Vaccinations: what does basic insurance cover?
Do you want to get vaccinated? Remember that basic insurance doesn’t cover all vaccinations. Comparis tells you what you need to know.
13.09.2022
iStock/Tero Vesalainen
1. What are the different vaccination categories?
The Swiss Vaccination Plan (document available in German) has the following recommended vaccination categories:
Recommended basic vaccinations for children, adolescents and adults
Recommended complementary vaccinations
Recommended vaccinations for high-risk groups and high-risk situations
Basic insurance covers the most important vaccinations according to the Swiss Vaccination Plan. This helps prevent illnesses and epidemics whose costs would far exceed that of vaccination.
For example, health insurance covers the costs for tetanus vaccinations in Switzerland (not including the deductible and coinsurance). The Swiss Vaccination Plan is regularly updated by the Federal Office of Public Health (FOPH) and the Federal Commission.
Some vaccines are approved for use in Switzerland but not recommended. These include vaccinations against meningococci of serogroup B as well as against rotaviruses. Basic insurance does not cover any costs for these vaccinations.
2. What vaccinations does basic insurance cover?
Basic insurance covers the cost of all vaccinations recommended in the Swiss Vaccination Plan (as of 2021):
Measles, mumps and rubella (MMR) (read more on measles vaccinations)
Chickenpox (varicella)
Diphtheria (every ten years)
Tetanus (every ten years); in the event of vaccination after an accident, Suva will cover the costs
Whooping cough (pertussis)
Haemophilus influenzae type B
Pneumococci
Polio (poliomyelitis)
Hepatitis B
Hepatitis A in special risk groups
Influenza: basic insurance covers influenza vaccinations in Switzerland for people aged 65 and over and those with an increased risk of complications (read more about flu vaccinations).
HPV-vaccine: the costs for the vaccination against human papillomavirus (HPV), which is thought to cause cervical cancer, are covered by cantonal programs and no deductible is charged. The vaccination is free for all adolescents and young adults.
The Swiss Vaccination Plan also regulates which vaccinations may be used and covered by insurance. For example, Twinrix for hepatitis A and B or Prevenar 13 for pneumococci are common vaccines, whereas the live vaccine Zostavax (shingles) is not covered. Special rules apply to coronavirus vaccination.
Good to know:
Even if the vaccinations are recommended, you have to pay coinsurance. However, you are exempt from the deductible for some vaccinations - for example, the measles vaccination.
3. Are costs covered for recommended complementary vaccines?
Compulsory health insurance also covers certain complementary vaccinations. They protect against clearly defined risks and have a rather low public health benefit. However, they can be very helpful for people.
The following supplementary vaccinations are currently recommended and covered by basic insurance:
Basic insurance covers the costs, minus coinsurance and deductible, for vaccination in children between two and five years of age as well as adolescents between 11 and 15 years of age (boosters up until 19 years of age).
As part of cantonal vaccination programmes, vaccination is free for 11 to 26-year-olds in accordance with the recommendations of the FOPH and Federal Commission on Vaccination.
Compulsory health insurance covers the costs for people aged 65 and over, provided they have a functioning immune system. The adjuvanted inactivated subunit vaccine Shingrix® must be used. However, vaccinations with the live vaccine Zostavax® are not reimbursed.
4. What applies to vaccinations for high-risk groups or high-risk situations?
Vaccinations for high-risk groups are intended to protect particularly vulnerable groups, such as premature babies or those with an immunodeficiency disorder. They are intended for people with regular contact to ill or vulnerable people, such as doctors or nursing staff. There are also additional vaccinations for people with risk behaviours such as intravenous drug use.
The vaccinations recommended for high-risk groups or situations are reimbursed by compulsory health insurance (without coinsurance and sometimes without the deductible). Basic insurance covers tick-borne encephalitis vaccinations in areas where they are recommended. If you work for long periods of time in high-risk areas − as a farmer or forester, for example − your employer must pay for the vaccination.
5. Which vaccinations are not covered by basic insurance?
Basic insurance doesn’t cover vaccinations that are recommended for holiday trips. These include vaccinations against:
Yellow fever
Rabies
Japanese encephalitis
Typhoid abdominalis
Hepatitis A and B if you are not in a risk group
Medications for malaria prophylaxis (vaccination in the proper sense doesn’t exist yet)
Supplemental insurance for travel vaccinations
With suitable supplemental insurance you don’t have to cover these costs yourself. Most insurers cover between 75 - 90% of these costs.
