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Choosing your health insurance

Choisir mon assurance maladie

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Health insurance costs are important in the budget of Swiss families. The swiss health insurance offer is complex. Choosing well requires method and time. Following a three-step process will help you choose your health insurance:
  • 1 - Define the level of care required Choose between Economic, Standard or Premium level of coverage
  • 2 - Prioritise the reimbursements The coverage that the compulsory basic LAMal insurance offers is standardized and defined by the regulations of the OFSP a.k.a Federal Office of Public Health; its coverage is compulsory and therefore does not affect the first two steps.
  • In a different way, the complementary health insurance can be adjusted to your needs in terms of coverage.
  • 3 - Reduce the price of health insurance Adjust basic LAMal insurance options to fit within your budget. Health insurance providers offer alternative models, deductible levels that reduce the cost of LAMal premiums.


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Step 1 - Define the level of coverage

The compulsory health insurance LAMal does not cover all types of healthcare. In Switzerland, LAMal insurance guarantees the access to what is called the “cantonal care network”; however, this regime has shortcomings. Additional insurance provided through complementary health insurance policies is optional but necessary if I want to benefit from good health coverage.

Access to the best coverage

Patients may have needs that can be covered by optional complementary health insurance contracts such as for example to reduce the lag for an surgery by changing the cantonal hospital, to seek a specialised doctor rather than an hospital resident, to have a single room for childbirth. Access to a wide range of medical services Complementary health insurance policies allows, among other things, to:
  • Access to private hospitals and clinics
  • Choose the general practitioner or specialist without constraint (“free choice”)
  • Seek advice from the department head rather than the advice of a hospital medicine resident
  • Reduce hospital or private clinics’ admission’s waiting time
  • Get double medical opinion (increasing demand) which enables to “challenge” medical opinions and to empower the patient ( in the article on the rise of Medtech in Switzerland, the “patient partner” program of the Hôpitaux Universitaires de Genève (HUG) affirms that empowering patients and providing them with additional information is beneficial for their recovery).
  • Medical costs being covered while abroad
  • Have a single room for childbirth
  • Get comfort services when sick (e.g. babysitting)
  • Bypass health questionnaire for additional health insurance contracts in the future

At the end of step 1, you should choose between the Economic, Standard or Premium coverage category for your health insurance.


Step 2: Prioritise the reimbursements

Step 2 allows you to review the reimbursements levels with regards to the coverage category chosen in step 1 ... The basic compulsory insurance LAMal reimburses badly or not at all some specific medical services whereas an additional insurance contract can fill these gaps in reimbursement. Not having a complementary health insurance contract implies a risk of being in financial difficulty in case of a serious illness or accident.

Compensation for gaps in health care and reimbursements

Complementary and optional health insurance contracts can improve the care and reimbursements of your basic and mandatory LAMal insurance contract with for example:
  • Additional preventive examinations (e.g. during pregnancy, mammogram)
  • Optical costs (e.g.glasses, contact lenses)
  • Dental treatment costs (e.g. dental implants)
  • Orthodontic treatment costs (e.g. braces)
  • Repatriation expenses when abroad
  • Alternative medicine costs (e.g. homeopathy, naturopathy, acupuncture)
  • Allowance to fitness and sports membership fees
  • Lump sum payment during hospitalization ...

Within step 2, you should choose the coverage of your complementary health insurance between a packaged insurance or "à la carte" insurance.


Investment in the future

In addition to access to one of the best medical systems in the world with best medical specialists and the latest medical technologies, complementary health insurance contract in Switzerland is also a financial investment: you subscribe to complementary insurance at a young age, as long as you can - without a health questionnaire - and you benefit from it when you are older (future request for additional insurance will not be subject to a health questionnaire).  

Restricted entry conditions

While subscription to basic LAMal health insurance is not subject to a health questionnaire, additional complementary health insurances are subject to :
  • examination of your health questionnaire by the health insurance company, which has no obligation to insure the applicant. The subscription must therefore occur before the occurrence of a health issue and medical care (as soon as this care appears in the health questionnaire , access to complementary insurance is limited)
  • your age. there is maximum age beyond which the subscription to a complementary health insurance is no longer possible

It is therefore best to subscribe to complementary health insurance without delay.


The development of complementary health insurance contracts

The Federal Office of Public Health (OFSP) notes a continuous increase in the costs of the Swiss health system. Care and medication are expensive in Switzerland. Therefore, future scenarios predict that this increase can no longer be reflected in the premium amount of LAMal insurance that is already very expensive (many Swiss already need cantonal subsidies to pay their basic LAMal insurance premiums) and some scenarios are even based on the end of the coverage of medical services by LAMal.

According to them, the complementary insurance will take over and reimburse this care. Technological developments in medicine are more and more expensive. To benefit from them, families will complement the basic compulsory health insurance LAMal and choose additional health insurances.


Step 3: Reduce the price of health insurance

After having defined the level of care you want (Economic, Standard or Premium) and the reimbursements’ targets, in step 3, you need to make adjustments to your health insurance contracts to reduce the basic and complementary health insurance premiums: Basic LAMAL health insurance
  • Amend deductible in the basic and mandatory LAMAL insurance
  • Choose an alternative model (incl. use of a family doctor , telemedicine, first contact by phone)
  Optional complementary health insurance
  • “Flex” hospitalization models
  • multi-year models
  • family discounts ...

Choose your health insurance with the help of helvicare


8,000 customers have already used the helvicare’s 3 steps approach.


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