Benefits

The ABC of basic insurance: what you're entitled to

INFORMATION
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Mandatory basic health insurance in Switzerland does not reimburse all costs. Source: iStock / SARINYAPINNGAM

Doctor's fees, medicines and vaccinations: people residing in Switzerland need to take out health insurance. But which costs are reimbursed under mandatory basic insurance?

It is compulsory to take out basic health insurance in Switzerland. But you are free to choose which health insurance company to purchase your cover from. All providers of basic insurance offer exactly the same range of benefits – but the costs vary substantially.

An alphabetical list: what is covered by basic insurance?

Alternative medicine / complementary medicine

Basic insurance covers the following types of alternative/complementary medicine: acupuncture, anthroposophic medicine, traditional Chinese medicine, homeopathy and phytotherapy (plant-based medicine). Note: Basic insurance only covers the respective treatment if the doctor is qualified in the discipline and has completed training in alternative/complementary medicine. Read more here on the subject of complementary medicine.

Dental treatment

Dental treatment is not covered unless it is required in the context of a “serious, unavoidable” disease of the masticatory system or a “serious general medical condition”. Here you can read more about dental and orthodontic treatment.

Doctor's fees

Virtually all treatment provided by a doctor is covered by basic health insurance. If your basic insurance does not pay for a certain treatment, your doctor must point this out. Here you can find out more about the choice of doctor available to you.

Hospital treatment

Treatment in a general ward of a hospital is covered – provided that the hospital is included in the Hospital List of the canton of residence. Any emergency or special treatment carried out in a hospital that is not on this list is covered in a general ward of the hospital.

Maternity

Insurance covers special preventive check-ups during pregnancy and after birth. Antenatal classes, breastfeeding support and midwifery services are also partially covered in accordance with the relevant ordinance. Maternity benefits under basic insurance are not subject to any out-of-pocket payment.

Medicines

Basic insurance covers medicine that is prescribed by a physician and is included in the list of reimbursable pharmaceutical specialities or in the list of medicines with tariff. If your doctor prescribes medicine that is not covered by basic insurance, he or she must point this out. Find out more here about medication not covered by basic insurance.

Non-medical therapies (physiotherapy, occupational therapy, nutrition counselling, etc.)

The Health Insurance Benefits Ordinance (KLV) details whether or not a non-medical therapy is reimbursed by basic insurance. The treatment must be provided by a certified therapist, and only a limited number of sessions may be reimbursed.

Prevention

Insurance also covers certain preventive measures such as vaccinations, selected examinations and screening or early detection tests. A definitive list of preventive measures is provided in the Health Insurance Benefits Ordinance.

Psychotherapy

Insurance will pay for a maximum of 40 evaluation and therapy sessions with a physician.

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 contact lenses – provided they have a prescription from their ophthalmologist. Adults no longer receive a contribution towards glasses or contact lenses, except when the need for optical aids is caused by a medical condition such as diabetes or opacity of the lens. Many supplemental insurance products cover optical aids. Such cover is available for less than ten francs per month. Here you can learn more about contributions towards the cost of glasses and contact lenses.

Spitex (in-home nursing services)

Doctors may prescribe up to 60 Spitex hours every three months, although the health insurance company’s approval is required. One condition is that the selected Spitex organization or nursing specialist is qualified and certified.

Transportation and rescue costs

Basic insurance reimburses half the cost of a medically necessary rescue mission (up to 5,000 francs per year) if the person rescued was in a life-threatening situation (e.g. heart attack, mountaineering accident). If there was no immediate danger to the patient's life, basic insurance covers 50 per cent or a maximum of 500 francs for medically necessary transportation.

Vaccinations

Basic insurance covers the cost of the various vaccinations listed in the guidelines and recommendations of the Swiss Vaccination Plan (in German, French and Italian only). Travel vaccinations (e.g. for yellow fever) are not covered.

This page provides a detailed overview of what is covered by mandatory basic health insurance.

Mandatory health insurance only reimburses costs in full when the deductible and coinsurance limits have been reached. Otherwise, it pays for the treatment minus the deductible and coinsurance. Here is more information about basic insurance cover.

 

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