Healthcare System and Market in Switzerland

Introduction

Switzerland’s health insurance system gives everyone living in the country access to adequate healthcare in the event of sickness and accident. Both health insurance (Krankenversicherung) and accident insurance (Unfallversicherung) are an important part of Switzerland’s social security system.

Background

The Swiss Health and Accident Insurance goes back to 1890, when a new constitutional article was accepted in a vote. In 1912, the Law on a Health and Accident Insurance followed this constitutional article (in 1981 Accident Insurance and Medical Insurance were separated) and in 1994, a comprehensive revision was accepted and came into force on 1st January, 1996, describing a compulsory health insurance (Law on Medical Insurance [KVG, KrankenVersicherungs-Gesetz]) and additional medical coverage (Law on Insurance Contracts [VVG, Versicherungs-Vertrags-Gesetz]). The Federal Act on Accident Insurance (Bundesgesetz über die Unfallversicherung [UVG]) defines the required minimum protection against occupational and non-occupational accidents as well as occupational diseases.

Framework – Health Insurance

The Swiss Health Insurance System is based on private provision, which supplies high quality but rather expensive services. According to KVG, a healthcare provider has to admit anyone for basic health coverage and charge more or less the same adult premium for basic treatment regardless of gender, age or state of health. However, premiums vary by canton and sometimes even political community.

Healthcare is provided by specialist Health Insurance Companies (Krankenkassen). As healthcare is organised on an autonomous, cantonal basis, some smaller health insurance companies only admit those living in their particular area. Due to this totally decentralised structure of the Swiss healthcare system (mirroring the federal political system), the provision of care varies from canton to canton. While some cantons provide the majority of inpatient care in state/cantonal hospitals, others have no or very few facilities and provide financial support to private hospitals or pay for patients to be treated at hospitals in other cantons.

In general, everyone resident in Switzerland, regardless of nationality, must take out a compulsory medical insurance. Premiums have to be paid personally by each individual. Exemptions are granted only based on rare cases described in KVG. The following groups of persons are eligible for exemption (in principle):

♦ Persons with compulsory health insurance under foreign law who

♦ have equivalent insurance cover and

♦ for whom insurance in Switzerland would mean a double charge (not valid for persons from EU or EFTA Member States)

♦ Students, schoolchildren, trainees or people undergoing work experience who

♦ are staying in Switzerland for training or further education and

♦ have equivalent insurance cover

♦ Lecturers or researchers who

♦ are staying in Switzerland on a teaching or research assignment and

♦ have equivalent insurance cover

♦ Employees seconded to Switzerland and members of their families accompanying them, provided they

♦ are exempt from compulsory contributions to the Swiss Old-Age and Survivor’s Pension/Invalidity Insurance (AHV/IV) under a bilateral social security convention and

♦ their employer undertakes to arrange insurance which at least covers the benefits under KVG

Despite the above listed exemption rules, it happens that, depending on the personal situation of the applicant, exemptions are also granted for other persons not belonging to one of mentioned groups. Every canton applies the rules slightly different.

Another group who is never subject to Swiss social security and therefore KVG: Diplomats and persons employed by an international organisation.

Benefits – Health Insurance

KVG pays benefits in the event of:

• Outpatient treatment: Treatment by officially recognised doctors.
• Inpatient treatment: Treatment including a stay in the general ward (public room) of a hospital in the canton of residence, which is on an official hospital list.
• Medicines and laboratory tests: If prescribed by a doctor and included in the official medicine list.
• Pregnancy and delivery: Seven check-ups and two ultrasound scans during pregnancy; CHF 100 for antenatal classes; three breastfeeding consultations and one follow-up consultation.
• Preventive treatment: Vaccinations; eight check-ups for pre-school children; preventive gynecological check-ups (every third year).
• Rehabilitation: Physiotherapy/ergotherapy if prescribed by a doctor.
• Surgical and/or medical appliance: Covered according to official appliance list.
• Transportation: 50% of the cost of ambulance transportation up to CHF 500 per year.
• Emergency: If an emergency (heart attack, mountaineering accident, etc.) 50% of the cost is covered up to CHF 5,000 (applies only in Switzerland).
• Emergency abroad: If incurred during a temporary stay abroad all costs in the given country are covered provided it doesn’t amount to more than twice the comparable cost in Switzerland.

The individual chooses excess (from CHF 300 to CHF 2,500) and pays 10% of costs above the excess, but only to an upper limit of CHF 700, as well as CHF 10 per day of an inpatient treatment. In case of childbirth, no contributions must be paid.

Framework – Accident Insurance

The Accident Insurance Law (UVG) stipulates the following: If a person is working more than 8 hours a week, both work-related (including occupational diseases) and non-work-related accidents are covered through the employer’s accident insurance. Employers generally transfer those risks to an authorized insurance company.

Non-employed persons have to include accident coverage in the compulsory medical insurance (KVG).

Benefits – Accident Insurance

Benefits for non-employed persons correspond to the ones in KVG (see above under “Benefits – Health Insurance”). If accident is covered through the employer, UVG is applicable. The most important benefits are:

• Outpatient treatment: Treatment by officially recognised doctors; paid in full.
• Inpatient treatment: Treatment including a stay in the general ward (public room) of a hospital in the canton of residence, which his on an official list of hospitals.
• Dental: Paid in full
• Medicines and laboratory tests: If prescribed by a doctor.
• Rehabilitation: Physiotherapy if prescribed by a doctor.
• Surgical and/or medical appliance: If prescribed; paid in full.
• Transportation / Emergency: Paid in full
• Emergency abroad: If incurred during a temporary stay abroad all costs in the given country are covered provided it doesn’t amount to more than twice the comparable cost in Switzerland

Supplementary Health Insurance – International Health Insurance

Approximately 40% of people living in Switzerland choose to take out supplementary health insurance. Amongst foreigners and persons travelling a lot abroad, the percentage is even higher. Reason for that: KVG limits benefits abroad (no elective treatment, limitations on emergency coverage). This makes private medical insurance very important for persons having a strong relation to another country.

Private health insurance coverage on top of KVG can be arranged with any Swiss insurer, but also – and recommended – with international health insurance companies.

An individual can cover various benefits (on top of KVG or besides KVG):

• Private (access to single room in a hospital) or semi-private (double room) coverage
• (Higher) Reimbursement for treatment abroad and emergency transportation abroad
• Dental and vision care
• Alternative treatment by practitioners recognised by the specific health insurance company
• (Higher) Contributions for prescribed spa treatments, wellness/fitness subscription

A good option for expatriates or foreigners living in Switzerland is to take out KVG minimum coverage (highest possible excess) and to arrange supplementary cover through an International Health Insurance Plan. This gives them access to elective treatment abroad (e.g. in their home country) and they can keep this international plan after moving to another country.

If an International Health Insurance Plan is chosen, coverage is granted anywhere in the world including the country of residence. There is no limit on the time an insured person can spend abroad. Indeed it does not matter where he/she lives, works or travels. The member can choose any place of treatment worldwide, and he/she is in charge when it comes to choosing a hospital, clinic or any qualified doctor or specialist. Any person – regardless of residence or citizenship – who has not reached 80 years of age can apply. Once accepted, you will enjoy guaranteed lifetime coverage (renewable every year).

Another important group of people needing international health insurance: Persons moving their residence out of Switzerland. In this case KVG coverage can’t be maintained (in general) and another solution (either a local insurance in the new country of residence or an International Health Insurance Plan) has to be bought.

Advice

The Swiss Healthcare System is very comprehensive, but not easy to understand (e.g. the premium depends on the community someone takes residence). Moreover there is a huge variety of Swiss health insurance providers offering KVG coverage and different options of supplementary insurance. Because of that, and even more if an International Health Insurance Plan could be an option, it is recommendable to ask for advice before a health insurance plan is chosen. Brokers and Insurance Consultants can help with these questions. But it only makes sense to seek such advice as long as the broker/consultant is really independent, has the necessary expertise and experience, and does not work under contract for only one insurer. Independent insurance consultants are experienced in identifying potential problems because they continuously monitor the health insurance market and compare cover, premiums and level of service.