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The health insurance system in Switzerland is complicated. And since it is mandatory to have health insurance, it is imperative to understand it correctly.
These last few years, health insurance has become very expensive. But many people are paying much more than they ought to. You need to know that there are a few things we can do to pay less!
In this post, I am going to cover the details of the health insurance system in Switzerland. I am going to cover mostly the base health insurance in great details. You must choose wisely, and there are many options. I am also going to cover supplemental health insurance, but it is too varied to be covered in details.
So, let’s get into Health Insurance!
The Health Insurance system
In Switzerland, everyone must have health insurance coverage. This has been in the law for many years.
There are two levels of coverages:
- The base insurance is mandatory. It covers standard health costs, such as doctor and hospitals. It is compulsory for everyone, regardless of age. Even babies need health insurance.
- The supplemental insurances are not mandatory. There are many different supplemental insurances available. For instance, private hospital insurance, dental insurance, eye insurance, and so on.
Regardless of the provider, the base insurance is the same. Unfortunately, there are many different providers and many different options. It makes it more complicated than it ought to be. For instance, you can choose between different models and different deductibles. You need to know the differences between these things. We are going to see all this in details.
The supplemental insurances are entirely different from one provider to the other. Even two dental insurances can be very different from one provider to the other. It makes it very difficult to compare such insurances.
The LAMal law governs the base insurance.
You can switch to a new health insurance provider every year. You need to cancel your current health insurance by the end of November if you want to change.
Being able to change often is good for us since we can optimize costs. But, it is also a curse. Because at the end of the year you will receive calls from insurance clerks that want you to change insurance. As a rule, you should completely ignore them. They are not doing that for you!
But, you need to cancel supplemental insurances six months in advance. It makes it so that most people rarely change supplemental insurances.
You need to know that an insurance provider cannot refuse you base insurance coverage! An insurance provider cannot refuse a person because it would be too expensive to cover! But they can refuse to cover you for supplemental insurances.
What is covered by the base insurance?
There are many things covered by compulsory base insurance. But, many of these things are subject to conditions that are sometimes complex. I am going to cover the basics here.
Here are the main things that are covered.
- Visits to the hospital, interventions, and emergency treatments. However, you still have to pay 15 CHF per day in the hospital. This also includes care after serious treatments.
- General treatments by doctors. But many specialist treatments are excluded.
- Prescriptions from the doctor.
- Childbirth expenses and abortions
- Mammograms and colon cancer screenings for people over 50.
- Gynecological examinations
- Glasses and contact lenses for children up to 18. This is only covered up to 180 CHF per year.
- Emergency dental cares. This is really restrictive to severe issues.
- Psychotherapy under some conditions.
- Most common vaccinations
- Some alternative therapies, such as acupuncture and homeopathy. However, this is only covered if an accredited specialist does it. And even then, there are some conditions.
These are the most important things being covered. If you want to know all the details, I would recommend reading the information from the Federal Office of Public Health.
How is it covered?
First of all, each insurance has a deductible. All the expenses below the deductible are not covered. If your deductible is 300 CHF (the smallest), you will have to pay the first 300 CHF of medical expenses before the insurance covers anything.
But even after the deductible, there is still a part that you have to cover. This is called the retention fee. For everything that is reimbursed by the insurance, you will have to pay 10% of it. This is up to a yearly maximum of 700 CHF for adults and 350 CHF for children. This retention fee does not apply to maternity fees. The retention fee is 20% on medicine which could be changed to a lower-cost drug.
Another important thing is who pays for the bills first. There are two models for that:
- Indirect Claim Settlement (Tiers Garant): Your doctor sends you its bills. You pay all your bills yourself. Then, you send your invoices to the insurance that will reimburse you for what is covered by your policy.
- Direct Claim Settlement (Tiers Payant): Your doctor will send the bills to your insurance. The insurance will pay what is covered. It will then send you a bill for the deductive or the retention fee.
If you do not think you can handle the upfront fees, you should choose an insurance provider with Direct Claim Settlement. However, if you are in that case, you should work on improving your financial situation.
Hospital fees are generally falling in the Direct Claim Settlement regardless of your insurances. This is because they can be costly and will often be reimbursed.
What is not covered?
Accidents are not covered by the health insurance but by the accident insurance. I will talk about this in more details below.
Generally, you will need to be treated in your state. If you are injured in another state, you will need to be moved to your own state to be treated there. That is, of course, if it is possible to move you.
The base insurance does not cover anything outside of Switzerland and the European Union! Costs should be covered in the European Union. Some insurances have some extra cover. But you should assume that you are not covered when you are abroad. There are a lot of supplemental insurances for that. This is one case where supplemental insurance is a great fit.
Which insurance deductible should you take?
The deductible is the amount you are going to pay before the insurance covers anything. The deductible is per year. For instance, if your deductible is 2000 CHF and you spend 1900 CHF in health expenses, the insurance will not cover anything.
As I mentioned before, there are several deductibles that you can choose from:
- 300 CHF
- 500 CHF
- 1000 CHF
- 1500 CHF
- 2000 CHF
- 2500 CHF
With a higher deductible, you get a lower monthly fee for your health insurance. For instance, here are the monthly prices for Assura for my specific case with various deductibles.
Now, to choose, you have to estimate how much health expenses you will have. With so many deductible options, it sounds complicated to select the best one.
However, it is simpler than that because only 300 CHF and 2500 CHF make any sense. All the other deductibles are useless. Here is a simulation with the same Assura case and various level of health expenses.
We can see on the graph that only two deductibles are interesting: 300 CHF and 2500 CHF. If you spend below 1900 CHF, the 2500 CHF deductible is the best. If you spend more than that, the 300 CHF deductible is the best. It is pretty simple, right?
If you want the exact breakdown number, it is relatively simple. Take the yearly price of the 300 CHF deductible (A) and subtract the cost of the 2500 CHF deductible (B). Then you need to multiply this by 1.1 to account for the retention fee. Finally, you can add 300 CHF to it.
So, if A = 4308 CHF and B = 1874.76 CHF, the breakdown is 1904.76 CHF (1.1*(A -B) + 300)). With less than that, you should take the smallest deductible. With more than that, you should take the highest deductible.
Now, if you take the highest deductible, you need to be ready to pay these fees. You could depend on an emergency fund for that. If you do not have, you may want to consider starting an emergency fund.
Which insurance model should you choose?
I mentioned before that there are several insurance models that you can choose. Now, not all insurances offer them all. But there are four principal families of insurance models:
- Standard Model.
- Family Doctor Model.
- Telmed Model
- HMO Model.
These models will have the exact same coverage. The difference is what you have to do when you have a health issue.
Now, of course, in case of emergencies, you can still directly go to a doctor or to the hospital. It is only in case of usual health issues that these restrictions will apply.
The Standard Health Insurance Model
With the standard model, you can choose to go to any doctor directly. You can change doctors all the time, and you do not need to inform your insurance about that.
This model is the most expensive because the insurance has no choice on which doctor you choose.
The Family Doctor Health Insurance Model
With the family doctor model, you have an assigned doctor. You have to go to this doctor, and he will send you to specialists if need be. But you cannot go to another doctor even if you want unless there is an emergency. And some insurances are limiting which family doctors they accept.
This model is between 10% and 20% cheaper than the standard model.
The Telmed Health Insurance Model
With the Telmed model, you will have to call a health call center before you go to any doctor. They will then choose the doctor you have to go to, either a specialist or a generalist based on your issue. Then, once you have been there, you do not need the call center anymore for this issue.
This model is also between 10% and 20% cheaper than the standard model.
The HMO Health Insurance Model
Finally, with the HMO model, you have to go to a particular health center. You do not have an assigned doctor but an assigned health center. So, likely, you will always see different doctors. Since there is not a lot of these health centers, you may have to go farther to see a doctor.
This model is generally the cheapest. But, not all insurance providers offer it. For instance, Assura, the most affordable health insurance in Switzerland, does not offer this model.
How to choose a model?
There is no definite rule on which model to choose. I believe we should select the cheapest model that is still convenient.
For instance, if you have an HMO center very close to your house, it may be great to choose an HMO model. But if the next HMO center is 40 minutes away, you may want to avoid this.
Most people should avoid the Standard model. It is simply too expensive. Between the other three models, you should choose the cheapest one that you are ready to accept.
Do you need accident insurance?
The base health insurance and the accident insurance are closely tied together. The accident insurance is also mandatory in Switzerland. And you need to take your accident insurance with your health insurance.
But, if you are employed, your employer is responsible for your accident insurance. This means only unemployed people need to get accident insurance.
If you need one, you should ask for accident insurance when you take a base health insurance. It is not very costly and it the same coverage for each insurance providers as well.
How can you pay less for health insurance?
There is no denying that health insurance in Switzerland is extremely expensive. For us, it is about 15% of our budget. And some people are spending up to 20% of their budget for health insurance coverage. And every year, the prices are increasing!
I am going to cover the subject of base insurance. All insurance providers have the same coverage since the law decides on the coverage. And you do not have to use the same provider for the base and the complimentary insurances.
1. Do not hesitate to change insurance
The first thing you need to do is compare and change often. There is no reason to stay with an insurance provider if it is significantly more expensive than another one. Yes, there are some insurances which are a bit less convenient than others.
If you can save several hundred each year, there is no reason not to change. Every year, you should check if your base insurance is still the cheapest!
Insurances are in for the money! There is no reason not to compare!
2. Choose the best model and deductible for you
We have already talked about deductibles. But I will repeat it: You need to take the best deductible for your case! If you spend less than around 1800 CHF, you want the 2500 CHF. Otherwise, you want the 300 CHF deductible. There is no reason to use any other deductible!
We have already talked about the insurance model. Most people should take the model that is the cheapest. If you have access to a family doctor that is recognized by your insurance, it is an excellent way to save money by choosing a family doctor model. And if you do not mind, you can save a lot by using a call center.
3. Pay your fees upfront
Also, you can pay all your monthly fees at the beginning of the year at once. Some insurance providers will give you a small reduction if you do that. Some also will offer you a discount if you pay per quarter. For instance, Assura gives you 2% reduction if you pay per year.
That is not a lot, but that could be a way to cut your expenses more. Do not forget to factor in the fact that you could have invested this money instead. I do not do that. But if you can get 2% returns, it is a good investment without risks.
4. Ask for health insurance subsidies
Finally, if your income is low, you may be eligible for help from your county or the state. If your income is below a certain threshold, they can pay a part or even all your insurance bills. If you have several children and medium incomes, this can be very helpful. When we were young, we got support for part of my family health insurances.
I cannot tell you the threshold since it is different from one state to another. In my state, you can request it from the county administration. But in some states, you need to request it from the state administration. If you think you would be eligible, contact your state or country administration, and they will help you ask for it.
5. Be aware of possible reductions
Some insurance providers also have some possible extra reductions. It is not always easy to find them, but it could be interesting.
For instance, with Assura, I could save money each month if I only went to one pharmacy in particular. I did not take this offer since this pharmacy was not in my village. But if I lived in the city, I would have taken it.
You should do some research and check what your insurance can offer you!
6. Suspend base insurance during military service
This tip is very specific. If you are serving in the army for more than 60 days, you are covered by the military insurance. Since most men do a military service of about four months, this could mean a nice saving.
Unfortunately, this is not possible for annual repetition courses since they last less than 60 days.
Which health insurance should you choose?
Now that you know which model you want and which deductible is best for you, it is time to choose an insurance provider.
As I said, the base insurance is a legal matter, so each insurance providers have to cover the same things. For me, you should simply choose the cheapest base insurance there is. And you should change as soon as it is not the cheapest anymore.
There are a few cases where you may want not to choose the cheapest insurance. First, unless you take the Standard model, some insurances will restrict you to some doctors. And they may not accept your current doctor.
If you have been with the same doctor for a very long time, you may not want to change. So, you may have to choose a provider that accepts him even though it is not the cheapest. Or you can take the most affordable Standard model.
There is another case where you would not want to take the cheapest option. It is if you have a condition and are often going to a hospital that is not accepted by the most affordable option. You may want to keep with your current hospital.
Otherwise, I recommend that you take the cheapest insurance that you can find.
Health Insurance Comparators
There are some comparators that can help a lot to choose health insurance in Switzerland.
The prices of insurance vary significantly by age and also by state. For all comparators, you need to enter this information to get accurate results.
It comes directly from the government. It is very fast and very complete. This is the one that I would trust the most. It is also very simple to use. Unfortunately, it is not available in English. It is only available in the three national languages from Switzerland (French, Italian, and German).
If you want a comparator in English, you should use the health insurance comparator from comparis.
It is straightforward to use, and it has a lot of information. However, you need to be a bit careful about some details. Sometimes, it will propose insurances with select options such as limited pharmacy choice. And sometimes, it will offer you models that are tied to a health center that is too far for you.
Comparison for my case
For instance, in my case, here are the five cheapest insurances:
- Assura with 207.70 CHF per month and Pharmed model (family doctor, limited pharmacy choice)
- CSS with 211 CHF per month and HMO Model (Medix Bern)
- Assura with 211.40 CHF per month and HAS model (family doctor, all pharmacies)
- CSS with 218.20 CHF per month and HMO Model (Reseau Delta Fribourg)
- Swica with 219.30 CHF per month and HMO Model (Favorit Sante)
It is essential to look at the details here. The first one is at a low price, but you have a limited number of pharmacies. For me, this is not acceptable since I cannot go to the pharmacy that is in my village. If you do not care about that or if the closest pharmacy is available, then go for it!
The second choice looks interesting, but I have to go to Bern for a doctor. That is bad since it is about 40 minutes drive to go there. So this one is also unacceptable for me.
The third one is what I would take. It is still cheap, and I can choose my pharmacy and my doctor.
The fourth one would be my second choice. And the fifth one is also okay.
So you must look at the details to make sure that is something you can use.
Now, to be honest, I do not have the cheapest health insurance. But my company has an insurance agent and is paying for our health insurance premiums. So I took the health insurance from the agent. With this, I have more coverage than I need.
Should you take supplemental insurances?
Finally, let’s see the main types of supplemental insurances. There are many more, of course. But these are the ones that people use the most.
There are two groups of supplemental insurances:
- supplemental hospital insurances
- supplemental outpatient insurances.
Supplemental Hospital Insurance
The base health insurance will pay for your hospital fees. However, it will only cover your expenses in the general ward. And some insurances will limit to which hospital you can go to. Supplemental hospital insurance can help improve the quality of your stay in the hospital. They are also called Supplemental Inpatient Insurance.
Instead of general care, you can decide on semi-private care. Such insurance will guarantee that you will only end up in a two-bedroom. It will also mean that a senior physician will take care of you. It can be expensive, but many people take this insurance.
You can also use private care supplemental insurance. This insurances will cover your expenses for a private room in a hospital. Also, you will generally have the chief physician for your treatment. But this can be very expensive. Very few people use this kind of supplemental insurances.
Finally, you can also opt for the free choice of hospital supplemental insurance. It will let you choose any hospital in Switzerland and cover your expenses there.
For most people, these insurances would not be necessary. However, semi-private care is a good option. Private care is simply too expensive and not worth it. But having a two-bedroom when you are trying to recover can be quite enjoyable. But of course, it is pure comfort. Free choice of hospital can also be a good choice.
I also think that for women that plan to have children, it is good to have semi-private care insurance. This will generally let you choose a clinic instead of a hospital and will let you choose your doctor. And you will be in a two-bedroom. This could make a significant difference for childbirth and the first days.
Now, for young people in good health, it is fine not to have any supplemental Hospital.
Supplemental Outpatient Insurances
Outpatient insurances are a bit more complicated since there are many different options. These insurances cover things outside of the hospital.
The most used ones are ones that cover some treatment not covered by the base insurance. For instance, there are dental supplemental insurance and glasses supplemental insurances.
There are also some supplemental insurances for travel. One that many people use can cover accidents in other countries. You can also get coverage in hospitals in other countries. Some insurances can also cover vaccinations for traveling abroad.
There are also some more special insurances. There are supplemental insurances that will pay back your costs of traveling to the doctor. And some insurances will pay for improving your health. This includes things such as medical checkups and gym memberships.
These insurances are dependent on the situation of each person. If you travel a lot outside of the EU, it is great to have some travel insurance. In my case, this is even mandatory for my job.
Some supplemental insurances can also make sense if you know that you are going to use them a lot. For instance, dental insurances can be great if you know that you have a lot of dental care expenses. But you have to make the math to see if it is worth it. You should only take such insurance if this makes you save money.
One supplemental insurance that can also be great is preventive care insurance. For instance, this could cover check-ups every few years. This can also include a gym membership, for example.
And some of these insurances come in packages. So you need to consider them entirely and not per single item.
If you have read so far, you should have a good understanding of how the health insurance system works in Switzerland. And you should know how to pay as little as possible for it.
It is important to choose the insurance policy that works best for you. Since base insurance is the same for all providers, you can generally pick the insurance that is the cheapest for you.
Unfortunately, even if you take the cheapest health insurance, it is still costly. And you will always have to pay for many things yourself. If you have a large deductible, it would be great to have at least this amount in your emergency fund.
Do you have any more questions? What health insurance do you have? Do you have any tips for lower health insurance coverage?