Co-payment for persons insured in Switzerland

Persons insured in Switzerland and resident abroad can be treated either in Switzerland or in their country of residence. The co-payment regulations vary depending on the country where treatment is received.

Treatment in Switzerland

Co-payment is subject to the provisions of Swiss law. Further information can be found under “Cost participation for persons insured in Switzerland”.

Treatment in the country of residence

Using the S1 form (previously E106, E109, E121) provided by the insurer, policyholders and/or family members can register to obtain benefits in kind from the healthcare institution of their country of residence, which will be reimbursed by the Swiss health insurer. Co-payment is subject to the legal provisions of the country of residence.

Treatment in another EU/EFTA country

With the European Health Insurance Card (EHIC) issued by the health insurer, policyholders, in the event of illness, accident or maternity during their stay, are entitled to receive all benefits in kind considered medically necessary given the type of treatment and expected length of their stay. Co-payment is subject to the regulations of the country where treatment is received and is generally payable directly. Co-payment in Switzerland is then not applicable. Nor is co-payment in an EU/EFTA country taken into account for the Swiss deductible or retention fee. For more information, see “Stay in EU/EFTA” (available in French/German/Italian) on the website of the Common Institution under the KVG (Swiss liaison body).

Treatment in a non-EU/EFTA country

During a temporary stay in a country outside the EU/EFTA, the costs of emergency treatment for illness or accident (in cases where a return to Switzerland is not possible for medical reasons) will be reimbursed up to a maximum of twice the amount that the insurer would have paid if the treatment had been provided in Switzerland. In the case of inpatient treatment, however, this means that the insurer will reimburse no more than 90% of the costs that would have arisen for hospitalisation in Switzerland. Co-payment is based on the Swiss regulations. Further information on this topic can be found under “Cost participation for persons insured in Switzerland”.
Other medical treatments abroad are not generally covered by compulsory health insurance.

Medical costs outside the EU/EFTA

Medical costs in certain countries outside the EU/EFTA (e.g. the US, Canada and Japan) are very high. Costs will be reimbursed up to a maximum of twice the amount that the insurer would have paid if the treatment had been provided in Switzerland.

Link
Legislation

Common Institution under the KVG – temporary stay in an EU/EFTA country (in French/German/Italian)

832.102 Federal Ordinance on Health Insurance (OAMal), articles 36 and 103