Health insurance benefits
From alternative medicine to orthodontics: find out here which treatments, medicines and medical aids are covered by basic insurance and when supplemental insurance is worthwhile.
Treatment and benefit types
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.).
Basic insurance benefits
The benefits under basic insurance are precisely defined in the Health Insurance Act (HIA) and ordinances (HIO and HIBO). For this reason, they are always the same – irrespective of the insurer. However, premiums vary from insurer to insurer and from canton to canton. Large cantons have multiple 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.
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, for example.
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.
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 this list, 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.
Medication
Cover for the cost of medicines
Specialities list
The Federal Office of Public Health (FOPH) publishes what is known as a specialities list. 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 a commitment to provide cover in advance from your health insurer.
Optional medicines
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 non-reimbursed pharmaceutical products
There are medicines whose costs are not covered by basic or supplemental insurance. They appear on the list of pharmaceutical products payable by the policyholder.
Proprietary drugs and generics
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 (containing the same active ingredient as the original with similar excipients and manufacturing processes). If you purchase generic drugs, you benefit from a reduced deductible.
Other health services
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. It pays to compare.
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 is quite 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.
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.
Nutritional advice may also be covered by this type of health insurance – under certain conditions. Comparis explains what these are.
Following an operation or serious illness, health resort treatment and inpatient rehabilitation can help you recover. Basic insurance only covers the cost of such treatments if they are medically necessary. Find out who covers the costs in each case.
Vaccinations
Basic insurance only covers the cost of vaccinations under certain conditions. Get an overview of the costs covered for different vaccinations.
Vaccinations: what does basic insurance cover?
Measles vaccine in Switzerland: what do I need to know about vaccination and costs?
TBE vaccine: what does Swiss health insurance cover?
Flu vaccine in Switzerland: will my health insurer pay?
Vaccination records lost: what should I do?
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 rescue in Switzerland. Find out who pays for the ambulance and which supplemental insurance polices for rescue costs are worth taking out.
Rega patronage
Rega patronage is no substitute for insurance. However, Rega may waive the cost of its services for patrons under certain conditions. When are you reimbursed for the rescue costs of a Rega call-out, and do you have to pay for it yourself?
Health and accident insurance for services abroad
Accident and illness abroad
Being ill or having an accident abroad is upsetting and can be 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. Find out what benefits are included in travel insurance in the event of accident or illness.
Alternative medicine
Basic insurance covers just five alternative 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 alternative medicine practice.
More information about health insurance in Switzerland
Find more information about health insurance here.
