Question 1

What’s the role of the FOPH in setting premiums?

Accepted Answer

The FOPH is the supervisory authority for health insurers. Every year, health insurers set the premiums for basic insurance for the following year. They then submit these premiums to the FOPH for approval.The FOPH checks whether the premiums cover the cantonal costs, ensure the solvency of the respective health insurer and safeguard the interests of the people it insures. It only approves premiums that comply with the legal requirements and cover the costs. However, the premiums must not be unreasonably higher than the costs or lead to excessive reserves.More about the premium approval process: Health insurance: Comparison of premiums | www.foph.admin.ch.

Question 2

Why do the increases in premiums vary so much from canton to canton?

Accepted Answer

Every health insurance company must basically ensure that its premium income covers healthcare expenditure in the respective canton. The cantons with the biggest increases in premiums are often those where costs have risen the most or where the sharpest increase is expected for the coming year.The reasons why cost increases differ from canton to canton include:

Demographics: Cantons with an older population tend to have higher healthcare costs, as older people use medical services more frequently.
Proportion of outpatient treatments: Outpatient treatments are currently still financed entirely by premiums. A higher proportion of outpatient treatments can therefore lead to higher costs, which are financed by premiums.
Range of care providers: Certain cantons have a higher density of care providers, i.e. doctors, physiotherapists, hospitals, etc. This often leads to higher healthcare costs.

Question 3

Why do premiums increase every year?

Accepted Answer

Premiums increase because the costs of health insurance are rising. This is because premiums follow costs. The increase in costs is due to a variety of factors, for example

the ageing population
medical advances
new drugs and treatment options
increasing use of healthcare services.

You will find more data on the health insurance dashboard (available in German and French).

Question 4

How do I get a premium reduction?

Accepted Answer

Insureds in modest financial circumstances and children and young people in education often receive a premium reduction. The canton of residence determines who is entitled. It decides who is eligible for a reduction and how much the reduction will be.Some cantons reduce premiums without the insured having to submit an application. In other cantons, the insured must submit an application for a premium reduction. The application for a premium reduction must be submitted to the competent cantonal authority.You’ll find the contact details of the competent cantonal authorities and further information on premium reductions on Priminfo (in German, French and Italian): Prämienverbilligung | www.priminfo.ch.

Question 5

How can I save on premiums?

Accepted Answer

Save money by switching health insurersCompare your premiums with those of other health insurers and switch to a cheaper one. Use the premium calculator at www.priminfo.ch. Priminfo is the only official premium calculator offered by the Swiss federal government. The calculations are anonymous, independent and free of advertising.Save money when choosing your deductibleYou can save money by choosing a high deductible. The deductible is the specific amount that you, as the insured person, pay towards your healthcare costs each year.

You choose the amount of the deductible yourself between CHF 300 and CHF 2,500.
With a high deductible, the premiums are higher.
With a low deductible, the premiums are lower.

Important: If you choose a high deductible, you must be able to pay this amount of money in the event of illness.Save money with special insurance modelsYou can save on premiums by choosing a special insurance model. The most common are the family doctor (GP) model and the HMO (health maintenance organisation) model. Under these models, you do not have a free choice of care provider (e.g. doctor) and instead always have to seek treatment first at an HMO centre or your family doctor (GP).You will find further information on insurance models in the section "What insurance models are available? What are their advantages?".You can find more options for saving on premiums at Sparen mit der Grundversicherung | www.priminfo.ch (in German, French and Italian).Premium reductionsIf you have only limited funds to cover your living expenses, you can apply for a premium reduction from your canton of residence.You will flind further information on premium reductions in the section "How do I get a premium reduction?".

Question 6

Can I also switch health insurers during the year?

Accepted Answer

Typically the switch takes place at the end of the year.However, in certain cases, the law also allows basic insurance to be terminated at the end of June.  This is only possible if you’re insured under the standard model (with a free choice of doctor) and have chosen the standard deductible of CHF 300. If you wish to switch at the end of June, the letter of termination must be received by the health insurer by 31 March at the latest.

Question 7

What insurance models are available? What are their advantages?

Accepted Answer

In addition to the standard model (with a free choice of doctor), Swiss health insurers offer a variety of basic insurance models that allow you to save on premiums. The most common types of insurance models are:Family doctor (GP) modelUnder the family doctor model, you choose a family doctor (general practitioner or GP) as your first point of contact. For all medical questions and complaints, you always go to your family doctor first. He or she coordinates the course of treatment and can also refer you to specialists.Telemedicine modelUnder the telemedicine (telmed) model, if you have health problems you first contact a phone hotline staffed by medical professionals. This hotline provides advice and coordinates further treatment steps if necessary.HMO modelHMO stands for health maintenance organisation, a group practice in which various healthcare professionals work. These include family doctors (general practitioners) and specialists, as well as therapists from various disciplines. Under the HMO model, you always go to your doctor at the HMO practice first with all medical questions and complaints. From there, you will be referred to specialists if necessary.Other modelsThere are also insurance models that combine several of the above features.  In addition, there are models that require the use of generic drugs or certain health apps, for example. Other models exclude certain benefits from the deductible and/or copayment.If you’re interested in switching to a different model, it's best to contact your current or future health insurance company. They can provide you with details. It's important to read the information you receive carefully.

Question 8

Can a provider of basic health insurance refuse to accept me?

Accepted Answer

No. Insureds are free to choose from among the providers of basic health insrance operating at their place of residence. Health insurers must accept every person subject to the compulsory insurance requirement for compulsory (basic) health insurance in their area of operation. This means that the health insurer must insure you without reservation and without a waiting period, regardless of your age and state of health.Please note: The situation is different for supplementary insurance. The health insurer may refuse to insure you altogether after a health check or exclude you from certain benefits.

Question 9

What’s the notice period for switching health insurers?

Accepted Answer

For insurance changes effective 1 January, the health insurer must notify its insureds of the new premium by 31 October at the latest. You can cancel your current insurance by 30 November. It doesn’t matter whether the premium has been increased or whether you’re insured under a special model.The letter terminating your insurance must be received by the health insurance company before the end of the notice period. It’s not the postmark on the letter of termination that counts, but the date on which the health insurer receives the letter of termination. As there may be delays in postal delivery, we recommend that you send the letter of termination by registered mail or A-Post Plus by mid-November at the latest. Keep the receipt so that you have proof that you cancelled in good time.You will find further information here (in German, French and Italian): Wechsel der Krankenkasse | www.priminfo.ch.

Question 10

How can I change health insurer?

Accepted Answer

If you wish to change your basic health insurer, you must cancel your cover with your present health insurer and register with a new one. Here's how to do it:

Cancel your current basic health insurance: Your notice of termination must be received by the health insurer by 30 November at the latest. It’s best to send the written notice of termination by registered mail or A-Post Plus to the health insurer by 15 November.
Register with the new health insurer at the same time: Do not wait until you receive confirmation of cancellation from your current health insurer.

Here you’ll find sample letters (in German, French or Italian) for cancelling your basic insurance and for registering for basic insurance with another health insurer: Sample letters | www.priminfo.ch.The new health insurer must confirm in writing to you and your previous health insurer that you are now insured with them.Please note: You cannot change health insurance companies if you still owe money to your current health insurance company as of 31 December. This applies to any money owed for which you have received a reminder by 30 November.Find out more (in German, French and Italian): Wechsel der Krankenkasse | www.priminfo.ch.

Question 11

What happens if I don’t pay my premiums?

Accepted Answer

If an insured person doesn’t pay their premiums or cost shares when due, the health insurer will proceed as follows:

It will send the insured person a reminder.
It will then send them a payment demand.
Finally, it will initiate debt recovery proceedings against the person.

Basic health insurers cover the costs of statutory insurance benefits even if there are outstanding bills.Please note: Certain cantons keep a list of insureds who fail to meet their payment obligations despite debt recovery proceedings. If a person is on this cantonal list, the health insurance company may only cover emergency treatment. Cover for further benefits is deferred until the outstanding bills have been paid. Currently, the cantons of Aargau, Lucerne, Ticino, Thurgau and Zug maintain such lists.Find out more: Health insurance: Overdue premiums | www.bag.admin.ch.

Question 12

What is meant by cost shares? What do the terms deductible, copayment and hospital copayment mean?

Accepted Answer

Cost sharesIn addition to premiums, insureds contribute to the costs of the care they receive. This share of costs comprises the deductible, copayment and hospital copayment. Women do not pay any cost shares for maternity benefits.DeductibleThe deductible is the amount that an adult must pay themselves each year before the health insurer covers any costs.Children and young people up to the age of 18 can choose a deductible between CHF 0 (standard deductible) and CHF 600. Adults can choose a deductible between CHF 300 (standard deductible) and CHF 2,500. If you choose a higher deductible, you pay lower premiums, but this also means that you will initially have to pay more out of your own pocket when you receive treatment.CopaymentOnce the deductible has been paid, the insured person pays 10 per cent of the remaining costs themselves. There is an upper limit of CHF 700 per year. This means that the health insurer covers the rest of the costs once this amount has been reached. For children and young people, this upper limit is CHF 350.Hospital copaymentIn the event of hospitalisation with overnight stay, insureds must contribute to the cost of meals. The copayment is CHF 15 per day, regardless of the length of stay in hospital. The copayment does not apply to children and young people up to the age of 18 or to young adults up to the age of 25 who are in education or training.Find out more: Health insurance: Co-payment for persons resident in Switzerland | www.foph.admin.ch.

Question 13

What's the difference between basic insurance and supplementary insurance?

Accepted Answer

Basic insuranceThe official term for basic insurance is “compulsory health insurance”. As the name suggests, it’s compulsory for anyone residing in Switzerland. Basic insurance offers the same range of benefits to all insureds, thus ensuring high-quality and comprehensive basic care for all. Basic insurance falls within the remit of the FOPH.Supplementary insuranceSupplementary insurance is voluntary. It covers additional comforts such as a semi-private or private ward in hospital or other services that are not covered by basic insurance. These include, for example, treatment by naturopaths, preventive medical check-ups and routine dental treatmentPremiums depend on the insured person’s state of health, age and sex. A supplementary insurance provider may refuse to accept individuals or may impose restrictions based on their state of health.Providers of supplementary insurance are supervised by the Swiss Financial Market Supervisory Authority (FINMA).

Premiums and costs: answers to frequently asked questions and useful links

Federal Office of Public Health FOPH