Voluntary daily benefits insurance covers the risk of temporary loss of earnings due to partial or complete inability to work because of sickness, maternity or an accident.
Two different insurance systems
- Daily benefits can be insured under the terms of two different laws: on the basis of the Federal Act of 18 March 1994 on Health Insurance (HIA; SR 832.10) and on the basis of the Federal Act of 2 April 1908 on Insurance Policies (Insurance Policies Act, IPA; SR 221.229.1).
- Daily benefits insurance under the terms of the HIA is a form of social insurance offered by statutory health insurance providers.
- Daily benefits insurance under the terms of the IPA is based on a private-law insurance contract. It can be offered by insurance companies as defined in the Federal Act of 17 December 2004 on the Oversight of Insurance Companies (Insurance Oversight Act, IOA; SR 961.01).
- Statutory health insurance providers can offer daily benefits insurance under the terms of the IPA on the basis of their ability to offer add-on policies in addition to statutory health insurance.
Daily benefits insurance under the HIA
- Providers of statutory health insurance are required to provide daily benefits insurance to individuals between the ages of 15 and 65 who live or work in Switzerland.
- Providers of statutory health insurance must offer the same level of daily benefits for the same length of time to all insured individuals. Reservations regarding insurance cover for existing illnesses lapse after five years.
- These insurance providers pay daily benefits if you are 50% unable to work for at least 720 days during a 900-day period. Special regulations apply to pregnancy and giving birth.
- They charge the same premiums for the same benefits in individual insurance policies. In a collective insurance policy, benefits that are not the same as (more generous than) those provided by individual insurance can be agreed and the premiums can be determined on the basis of the risk covered by each policy.
- If the insured person has to change insurer when starting or ending a job, no new reservations may be introduced.
- Anyone who leaves a collective insurance policy is entitled to transfer to an individual insurance policy with the same benefits as before.
- Unemployed insureds are paid half the daily benefit if they are more than 25 per cent unable to work and the full daily benefit if they are more than 50 per cent unable to work. In addition, on appropriate adjustment of their premium, unemployed insureds are entitled to change their previous insurance to a policy that starts paying benefits from the 31st day of unfitness for work.
- The Health Insurance Act does not specify a minimum level of daily benefits that insurers must provide. This means that insurance providers are not required to offer applicants the insurance they need to cover the anticipated loss of earnings if they become ill. Many insurance providers offer only a low level of daily benefits under the terms of the HIA. Many people are therefore insured for a higher level of benefits under the terms of the IPA.
Daily benefits insurance under the IPA
- The principle of freedom of contract applies to daily benefits insurance under the terms of the IPA. Insurance providers are therefore not obliged to accept applicants.
- Reservations regarding existing diseases may be attached to the insurance policy for an unlimited period, and certain sickness risks can be excluded from the obligation to provide benefits.
- The level and duration of benefits can be agreed freely.
- The law does not guarantee the right to switch from one policy to another or to change from collective to individual insurance. However, the provisions of the HIA concerning the protection of unemployed insureds must also be observed in insurance policies under the terms of the IPA.
The employer’s obligation to continue paying salary
- Employees’ risk of loss of earnings in case of sickness is also covered by the employer’s obligation to continue paying salary as stipulated in the Code of Obligations and the administration of justice.
- This obligation to continue paying salary frequently results in the employer taking out daily benefits insurance under the terms of the HIA or the IPA.
- The obligation to take out daily benefits insurance is usually also stipulated in collective labour agreements.
Last modification 03.07.2018