screenings for those aged over 50.
- Dental care: Covers only emergency treatment relating to serious mouth or jaw disorders or diseases.
- Doctors and medical specialists: General check-ups and treatments are covered, including physiotherapy. Some specialist treatments are excluded and premiums are higher for those with high-risk profiles.
- Eye care: Covers children aged up to 18 for prescriptions of glasses and contact lenses up to CHF 180 a year. Also covers adults with serious visual conditions.
- Hospital visits: Covers inpatient, outpatient, and emergency treatment.
- Maternity care: Antenatal classes, childbirth expenses, and abortions are covered.
- Medical devices: Claims are possible for items such as bandages, inhalers, or incontinence devices.
- Medical transport: Covers half of the costs.
- Medication: Covers either 80% or 90% of prescriptions.
- Mental healthcare: Covers some services, including psychotherapy. Alternative or rehabilitative programs might not be.
- Rehabilitation: Covers care provided after an operation or serious illness.
- Sexual health: Covers gynaecological screenings.
- Treatment abroad: Coverage in EU/EFTA countries through the European Health Insurance Card. Covers some costs in non-EU countries during short trips, although you may need additional travel insurance. Check which conditions apply.
- Vaccinations: Covers the Swiss Vaccination Plan guidelines.
Applying for health insurance in SwitzerlandIn Switzerland, it is your responsibility to arrange your own Swiss health insurance. Foreigners can’t sign up for Swiss healthcare until they have arrived in Switzerland and applied for their Swiss residence permit or registered their residence with the local commune (i.e. EU citizens moving to Switzerland). After arriving in Switzerland, you have 90 days to join a Swiss health insurance plan or apply for an exemption. It’s advisable to shop around and choose a provider that best suits your circumstances and preferences. You will usually have to provide proof of residence and details of your address to take out a policy. Once you have registered with a Swiss heath insurance company, your coverage will backdate to the day you were liable for compulsory Swiss health insurance, for example, when you took up residency or gave birth in Switzerland. As you can claim expenses retrospectively, you must also pay the premiums from the beginning of your compulsory insurance period. Policies usually only include coverage for an individual and not additional family members, so spouses and children need to have separate coverage.
Choosing a Swiss health insurance providerYou can find details of authorized health insurance providers in Switzerland from your local cantonal authority. When choosing a provider, look at costs as well as what they cover and the claims process. You can check for things to consider in this short guide here. If you wish to change Swiss health insurance companies, you can do so with three-months notice before the end of June or end of December, providing you’re on a package where you pay the standard CHF 300 excess. Otherwise, you can only change your Swiss health insurer at the end of each calendar year, typically giving one month’s notice. Full information, including sample cancellation letters, can be found on the Swiss government website. Some of the largest health insurance companies in Switzerland include:
Private Swiss health insuranceMany Swiss residents choose to top-up their insurance with private supplementary health insurance; this is to give themselves access to a wider range of treatments or better accommodation should they be admitted to hospital.
Who should get private health insurance in Switzerland?Private health expenditure accounts for 32.6% of all health expenditure in Switzerland according to 2014 statistics, which is high compared to other OECD countries. Although the basic Swiss health insurance package is good, many people choose a supplementary package to access a wider and better range of services and treatments. Private Swiss health insurance is popular with expats, who can benefit from global plans offered by international companies. It’s also worth considering for those with chronic conditions or think they may need or want to access specialist treatments not available through basic packages.
The advantages of getting private health insurance coverage in SwitzerlandPrivate insurance coverage will enable you to access additional treatments. These include dental treatment, specialist treatments and complementary treatment such as osteopathy, private healthcare services and benefits during hospital stays (private room, free choice of doctor, etc.). However, risk factors such as age, lifestyle, and health condition can determine premiums; so can be costly for some. Also, whereas companies cannot refuse coverage for basic insurance, they are not obliged to offer a supplementary package to someone they view to be too high risk.
How does private health insurance work?You can usually take out private health insurance with either the same provider of your basic package or a different one. You can choose the level of extra coverage you want; the costs will be determined by your risk profile, the range of benefits you’re choosing and your location (the most expensive cantons are around 60% dearer than the cheapest). Typically, you will have to pay medical fees upfront and then claim reimbursements from the insurer by sending them copies of invoices and receipts.
How to choose a private health insurance providerIt is advisable to shop around for quotes from different companies and see who is offering the best supplementary deals; to suit your individual circumstances. See this guide on choosing expat health insurance for further information. Expat-friendly insurance brokers can help you compare different health insurance packages and choose the best fit for your situation.
Private health insurance companies in SwitzerlandCompanies providing good supplementary expat health insurance in Switzerland include:
Swiss health insurance costs and reimbursements
How much does Swiss health insurance cost?In general, you must pay a monthly premium fee, which varies between Swiss health insurance companies. Each year Swiss health insurance fees undergo a review according to a number of factors; these include things like healthcare costs and company debt. This can mean premium costs can vary widely year-on-year when companies fail to cover costs; in 2017, for example, premiums increased by an average of 4.5% across all cantons; some low-cost providers also raised their premiums by as much as 15-20%. According to the Swiss Federal Office for Public Health (FOPH), Swiss health insurance premiums will rise by an average of 1.2% in 2019; with the average monthly payment for an adult over 26 being CHF 372.3 per month. The cantons with the highest monthly insurance costs include Basel-City, Geneva, Vaud, Jura, and Basel-Landschaft. The cheapest five cantons are Appenzell-Innerrhoden, Nidwalden, Ury, Zug and Obwalden. You can find details of prices for all cantons for 2019 here.
Annual health insurance excess and deductible in SwitzerlandState healthcare in Switzerland works on an excess system; so you’ll need to pay a minimum of the first CHF 300 of your medical expenses each year (no excess applies to children under 18). Your Swiss health insurance provider will only cover bills above this excess. You can elect to pay a higher excess or deductible, which will result in lower monthly fees. Regardless of your deductible, you’ll also need to pay between 10-20% of healthcare charges up to a maximum of CHF 700 per year; or CHF 350 per year for children. If you’re admitted into hospital, you will also have to pay CHF 15 each day. Pregnancy, birth and post-natal care in Switzerland are exempt from excess charges and are covered in full by state health insurance.
Health insurance claims and reimbursements in SwitzerlandMost health insurance firms in Switzerland will expect you to pay fees upfront and then claim reimbursements afterwards. You will need to submit a claim form (available through your insurer) along with necessary invoices or receipts. Reimbursements usually take a few weeks to come through. Check with your insurer for exact details of the process and likely waiting times.
Tips to pay a lower health insurance premiumThere are a few ways to reduce your monthly premiums. These include:
- Choosing a policy with a restricted choice of doctor or health maintenance organization (HMO);
- Taking out a Telmed policy; where you have to call a telephone service and get a referral to a doctor or hospital;
- Increasing your excess above CHF 300 a year;
- Paying a lump amount of fees upfront (you can get a discount of around 2% for annual upfront payments).