Basic Health Insurance in Switzerland
Understanding mandatory health insurance (KVG/LAMal) - coverage, costs, models, and how to choose the right option for your needs.
What is Basic Health Insurance (KVG/LAMal)?
Basic health insurance (KVG/LAMal) is mandatory for everyone living in Switzerland. This requirement ensures that all residents have access to high-quality healthcare without facing excessive financial burdens.
The beauty of the Swiss system lies in its standardized benefits: the core services you receive are identical regardless of which insurance company you choose. What differs are the service quality, premium costs, and available insurance models.
For newcomers to Switzerland, you have a three-month window to secure your basic health insurance after registering as a resident. Coverage is retroactive to your arrival date, so any medical expenses during this period will be covered once you've enrolled.
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What's Covered by Basic Insurance
Swiss basic health insurance provides a comprehensive package of essential medical services. These benefits are standardized across all insurers, ensuring equal access to necessary care for all residents.
Here's a closer look at what's included in the basic insurance package (KVG/LAMal):
Core Medical Treatments
This encompasses visits to general practitioners (GPs) and specialists (though specialist access might require a referral depending on your chosen insurance model). It also covers hospital stays in a general ward within your canton of residence.
Emergency treatments are covered worldwide, although there are limitations—typically up to double the cost of what the same treatment would cost in your canton of residence.
Medications
Prescription drugs listed on the official list of pharmaceuticals, known as the "Spezialitätenliste" (SL), are covered. However, not all medications are included. Some newer or very expensive drugs might require special approval from your insurer's medical officer, or they might be excluded from basic coverage altogether.
Maternity Care
Comprehensive maternity care is fully covered, including regular check-ups during pregnancy, the costs of childbirth (whether at a hospital, birthing center, or at home with a midwife), and postnatal care for both mother and baby. Importantly, no deductible or co-payment applies to maternity services.
Preventive Measures
Certain preventive measures are covered, such as specific vaccinations outlined in the national or cantonal vaccination plans, gynecological check-ups (every three years), and developmental screenings for children.
Specific Therapies (with limitations)
- Physiotherapy: Covered if prescribed by a doctor, usually for a specific number of sessions.
- Psychotherapy: Covered when provided by a medical doctor who is a psychiatrist, or by a psychologist if they are working under the supervision of a doctor.
- Chiropractic: Treatments by recognized chiropractors are covered directly.
- Alternative medicine: Limited coverage for specific therapies when performed by qualified medical doctors with additional certifications in that therapy.
Transportation & Rescue Costs
Basic insurance contributes to necessary medical transportation, but with significant limitations:
- Ambulance transport: 50% of costs covered, up to a maximum of CHF 500 per calendar year.
- Rescue costs: (e.g., helicopter rescue): 50% of costs covered, up to a maximum of CHF 5,000 per calendar year.
Note: These are annual maximum contributions, not per-incident coverage. Supplementary insurance is recommended for more comprehensive transport coverage.
Medical Aids & Devices
Coverage is provided for specific medical aids and devices that are listed on the official inventory called the "Mittel- und Gegenständeliste" (MiGeL). This includes items like certain bandages, incontinence supplies, insulin pumps, and CPAP machines.
What's NOT Covered by Basic Insurance
While comprehensive, Swiss basic health insurance doesn't cover everything. Understanding these exclusions is key to managing your healthcare expenses.
Dental Care
For adults, dental treatments are generally not covered by basic insurance. Exceptions are made for severe diseases of the masticatory system or if dental work is required due to a serious accident. For routine dental care, you'll need supplementary dental insurance or to pay out-of-pocket. Learn more about Dental Insurance in Switzerland →
Alternative Medicine/Complementary Therapies
Coverage for alternative therapies like acupuncture, homeopathy, or osteopathy is very limited under basic insurance. Some specific therapies might be covered if performed by a conventionally trained medical doctor who also has a recognized certification in that complementary therapy. For broader coverage, supplementary insurance is usually necessary. Explore alternative therapy coverage →
Private Hospital Rooms
Basic insurance covers accommodation in a general (multi-bed) ward in a hospital within your canton of residence. If you desire a semi-private or private room, this would require supplementary hospital insurance.
Vision Care (Glasses/Contacts)
For adults, basic insurance generally does not cover the cost of eyeglasses or contact lenses. There are some contributions for children under 18 under specific medical conditions or for significant vision impairments.
Non-Prescription Medications
Medications that can be purchased over-the-counter without a doctor's prescription are typically not covered.
Cosmetic Surgery
Procedures that are purely cosmetic and not medically necessary are not covered.
Treatments Abroad (Non-Emergency)
If you choose to receive non-emergency medical treatment outside of Switzerland, basic insurance generally will not cover it, or will only cover it up to the amount it would have cost in Switzerland. Emergency coverage abroad is, as mentioned, limited.
Consider Supplementary Insurance: If you regularly need services not covered by basic insurance, supplementary insurance plans can provide valuable coverage for dental care, private hospital rooms, expanded alternative medicine options, and more.
Good to Know
While basic insurance has comprehensive coverage, you may want to consider supplementary insurance for additional benefits like private hospital rooms, more extensive dental care, or broader alternative medicine coverage.
Insurance Models
Swiss health insurers offer several models for basic health insurance. Each model offers different levels of premium savings in exchange for certain restrictions on healthcare provider choice.
Pro Tip: Consider your healthcare habits when choosing a model. If you prefer flexibility and direct specialist access, the Standard model may be worth the higher premium. If you don't mind having a primary contact point, alternative models can save you 15-25% on premiums.
Standard Model
Free choice of doctors throughout Switzerland
- Choose any doctor in Switzerland
- Direct specialist access
- No restrictions on medical providers
- Maximum flexibility
Family Doctor
Designated family doctor as first point of contact
- Personal relationship with doctor
- Coordinated healthcare
- Need referral for specialists
- Lower premiums
HMO Model
Treatment through a health maintenance organization
- All services from one healthcare center
- Coordinated treatment approach
- Referrals required for specialists
- Substantial premium discount
Telemedicine
Initial consultation via phone or video call
- 24/7 medical advice
- Convenient remote access
- Virtual triage before appointments
- No geographic limitations
Looking for More Details?
Each insurance model has specific rules about how you access healthcare services. Understanding these details can help you make the best choice for your situation.
Deductibles & Cost Sharing
In the Swiss healthcare system, your costs consist of three main components: monthly premiums, annual deductibles, and co-payments.
Your deductible (franchise) is the amount you pay for medical expenses before insurance coverage begins. Higher deductibles mean lower monthly premiums but higher initial out-of-pocket costs.
After meeting your deductible, you pay a co-payment (Selbstbehalt) of 10% of costs up to an annual maximum of CHF 700 for adults and CHF 350 for children.
Monthly Premium
Fixed monthly amount paid to your insurer regardless of whether you use medical services. Varies based on your region, age, chosen deductible, and insurance model.
Premiums are calculated based on your age group (child, young adult, adult), your canton and specific premium region of residence, the insurance company you choose, and the insurance model you select. Importantly, premiums for basic health insurance cannot be set based on your health status or pre-existing conditions.
Annual Deductible
The amount you pay before insurance starts covering costs. Ranges from CHF 300-2500 for adults and CHF 0-600 for children. Resets every calendar year on January 1st.
For adults, the standard minimum deductible is CHF 300, but you can opt for higher deductibles (CHF 500, 1000, 1500, 2000, or 2500) in exchange for lower monthly premiums. For children (up to age 18), the minimum deductible is CHF 0. Choosing a higher deductible means taking on more initial risk but benefiting from reduced monthly payments.
Co-payment
After meeting your deductible, you pay 10% of costs up to CHF 700/year (adults) or CHF 350/year (children). For hospital stays, there's an additional CHF 15/day charge (not for children or maternity).
For example, if an adult has a CHF 300 deductible and incurs CHF 2000 in medical bills, they pay the first CHF 300 (deductible), and then 10% of the remaining CHF 1700 (which is CHF 170), totaling CHF 470. If further costs arise, they continue to pay 10% until reaching the annual co-payment cap.
Important exceptions:
- Maternity services have no deductible or co-payment
- For hospital stays, adults pay an additional contribution of CHF 15 per day (not applicable to children or maternity stays)
Adult Deductibles (26+ years)
| Deductible (CHF) | Premium Savings |
|---|---|
| CHF 300 | Base premium (no savings) |
| CHF 500 | Approx. 7% savings |
| CHF 1,000 | Approx. 14% savings |
| CHF 1,500 | Approx. 21% savings |
| CHF 2,000 | Approx. 28% savings |
| CHF 2,500 | Approx. 35% savings |
Child Deductibles (0-18 years)
| Deductible (CHF) | Premium Savings |
|---|---|
| CHF 0 | Base premium (no savings) |
| CHF 100 | Approx. 8% savings |
| CHF 200 | Approx. 15% savings |
| CHF 300 | Approx. 21% savings |
| CHF 400 | Approx. 28% savings |
| CHF 500 | Approx. 35% savings |
| CHF 600 | Approx. 40% savings |
Choosing the Right Deductible
When choosing a deductible, consider your expected healthcare usage. Higher deductibles work well if you're generally healthy with few expected medical expenses. Lower deductibles are better if you anticipate regular healthcare needs.
Premium Ranges
Health insurance premiums in Switzerland vary significantly across different regions and age groups. These variations reflect the differing healthcare costs and utilization patterns across the country.
Premium Regions
Monthly premium costs by geographic region
| Region | Monthly Premium (CHF) | Example Areas |
|---|---|---|
| High-Cost Region | CHF 450-600 | Geneva, Basel, Zurich |
| Medium-Cost Region | CHF 350-450 | Bern, Lausanne, Lucerne |
| Lower-Cost Region | CHF 300-400 | Rural areas of Valais, Graubünden, Appenzell |
By Age Group
Monthly premium ranges by age category
| Age Group | Monthly Premium Range (CHF) | Notes |
|---|---|---|
| Children (0-18) | CHF 80-140 | Reduced premiums, no mandatory deductible option |
| Young Adults (19-25) | CHF 250-400 | Discounted rates compared to adults |
| Adults (26+) | CHF 300-600 | Standard rates, varies by region |
| Seniors (65+) | CHF 350-650 | Same rates as adults (no age-based premium increase) |
Why Premium Regions Exist
Switzerland divides cantons into different premium regions based on healthcare costs. Urban areas generally have higher premiums due to greater healthcare costs, more specialists, and higher utilization rates.
Key Factors Affecting Premium Regions:
Frequently Asked Questions
When do I need to get Swiss health insurance?
You must obtain Swiss health insurance within 3 months of arriving in Switzerland. The coverage is retroactive to your arrival date. If you don't arrange insurance within this period, authorities may assign you to an insurance provider and you may face penalties.
Can I choose any insurance provider?
Yes, you can choose any insurance provider in Switzerland for your basic insurance. The coverage is identical across all insurers as it's regulated by law. What differs are the premium costs, service quality, and available insurance models.
Can I change my insurance provider?
Yes, you can switch basic insurance providers twice a year: by November 30 to change from January 1, or by March 31 to change from July 1. You must have paid all outstanding premiums, and your current deductible doesn't transfer to the new insurer.
Do I need supplementary insurance?
Supplementary insurance is optional and covers services beyond the basic insurance package. Whether you need it depends on your personal preferences and health needs. Common supplementary options include dental care, private hospital rooms, and expanded alternative medicine coverage.
What happens if I don't pay my premiums?
If you don't pay your premiums, your insurer will send reminders followed by debt collection procedures. Eventually, the canton may list you in a registry of defaulters. While insurers cannot terminate your basic coverage, they can restrict you to emergency treatment only until outstanding payments are resolved.
How does basic health insurance work for cross-border commuters?
Cross-border commuters working in Switzerland generally have the right to choose whether to be insured in Switzerland or their country of residence (if it's an EU/EFTA state). The decision depends on your specific situation, residency status, and other factors. Once you make your choice, you need to formally request an exemption from the mandatory Swiss insurance if you choose to be insured in your country of residence.
Are pre-existing conditions covered?
Yes, basic health insurance must cover pre-existing conditions. Unlike in some countries, Swiss insurers cannot refuse coverage or charge higher premiums for basic insurance based on your health status or medical history.
What if I need treatment while temporarily abroad?
For emergency medical treatment during a temporary stay abroad (e.g., on vacation), basic insurance covers costs up to twice the amount that the same treatment would cost in Switzerland. For EU/EFTA countries, the European Health Insurance Card (EHIC), usually on the back of your Swiss insurance card, facilitates access to necessary medical care under the same conditions and at the same cost as people insured in that country.
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