Overview
Mandatory Basic Insurance
Since 1996, there has been mandatory health insurance for every resident of Switzerland, as required by the Health Insurance Act. This basic insurance covers the costs for treating illnesses, care after accidents, and prenatal and postnatal care during pregnancy. New residents from abroad have three months to choose a mandatory health insurance plan. Anyone living in Switzerland has the right to be included in the basic insurance.
What Does Basic Insurance Cover?
Health insurance providers must adhere to strict guidelines regarding the benefits of basic insurance. Due to these precise regulations, insurers cover the same level of care. Health insurers are not allowed to include additional services in the basic insurance offer. You can find an overview of all services covered by basic insurance here.
The Four Models of Basic Insurance
Under the mandatory health insurance, there are four different models to choose from. The medical services are the same for all insurance options, differing only in the initial point of contact for health issues and concerns.
To decide on a specific type of basic insurance, you should first consider who you want to contact for medical issues. Four different alternatives are available from insurers, and financial aspects are also important—those who are flexible regarding their initial point of contact in case of illness will find that a savings model can be advantageous.
Free Choice of Doctor
Under the traditional model, insured individuals are free to choose any doctor they wish, as long as the doctor practices in their home canton. This means that in case of illness, you can see the required medical professional directly. No premium discount is offered with this model.
Primary Care Doctor Model
The Primary Care Doctor Model is based on choosing a general practitioner who is always your first point of contact, unless there is an acute emergency. If necessary, the primary care doctor provides a referral that allows you to see a specialist or visit a hospital.
HMO Model
The second alternative model, the HMO Model, is based on visiting a doctor you have chosen who works within a network of physicians or in a group practice. There is always a specific catchment area established where you reside. In case of illness, you visit the designated medical center within this network.
Telmed
Another version is the so-called telemedicine model, where you first contact your health insurance company by phone before seeing a doctor. At the designated consultation center, you will receive advice on the best course of action for your medical issue.
Deductible and Co-Payment in Health Insurance
In the basic health insurance in Switzerland, insured individuals must choose a deductible (Franchise). The deductible can be up to a maximum of 2,500 francs. Insured individuals are responsible for covering their healthcare costs up to the amount of the deductible. For costs that exceed the deductible, insured individuals must pay a co-payment of ten percent. The remaining costs are covered by the health insurance premiums. Each year, insured individuals can select a new deductible. With a deductible of 300 francs, there is no discount. Higher deductibles come with discounts. Typically, a deductible of 300 francs is sufficient.
Costs
According to the territorial principle, the premiums for basic health insurance in Switzerland vary depending on the provider and the canton of residence. Other factors also influence the individual premium amount: the deductible, the chosen model, possible accident coverage, and the age of the insured person all play a role in the calculation. Consequently, there are significant differences in induvidual health insurance premiums.
This is particularly interesting when you consider that the benefits of basic insurance are the same for everyone. So, those who pay a higher premium don’t get anything extra—except less money in their wallet at the end of the month. The simplest way to avoid this is by doing a basic premium comparison. This way, you can find the cheapest offer for your health insurance, switch at the beginning of the new year, and save money.
Online Premium Comparison
With our convenient premium calculator, you can find out in just one minute which provider offers the lowest premium for you.
