Benefits

The ABC of basic insurance: these are the benefits you're entitled to

INFORMATION
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Which costs does my health insurance cover?

Doctor's fees, medication or vaccination: people residing in Switzerland need health insurance. But which costs are reimbursed under mandatory basic insurance?

Basic insurance in Switzerland is mandatory. At the same time, everybody is free to choose the company whose health insurance scheme they wish to join. All providers of basic insurance offer exactly the same range of benefits – but the costs vary substantially. Comparing pays off.

Which costs are covered, though? Basic insurance generally becomes effective in case of sickness and maternity; accidents are only included if they are not covered under any other insurance. There is no conclusive list of all benefits.

Here is a basic ABC with examples of the benefits covered under basic insurance:

Alternative medicine / Complementary medicine: The following four treatment methods are covered on a provisional basis up to the end of 2017: anthroposophic medicine, homoeopathy, phytotherapy and traditional Chinese medicine. Important: in order for basic insurance to cover the treatments, they must be provided by a doctor with the necessary qualification.

Contacts: See spectacle lenses.

Dentist: Dental treatment is not covered unless it is administered in the context of a serious general medical condition.

Doctor's fees: The cost of a visit to the doctor is generally reimbursed under basic insurance, on condition that the physician is a member of the Swiss Medical Association FMH. If your basic insurance does not pay for a certain treatment, your doctor must point this out.

Hospital treatment: Benefits include treatment in the general ward of a hospital – provided that the hospital is included in the Hospital List of the canton of residence. Emergency treatment is reimbursed in all Swiss hospitals.

Maternity services: The insurance reimburses special preventive medical check-ups during pregnancy and after birth. Antenatal classes, breastfeeding support and midwifery services are also partially covered according to the relevant ordinance (not available in English).

Medications: Basic insurance covers medications which are prescribed by a physician and included on the list of reimbursable pharmaceutical specialities (Specialities List/SL) or in the list of medicines with tariffs (LMT). If your doctor prescribes a medication that is not covered under basic insurance, he or she must point this out.

Non-medical therapies (physiotherapy, ergotherapy, nutrition counselling, etc.): The Health Insurance Benefits Ordinance (KLV, not available in English; for more information see here) specifies whether or not a non-medical therapy is reimbursed under basic insurance. The treatment must be provided by a certified therapist. The number of sessions that are reimbursed is limited; with physiotherapy, for example, it is nine sessions in the course of three months.

Prevention: The insurance also covers certain preventive measures such as vaccinations, certain examinations and early diagnosis. A conclusive list of preventive measures can also be found in the Health Insurance Benefits Ordinance (KLV, not available in English; for more information see here).

Psychotherapy: The insurance reimburses a maximum of 40 work-up and therapy sessions with a physician (not a therapist).

Spectacle lenses / Contact lenses: Under basic insurance, children and young people up to 18 years of age are entitled to up to 180 francs per year for spectacles or contacts – provided that they have a medical prescription from their ophthalmologist. Many types of supplemental insurance will pay benefits for optical aids, though.

Spitex (in-home nursing services): The doctor may prescribe up to 60 Spitex hours every three months. For this, he or she needs the insurance company's approval, though. The conditions require that the selected Spitex organisation or nursing specialist are qualified and certified.

Transportation and rescue costs: Basic insurance reimburses half of the costs of a rescue mission (up to 5,000 francs) if the life of the person rescued was in danger (heart attack, mountaineering accident, etc.). If there was no immediate danger to the patient's life, basic insurance covers 50 percent or a maximum of 500 francs for transportation.

Vaccinations: The costs of vaccinations in accordance with the guidelines and recommendations of the Swiss Vaccination Plan (not available in English) are covered. Travel vaccinations, on the other hand, are not.

Mandatory health insurance only reimburses the full costs if the deductible and coinsurance have already been exhausted. If that is not the case, it pays for the treatment minus the deductible and coinsurance. You can find additional information on the benefits under basic insurance here.