Health insurance: Key points in brief

Health insurance is compulsory in Switzerland.
Around 60 authorised non-profit insurers offer compulsory health insurance (basic insurance) and optional daily allowance insurance.

What does compulsory health insurance cover?

Compulsory health insurance provides cover for illness, maternity and accidents and offers the same range of services and benefits to all insured people. Insurers must ensure equal treatment for everyone, making no distinctions on the basis of health status or indicators. This applies in particular to enrolment, the choice of insurance type and reimbursement of costs.

How is compulsory health insurance financed?

Compulsory health insurance is financed by policyholders’ contributions (premiums) and co-payments (deductible, retention fee, contribution to the costs of a hospital stay) and federal and cantonal funding (premium subsidies).
The premiums charged by an insurer must cover its costs (return on capital can be taken into account when calculating the cost of premiums).
Premiums are not dependent on income and vary according to the insurer, place of residence and type of insurance selected (optional deductible, restricted choice of providers).
People on a low income, children and young adults in education/training often receive premium subsidies. Entitlement to subsidies is determined by the cantons.
Insurers may only use compulsory health insurance resources for the purposes of social health insurance.

Choices for the insured.

People are free to choose any insurer operating in their place of residence. Within their area of activity, insurers must accept any person subject to compulsory insurance.
People may choose any type of insurance (optional deductible, free or restricted choice of providers) offered by the insurer in their place of residence.
People who require medical examination or treatment can choose any authorised provider suitable for the treatment of their condition or included in the Hospital List, unless they have selected a type of insurance with a restricted choice of provider. Policyholders may change to a different insurer after one year.

How are services paid for?

Providers can be compensated for their services in two ways:

  1. By policyholders, whose costs are in turn reimbursed by their insurer (tiers garant system, e.g. for physicians’ bills).
  2. By insurers, if it has been agreed with the providers that their services will be paid for directly (tiers payant system, e.g. for hospital bills or medicines).

Last modification 06.04.2020

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Contact

Federal Office of Public Health FOPH
Health and Accident Insurance Directorate
Schwarzenburgstrasse 157
3003 Berne
Switzerland
Tel. +41 58 462 21 11
E-mail

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