Swiss health insurance for Americans — what works differently.

Swiss health insurance differs from the US in five ways: it is compulsory for every resident, you buy it yourself rather than through your employer, every insurer covers the same basic benefits, insurers must accept you whatever your health, and doctor access runs through “models” rather than networks. The deductible is called the franchise, and you have three months from registering to choose an insurer.

The one idea to drop: it is not an employee benefit.

In the US, health insurance usually arrives with a job. In Switzerland it does not. Basic insurance (KVG) is an individual mandate: everyone resident in Switzerland must hold it, and each person holds their own contract, children included. Your employer does not choose it, does not pay a share of it and does not follow you into it. When you change jobs, nothing changes. When you lose a job, nothing changes.

That is the biggest shift for a US transferee, and it has a practical consequence: nobody hands you a benefits pack. You choose the insurer, the deductible and the model yourself, inside a window of three months. The full setup sequence — registration, choosing, the first letters — is on our page on health insurance for foreigners in Switzerland. This post stays with the comparison.

A US↔Swiss terms table.

Franchise and co-pay: the same money, different arithmetic.

The franchise is your deductible: the first slice of covered costs each calendar year is yours. Above it you pay 10% of the covered costs — the Selbstbehalt — until that 10% has reached CHF 700 in the year. After that the insurer pays everything covered.

So the ceiling is easy to state. At the default CHF 300 franchise, the most you can pay in cost-sharing in a year is CHF 300 + CHF 700 = CHF 1,000. At the highest franchise, CHF 2,500, it is CHF 2,500 + CHF 700 = CHF 3,200. Adults choose anywhere from CHF 300 to CHF 2,500; the higher the franchise, the lower the monthly premium. Children carry a separate, lower structure, described in our post on the family franchise cap.

Two American reflexes to unlearn. First, a high deductible is not a trap by default: because the co-pay stops at CHF 700, the worst year is bounded and known. Second, the choice is not permanent — you can change the franchise for the following year, with the deadline rules in our post on the 30 November cancellation.

Same benefits at every insurer.

The basic package is defined by law, not by the insurer. The benefits catalogue sits in KVG Art. 25 and the ordinances behind it, and every approved basic insurer provides exactly that. There are no bronze, silver or gold tiers to compare. What differs between insurers is the premium, the service, and the models on offer — not what a hospital stay or a specialist visit is covered for.

This is why “which insurer covers most” is the wrong question for basic cover, and why the price comparison is genuine: the calculator shows every approved insurer for your postcode, age, franchise and model, on the same benefits.

Mandatory acceptance: the part US individual insurance used to lack.

Under Art. 5 KVAG, basic insurers must accept everyone, and they may not vary the basic premium by health status. A health condition does not change what you are offered, or whether.

Supplementary insurance is the opposite. It sits under a different law (VVG), and the insurer may ask health questions, exclude a condition, add a surcharge or decline. If you remember what individual insurance in the US looked like before mandatory acceptance, supplementary cover in Switzerland works like that. The consequence is a sequencing rule: never cancel supplementary cover before the new insurer has accepted you in writing. Cheap supplementary premiums at 32 also become expensive at 55 — the age-curve trap — which is why we match supplementary cover to what you’ll actually use, and for many people that is very little.

Models instead of networks.

There is no in-network and out-of-network bill in Switzerland. Instead you choose a model — a way in to care — and the model sets your premium.

• Standard: see any doctor directly.
• Family doctor (Hausarzt): a chosen practice is your first call, and it refers you on.
• HMO: a chosen HMO centre is your first call.
• Telmed: you phone or use an app first, then are directed to care.

The 2027 federal premium data shows what the choice is worth. Across all approved offers, the median adult premium at CHF 300 franchise is CHF 596.10 a month on the standard model, against CHF 531.60 for HMO, CHF 530.30 for family doctor and CHF 525.20 for telmed. These are unweighted medians across offers — a guide to the size of the gap, not a price for you. In Zürich Region 1 the median standard premium is CHF 677 a month, with about CHF 588 to CHF 592 on the alternative models.

The trade is simple: a lower premium in exchange for a fixed first contact. If you already have a family doctor you like, or you travel too often to use a telephone first, standard can be the right choice. We say so plainly when it is.

Accident cover comes through your employer.

In the US, accident and illness sit inside one plan. In Switzerland, if you work more than eight hours a week for one employer, that employer must insure you against accidents, at work and outside it, under a separate law (UVG). Because you are then covered, you can switch accident cover off in your basic health policy, which lowers the premium. If you stop working or work fewer hours, the accident cover has to be switched back on with your health insurer. Check this the day you start and the day you stop; it is a small line that is easy to leave wrong.

The three-month rule.

Register with your commune first. From that date you have three months to take out basic insurance (KVV Art. 7). If you insure inside the window, cover starts from your registration date, even if you sign in week ten. Miss the window and cover starts only when you join, with a possible premium surcharge and an insurer assigned by the canton. This is the deadline we see missed most often by people who assume an employer or a relocation company has handled it.

What to do about your US plan.

Two separate questions. Once you are resident, Swiss basic insurance is compulsory whatever else you hold. Separately, what your US plan does abroad is a question for your carrier, in writing: which countries, which services, for how long, and whether it ends when you stop being a US-based employee. Do not assume it continues, and do not cancel it before you know what you are giving up.

Where a life is genuinely mobile — several countries, long stays outside Switzerland — international private medical insurance sits on top of Swiss basic cover rather than replacing it. Our page on Swiss versus international health insurance covers who needs it. For plans built for that segment we work with sip.ch, who specialise where Swiss-domestic advisors typically do not.

Where this leaves you.

Coverage in Switzerland is simpler than the US in one respect — the benefits are the same everywhere — and less familiar in every other: you pick the deductible, the model and the insurer, and nobody does it for you. The premiums are set by the federal office and published, so the comparison is honest. You can check what your postcode and age cost in the premium calculator, and read the 2027 picture in the 2027 premiums report.

If you want the setup checked against your actual life, that is what the first review is for.