Health insurance benefits

From alternative medicine to dentistry: find out here which treatments, medicines and medical aids are covered by basic insurance, and when it’s worth getting supplemental insurance.

Types of benefits and treatment

Basic insurance benefits

Basic insurance benefits are precisely defined in the Health Insurance Act (KVG/LAMal) and ordinances (KVV/OAMal and KLV/OPAS). For this reason, they are always the same – irrespective of insurer. However, premiums vary from insurer to insurer and from canton to canton. Large cantons have different premium regions. The premium is always determined by the insured person’s place of residence.

Supplemental insurance benefits

Optional supplemental insurance products cover treatments and benefits that basic insurance covers either only partially or not at all. The benefits vary depending on your chosen supplemental insurance product and provider.

Benefit types and service providers

  • Benefit types

    Your premiums are used to fund the benefits provided by health insurers. The health insurer covers the cost of these insured benefits, which are divided into different types. Benefit types include treatment by a doctor, medicines, health resort treatments in Switzerland, vaccinations and rescue abroad.

  • Service providers

    The benefits covered by health insurance are delivered by service providers. For example, if you go to your family doctor’s practice for a health check-up, the practice is the service provider. Pharmacies and hospitals are also service providers.

  • Cantonal hospital list

    The cantonal hospital list is a list of hospitals that together cover all the medical service requirements of the canton. Each canton keeps its own hospital list. In it, the canton also defines which services each health facility should provide. Residents of the canton in question can have inpatient treatment in a general ward at any of the listed hospitals and this will be covered by basic insurance.

Treatment

A distinction is made between outpatient and inpatient medical treatment. With outpatient treatment, you can go home within 24 hours. With inpatient treatment, you are cared for overnight. Find out who covers the cost in each case. Each treatment that is covered by basic insurance must be provided by a medical service provider (doctor, pharmacist, midwife, physiotherapist, etc.).

Benefits for illness

According to Swiss law, the term “illness” is defined as “any impairment of physical, mental or psychological health that is not caused by an accident and requires medical examination or treatment or results in the inability to work”. Compulsory basic insurance covers the cost of treatment in this case. If you are unable to work and your employer has taken out daily benefits insurance, you may be entitled to a daily sickness allowance.

Benefits for maternity

For maternity benefits covered by basic insurance, insured women are not required to pay any out-of-pocket expenses (deductible, coinsurance). In addition, from the 13th week of pregnancy until eight weeks after the birth, women do not have to pay any out-of-pocket expenses towards the cost of general medical treatment and care if they are ill. It’s a good idea to check early on what benefits you are entitled to during pregnancy.

Benefits for accidents

People who are either unemployed or self-employed (and there is no industry solution with Suva) must take out accident insurance through their health insurer. Here you can find information on the accident cover of the basic insurance.

Medication

Cover for the cost of medicines

  • Specialities list

    The Federal Office of Public Health (FOPH) publishes a so-called specialities list (SL/LS). This list contains all the medicinal products covered by basic insurance. In the case of serious illness, if all other treatments fail, health insurers may also pay for drugs that are not on the specialities list, are not listed for the treatment in question, or have not yet been approved by Swissmedic. In these exceptional cases, you need to obtain confirmation of commitment to provide cover in advance from your health insurer.

  • Medicine not covered by basic insurance

    Not all medicines will be paid for by basic health insurance. However, supplemental outpatient insurance may reimburse the cost of medicines not covered by basic insurance.

  • List of uninsured products

    Some medicines are not covered by basic or supplemental insurance. They appear on the list of pharmaceutical products payable by the policyholder (LPPV/LPPA).

  • Proprietary and generic drugs

    When medicines first arrive on the market, they are known as proprietary drugs. They are usually protected by a patent for up to 20 years, during which time they cannot be manufactured as generics. Once the patent expires, other manufacturers are free to market generic versions (same active ingredient as the original with similar excipients and manufacturing process). If you purchase generic drugs, you benefit from a reduced deductible.

Medication for hay fever

Every year is the same – spring time is pollen time. But relief is available for allergy sufferers. Comparis has compiled some tips for alleviating hay fever symptoms and explains what is covered by basic insurance.

Contraceptives

As a rule, neither basic nor supplemental insurance covers the cost of contraceptives. What the exceptions are, and what you need to know.

Medical cannabis

Cannabidiol is becoming increasingly popular. In Switzerland, you can obtain medical CBD on prescription from medical practices and pharmacies. Note: CBD products are very expensive and are only covered by health insurance in exceptional cases.

Ordering medicines from abroad

Medicine is often cheaper abroad. Private individuals are allowed to import medicine for their own use, but only enough for one month. However, you always need a prescription, even for non-prescription drugs. Your health insurer (basic insurance) is not allowed to pay for these medicines. When ordering medicines from abroad find out what must be taken into account.

Services to improve vision and hearing

Glasses and contact lenses

For children under 18, basic insurance will contribute 180 francs per year towards the cost of glasses and contact lenses. Adults only benefit from a contribution if they need glasses or contact lenses due to selected illnesses. Find out when you are entitled to reimbursement.

Hearing aids

Hearing aids are expensive. And unfortunately, they are not covered by basic insurance. However, in certain circumstances, you can claim on disability insurance or old age and survivors’ insurance.

Health benefits

Dental treatment

  • Supplemental dental insurance

    In most cases, dental costs are not covered by basic insurance. It is therefore worth taking out supplemental dental insurance, especially for children.

  • Braces

    Basic insurance only covers the cost of braces in exceptional cases. It can therefore be useful to take out supplemental dental insurance. However, the benefits offered by these policies vary considerably. This means it’s worth comparing the options.

  • Wisdom teeth removal

    Do you need to have your wisdom teeth removed? Basic insurance will only cover the cost under certain conditions. Learn more about cost coverage.

Cosmetic surgery

  • Cosmetic surgery

    Cosmetic procedures are very popular. However, compulsory basic insurance only contributes towards the cost of treatment that is medically necessary due to illness. Here’s what you need to know about cost reimbursement.

  • Breast reduction

    If the size of your breasts is causing health issues, basic insurance will cover the cost of breast reduction surgery.

Benefits relating to gym memberships

Do you have a gym membership? Some supplemental insurance policies will cover part of the cost of a gym membership and reward their customers if they record their fitness activities on a tracker and share the data with the insurer. Comparis provides tips and information on supplemental insurance and gym memberships.

Benefits for rehabilitation and wellness

Following an operation or serious illness, health resort treatment and inpatient rehabilitation stays can help you recover. Basic insurance only covers the cost of such stays if they are medically necessary. Find out who covers the costs in each case.

Vaccinations

Cover for the cost of vaccinations

Basic insurance only covers the cost of vaccinations under certain conditions. The vaccination must feature on the Swiss vaccination schedule. Find out more about the Swiss vaccination schedule, vaccine categories and how the costs are covered.

Flu vaccinations

Many people are reluctant to get the flu vaccine. Comparis explains the pros and cons of getting the flu vaccine.

Measles vaccinations

Measles is a highly contagious viral infection. The illness is not yet eliminated in Switzerland. What you need to know about the MMR vaccination, and what you should expect to pay for the measles vaccine in Switzerland.

Tick vaccinations

Ticks emerge from dormancy once temperatures rise above 8 degrees Celsius. Tick season is then under way, bringing with it the risk of catching Lyme disease or tick-borne encephalitis from a tick bite. From a legal perspective, a tick bite is an accident. For this reason, compulsory accident insurance covers the cost of treatment. Read more about tick vaccinations and who covers the cost.

Ambulance and rescue

Ambulance services

If a special means of transport (e.g. ambulance) is medically necessary to transfer a patient to where they can be treated, or if the state of the patient’s health prevents them from using a private car or public transport, basic health insurance will cover half the cost up to a maximum of 500 francs per year.

Rescue

In an emergency, every second counts. The emergency services will transport patients to the nearest hospital as quickly as possible. In Switzerland, the cost varies by canton. If someone is rescued from an acute health-threatening or life-threatening situation and taken by emergency transportation to the nearest suitable medical facility, basic insurance will cover half the cost up to a maximum of 5,000 francs per year. This only applies to rescues in Switzerland. Find out who pays for the ambulance and which supplemental insurance polices for rescues are worth taking out.

Rega patronage

A Rega patronage is no substitute for insurance. However, Rega can waive the cost of its services for patrons under certain conditions. In which cases do you need to cover the rescue costs of a Rega operation and when you will have to pay it yourself.

Health and accident insurance for services abroad

Accident and illness abroad

Falling ill or having an accident abroad is upsetting and can prove expensive. Comparis explains who covers the costs incurred through illness or accident abroad and which supplemental insurance may be worth taking out.

Travel cover through health insurance

For medical services provided in non-EU/EFTA countries, basic insurance covers a maximum of double the cost of the same treatment in Switzerland. It can be worth taking out an additional travel policy. Travel insurance in the event of accident or illness find out the benefits.

Complementary medicine benefits

Complementary medicine in Switzerland

Treatment and therapies in the field of complementary and alternative medicine do not fall under the category of conventional medicine. Alternative medicine in Switzerland what you need to know.

Complementary medicine benefits under basic insurance

Basic insurance covers just five complementary medicine treatment methods – acupuncture, anthroposophic medicine, traditional Chinese medicine (TCM), homeopathy and phytotherapy (plant-based medicine). However, they must be provided by a conventionally trained doctor who is also qualified in the relevant complementary medicine practice.

More information

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