Basic health insurance in Switzerland
In Switzerland, basic health insurance is compulsory. Basic health insurance is sometimes referred to as LAMal insurance. Newcomers have 3 months to join the health insurance fund of their choice. There are more than 80 insurance companies to choose from.
If no choice has been made after 3 months, the Canton can automatically affiliate the resident to a health insurance fund. This automatic affiliation is done by random draw. The late applicant may therefore be automatically affiliated to the most expensive fund. The newly arrived Swiss resident must take the necessary steps to join a health insurance fund if he or she wants to benefit from the best insurance coverage and the most advantageous prices.
Be aware that although there is a 3 month deadline for choosing a health insurance fund, the obligation to be insured from the first day in Switzerland remains. Consequently, the newcomer will have to pay retroactively their insurance for the days or weeks preceding their effective affiliation.
Certain categories of residents in Switzerland are exempt from compulsory membership of the LAMal. Please visit our ‘LAMal health insurance’ page to find out more about these exceptions and to explore the subject of compulsory insurance in Switzerland.
Understanding health insurance in Switzerland
In order to choose the right insurance, it is important to understand how health insurance works in Switzerland.
The three most important concepts for understanding insurance are:
- Premiums
The amount you have to pay to your insurer each month, regardless of your health costs. - Deductible
The amount that must be exceeded before your insurance fund will start to reimburse your health costs. - The co-payment (cost share)
Your contribution to the costs of your health care (10% of the costs of your health care services). This co-payment is limited to CHF 700 per year for adults and CHF 350 per year for children.
Making the right choice in terms of health insurance requires a good understanding of these key concepts. Visit our deductible and co-payment simulator to practice and understand the deductibles and co-payments in Swiss health insurance in 5 minutes.
Alternative models
In addition to premiums, deductibles and co-payments, it is also important to know about alternative health insurance models. A large majority of Swiss residents have chosen an alternative model to reduce their health insurance bills.
Most health insurers offer alternative models. Each insurer gives different names to its services. However, the alternative models can be grouped into 3 categories, the Telmed model (telemedicine), the Family Doctor model, and the HMO model (healthcare network).
Telmed – Telemedicine
The concept is simple. You undertake to systematically contact a medical centre by internet or telephone before going to see your doctor. In exchange, your health insurance premiums are reduced by 10% to 20%.
In addition to the savings on health insurance premiums, the alternative model of telemedicine has many advantages and some disadvantages that you should be aware of.
Visit our ‘Telemedicine’ page to learn more about this alternative model.
Family doctor
The family doctor model is the preferred model of the policyholders. In short, the insured person undertakes to contact his or her family doctor before going to see a specialist. In exchange, their health insurance premiums are reduced by around 10%.
The family doctor model has many advantages, especially for newcomers. But the model also has risks. What happens if your family doctor is no longer recognised by your insurer?
Visit our ‘family doctor’ page to answer these questions and to better understand this health insurance model.
HMO – Healthcare network
HMO stands for Health Maintenance Organization. In French, one speaks of “réseau de soins”.
With this model you undertake to systematically contact your referring doctor in the event of a health problem. The latter will then refer you to a specialist or therapist who is a member of the same health network.
In exchange, you receive significant discounts on your health insurance.
This alternative model is currently the least popular among policyholders. However, it is the fastest growing insurance model. The restructuring of the medical landscape is moving in the direction of care networks. This is undoubtedly one of the key models for the future of the LAMal.
Visit our ‘HMO – healthcare network’ page to learn more about this alternative health insurance model.
Choosing your health insurance
Once you understand how health insurance works in Switzerland, the next step is to find out how to optimise your health insurance cover. In other words, how to pay as little as possible for the best possible insurance.
To choose the right insurance, you have to decide between the cost of the premium you are prepared to pay each month, and the expected reimbursements and the desired levels of care.
To achieve this, we have developed a 4-step method that allows you to choose your health insurance in Switzerland quickly and efficiently.
Visit our page ‘Choosing health insurance’ to learn more about this method and choose the best health insurance at the best price.
Supplementary health insurance
Once you have understood and chosen your basic insurance, it is strongly recommended that you take out supplementary insurance. The basic LAMal insurance is very basic and many essential services are not covered. This is the case, for optical care or dental and orthodontic care.
In addition, supplementary insurance allows you to have better services. For example, they include access to private clinics or to choose the best specialists.
It should be noted that supplementary insurance is modular and can be chosen according to your needs. Some supplementary insurance plans cost only CHF 5 or 10 per month and allow you to customise your cover to your own needs. For example, by adding alternative and complementary medicine to your coverage.
There are many supplementary insurances and each insurance company creates its own products and gives them different names. However, it is possible to group supplementary insurances into the following categories:
- Hospitalisation
Allows you to obtain additional services during your stay in hospital (e.g. private clinic, choice of specialist, etc.) - Outpatient
These top-ups include outpatient services (e.g. optical, sport, prevention, etc.). - Natural medicines
Extend your coverage to alternative medicine. - Dental
Reimburse dental and orthodontic costs that are not covered by the LAMal. - International
For better coverage when you are abroad.
Bear in mind that the insurer, unlike your registration with a LAMal insurance company, may refuse your application for supplementary insurance. This decision is made on the basis of a health questionnaire that you will have to fill out in order to be able to take out supplementary insurance.
To find out more about supplementary insurance in Switzerland, visit our page ‘supplementary insurance’.
Questions / Responses
There are certain questions about health insurance in Switzerland that come up frequently.
Are you still covered by the health insurance of your former country of residence? How do you terminate your health insurance? What is the waiting period for your supplementary health insurance?
To answer these questions, visit our page ‘Health insurance – Questions / Responses’.
