Compulsory accident insurance in Switzerland: what is it?
Accident insurance is compulsory in Switzerland. But what is it? Are all accidents insured? Do I have to pay a deductible? Comparis explains.
21.07.2022
iStock/RealPeopleGroup
1. What is compulsory accident insurance?
AIA (the Federal Accident Insurance Act) sets out the law regarding accident insurance. Under this act, all employees in Switzerland must be insured against occupational accidents and illnesses.
2. How can I insure myself against accidents?
If you work fewer than eight hours per week for the same employer or aren’t working, you need extra accident cover as part of your compulsory health insurance. The provisions of the Health Insurance Act and not of the AIA apply here. Contact your health insurer to arrange cover.
People who work at least eight hours per week for the same employer are insured by the employer against accidents. The provisions of the AIA apply here.
Self-employed people can take out voluntary insurance against accidents and occupational illnesses with Suva or another accident insurance company.
3. Accident insurance: who pays the premiums?
Who pays the premiums of accident insurance under the AIA depends on the type of accident:
Occupational accidents and illnesses: employers pay the premiums.
Non-occupational accidents: employees usually pay the premiums. The amount owed will be deducted directly from the employee’s salary. In some cases, the employer pays all the premiums.
Premiums vary according to the insured person’s income and the type of company. The maximum insured salary covered under accident insurance is 148,200 francs (2022).
4. Is there a deductible/coinsurance for compulsory accident insurance?
Obligatory accident insurance provided by the employer in accordance with the AIA is not subject to a deductible or coinsurance. This applies not only to occupational accidents and illnesses, but also to non-occupational accidents.
5. What accidents are covered by accident insurance?
Accident insurance under the AIA pays for occupational accidents and illnesses as well as for non-occupational accidents. This applies to accident insurance offered both by private insurers and by Suva.
According to Swiss law, an accident is defined as “an unusual external event causing sudden and unintentional harm to the human body leading to detrimental effects on physical, mental or psychological well-being or death”. If one of these conditions isn’t met, the incident is considered an illness from an insurance point of view.
Occupational accidents are defined as accidents that occur:
During work ordered by or in the interest of the employer.
During work breaks.
Before and after work if you are legally in the work area.
If you work for the same employer for fewer than eight hours per week, accidents on the way to work are also regarded as occupational accidents.
What are non-occupational accidents?
Non-occupational accidents include all accidents that do not count as occupational accidents. These include, for example, a tick bite, bee sting or a sports accident.
What are occupational illnesses?
Occupational illnesses are conditions that have been caused by professional activities involving:
Harmful substances such as ammonia, dust or chlorine.
Certain work such as animal care or contact with plants.
The definitive list of harmful substances and work is set out in Appendix 1 of the Accident Insurance Ordinance.
Occupational illnesses also include diseases which have been caused exclusively or largely by the person’s work. An example could be suffering from long COVID caused by close contact with infected people.
What else is defined as an accident?
The following health issues – if they are not primarily due to wear and tear or illness – are considered in insurance terms to be accidents:
Fractures
Dislocated joints
Torn meniscus
Torn muscles
Pulled muscles
Ruptured tendons
Ligament lesions
Eardrum injuries
6. What does accident insurance cover?
The specific benefits provided by accident insurance include:
Medical expenses following the accident.
Aids (crutches, wheelchairs, shoes, etc.).
Travel, transportation, rescue and recovery costs (restrictions apply when abroad).
Accident insurance daily allowance: from the third day following the accident, you’ll receive 80% of your lost earnings until recovery or a pension has been set. If you work part time, the daily benefits are reduced accordingly.
Invalidity pension in case of permanent inability to work: 80% of the loss of earnings.
Impairment compensation and helplessness allowance.
Funeral expenses and survivor’s pension in the event of death.
The insurance also provides benefits if the injured person is further harmed during any treatment.
7. Accident insurance: what’s the difference between AIA (employer-based) and HIA (taken out via health insurance)?
Employer-based AIA cover provides much better protection than HIA (health insurance act) accident insurance taken out through your health insurer. With compulsory accident insurance from a health insurer (under basic insurance), insured persons must contribute to the costs with a deductible and coinsurance. In addition, employer-based insurance provides for more benefits than accident insurance provided by your health insurer in the event of a serious accident.
This article was first published on 21.07.2022
