Health insurance: The Essentials in Brief

Health insurance is compulsory in Switzerland.
Some 60 government-approved non-profit insurance providers offer basic mandatory insurance and optional loss of earnings insurance in accordance with legal requirements and the supervisory authority’s directives.

What does mandatory health insurance cover?

Mandatory health insurance provides cover for illness, maternity and accidents and offers all insureds the same range of benefits. Insurance providers must treat insureds equally, making no distinction according to their state of health or indicators of their health. This applies particularly to acceptance, the choice of insurance type and reimbursement of benefits.

How is mandatory health insurance funded?

Mandatory health insurance is funded by insureds’ contributions (premiums), insureds’ contributions to costs (deductible, retention fee, contribution to the costs of a hospital stay) and subsidies from the federal government and the Cantons (premium reduction).
The premiums charged by an insurer must cover its costs (income from capital may be included when calculating the cost of premiums).
Premiums do not depend on revenue and vary according to insurer, the insured’s place of residence and the type of insurance (level of deductible, restrictions on choice of healthcare providers).
Insureds on a low income, children and young adults in full-time education or training often pay reduced premiums. The Cantons decide who is entitled to a reduction.adults in full-time education or training. The resources provided by mandatory health insurance may only be only be used for purposes associated with that insurance.

Insureds have a choice.

Insureds have a free choice of insurer from among those operating in their place of residence. Within the scope of their activities, insurers must accept anyone who requires insurance.
Insureds may choose any of the forms of insurance (level of deductible, free or restricted choice of healthcare providers) offered by the insurer in their place of residence.
If insureds require medical examination or treatment, they can choose any of the approved providers capable of treating their condition or hospitals included in the hospital list unless they have restricted their choice by selecting a particular form of insurance. Insureds may change to a different insurer after a maximum of one year.

How are benefits reimbursed?

Providers of healthcare benefits can be remunerated for their services in two ways:

  1. By the insureds, whose expenses are subsequently reimbursed by their insurer (third-party guarantee system for doctors’ bills, for example).
  2. By the insurers if they have agreed with the healthcare providers that the benefits they provide will be paid for directly (third-party payer system for hospital bills or medicines, for example).

Last modification 27.08.2019

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

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