Benefits

Ambulance costs – when will basic health insurance pay?

INFORMATION
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Source: iStock / cookelma

You have a medical emergency and cannot be transported by private car or public transport? If you call an ambulance on the emergency number 144, basic health insurance will cover the cost of patient transportation in this case.

In an emergency, every second counts. The emergency services will transport the patient to the nearest hospital without delay. The costs of such emergency transportation vary significantly between cantons. For example, as reported on Swiss television, if someone has a heart attack in the canton of St. Gallen, the cost for the emergency services is greater than that in the canton of Aargau.

If you have accident insurance through your employer or a private insurer, this will cover all emergency transportation costs. However, if the emergency transportation is required because of an illness, or if you have accident insurance through your health insurer, the costs can soon mount up, as you will see from the answers below.

When does basic health insurance pay for emergency transportation?

Basic health insurance policies will cover a share of the costs of emergency transportation if it is a medical necessity. If the patient could have travelled by private car or public transport, basic health insurance policies will not pay out for emergency transportation.

How much will my basic health insurance pay for emergency transportation?

Basic health insurance will cover 50 per cent of the costs, up to a pre-determined maximum limit. The maximum limit for the cost of rescuing you from a life-threatening situation is 5,000 francs per calendar year (rescue costs). If the situation is not life-threatening but transportation by ambulance is still medically necessary, basic health insurance will pay up to a maximum of 500 francs per calendar year (transportation costs).

Will my basic health insurance pay out if I take a taxi to hospital?

The cost of a taxi journey is only covered in exceptional circumstances. If it is not possible for you to get to hospital by private car or public transport for medical reasons, your basic health insurance will cover 50 per cent of the costs, up to 500 francs per calendar year. Note: you must be transported by a means of transport that is appropriate for your medical needs. You are advised to clarify the details with your health insurer in advance.

Is there an insurance policy that covers all the costs?

Yes. There are supplemental insurance policies which guarantee a higher level of cover. Some are even unlimited and will cover all transportation and rescue costs. You need to decide for yourself what level of cover is right for you.

Will basic insurance cover transportation if I have an accident abroad?

Basic health insurance policies will pay a proportion of emergency transportation costs even when you are abroad. The conditions for this are the same as if you were in Switzerland. However, the situation is not the same for rescue costs. Basic health insurance policies do not cover rescue costs abroad. If you are travelling abroad, it is sensible to take out supplemental insurance, as transportation and rescue costs abroad can easily run into thousands or tens of thousands of Swiss francs. It is important to ensure that you have enough cover in the event of an accident abroad. Before you travel, check to see if you have sufficient insurance.

I’m a Rega Swiss air ambulance patron – do I still need supplemental insurance?

Rega is not an insurance provider. Furthermore, you do not have a legal entitlement: Rega is permitted to provide its services, but is not obliged to do so. Rega can waive the costs of repatriation for its patrons in the event that insurance companies or any other third party are not liable to pay and thus are either not required to reimburse the costs or required only to reimburse a proportion of the costs. This applies to repatriation on a Rega jet as well as on scheduled flights. In addition, Rega does not pay for emergency treatment abroad. Cover for such treatment can be obtained from your health insurer (basic health insurance and supplemental insurance) or via a foreign health insurer.

Who pays if I need to be transferred from one hospital to another?

If a patient needs to be transported from one hospital to another for treatment and due to medical necessity, the costs are covered completely by basic health insurance. In this case, the transfer is part of the inpatient treatment.

Someone calls an ambulance for me but I don't need one. Who pays?

If an ambulance is called and paramedics attend the incident, then costs are incurred. As a rule the patient – or their insurance company – must cover these costs. The actual person who called the ambulance is not required to reimburse any costs – unless the call was intentionally fraudulent.

All the above answers apply to persons who have accident insurance through their health insurer and to transportation in the event of illness.

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