Accident cover under health insurance

1. Accident cover under basic insurance

Compulsory health insurance (basic insurance) with accident coverage covers treatment costs in the event of illness and accident. Policyholders are entitled to treatment, meals and accommodation in the general ward of the nearest hospital. As in the case of illness, out-of-pocket expenses will be charged for these benefits.

If treatment abroad is necessary, the insured person will be reimbursed up to a maximum of twice the amount of the costs that would have been incurred for treatment in Switzerland.

For children, accident insurance is mandatory. They are insured against accident risks through the health insurer.

2. Accident cover under supplemental insurance

If, in the event of an accident, you want to receive care in a 2-bed room (semi-private) or in a 1-bed room (private) or if you want to choose the hospital or doctor freely, you need supplemental hospital insurance with accident cover. Should you already have semi-private or private cover through your employer’s accident insurance, you don’t need any accident coverage in supplemental insurance.

If you do not wish to go without additional outpatient services such as non-medical psychotherapy or naturopathic treatment, you need to take out supplemental outpatient insurance with accident cover if this is not already provided by your employer’s accident insurance under the Accident Insurance Act (AIA).

3. Exclude accident cover in health insurance as an employee and save on premiums

Anyone who is employed for at least eight hours per week by a single employer is automatically insured against accidents by their employer (under the AIA). Employees can therefore take out health insurance without accident cover. Depending on the insurance company, this results in a premium discount of up to 10%. This AIA accident insurance covers both occupational and non-occupational accidents, i.e. those occurring during time off. You must notify your health insurer as soon as you are no longer covered for accidents by your employer. Accident cover then comes into effect again and the premium will increase.

Keep in mind: accident insurance in accordance with the AIA offers much better protection than accident insurance under the Health Insurance Act (HIA) (basic insurance with accident cover). Benefits covered under the AIA are not subject to any out-of-pocket expenses. There are also additional benefits in case of serious accidents such as a daily allowance for loss of salary, disability and survivor’s pensions, impairment compensation, helplessness allowances and partial payment of funeral costs.

4. Accident insurance for daily unemployment benefits

Anyone receiving unemployment benefits is insured against accidents by Suva. This insurance cover ends 30 days after the end of entitlement to unemployment benefits. The policyholder has the possibility of extending the insurance cover by up to 180 days by taking out interim insurance. In that case, the policyholder must contact the relevant Suva agency before the regular insurance cover expires.