With the basic health insurance, the insured individual always shares part of the treatment costs. Notably, the scope of assistance and specific types of treatments are predetermined by law, meaning not all services fall under compulsory basic insurance.
Additional types of insurance are available to cover what basic insurance does not, such as outpatient treatment abroad, improved supplementary health insurance, dental insurance, and insurance regarding alternative therapies.
What deductibles do I have to pay?
The cost participation by the insured individual comprises a variable annual deductible and a cost sharing. The deductible is the annual amount that an insured adult contributes towards treatment costs, ranging from CHF 300 to CHF 2500. This deductible can be adjusted annually, with a higher deductible resulting in lower monthly premiums. The deductible does not cover children.
How much is the cost sharing?
Once the deductible is met, the cost sharing kicks in. This is 10% of the treatment cost, capped at CHF 700 per calendar year for adults and CHF 350 for children and adolescents under 18. The cost sharing does not apply to costs of special maternity services.
What insurance models are available to me?
Swiss insurance offices propose various models of compulsory health insurance that comply with the compulsory health insurance law :
Standard model: This traditional model allows insured individuals to freely choose their healthcare providers. It offers the highest degree of flexibility but generally comes with higher premiums compared to other models.
Family doctor model: This model centers on a gatekeeper approach to healthcare. The insured individual's first point of contact in case of illness is their assigned family doctor, who coordinates their care and refers them to specialists when necessary. This model encourages continuity of care and is typically cheaper than the standard model.
HMO model: The health maintenance organization (HMO) model requires insured persons to visit an assigned medical center when they fall ill. These centers typically have various specialists under one roof, promoting coordinated care. This model generally has lower premiums due to its managed approach to healthcare.
Telemedicine model: Under this model, the first consultation in case of illness is carried out over the phone by a healthcare professional provided by the insurance office. This model emphasizes the use of telecommunication and digital technologies for health consultations and typically offers lower premiums.
How are accidents covered?
If a person in Switzerland works less than 8 hours and is thus not automatically insured against accidents by their employer, they must take out accident insurance with an insurance provider. Accident insurance is mandatory for children and adolescents.
This additional accident insurance fills a crucial gap, ensuring you're protected against medical costs stemming from any accidents. Notably, this insurance doesn't only cover workplace incidents, but any accidents that might occur in your daily life, from home mishaps to sports injuries.
What can outpatient supplementary insurance do for me?
In Switzerland, outpatient supplementary health insurance provides additional coverage that complements the basic compulsory insurance. This individually tailored policy, popular amongst Swiss residents, offers enhanced health protection according to the specific needs of each client.
The benefits of this insurance extend globally, including comprehensive insurance coverage abroad and coverage for medical transport expenses worldwide. It also embraces holistic health, covering complementary medicine such as massages, acupuncture, and manual therapy, as well as prescribed medicines and eyewear.
Beyond medical coverage, the insurance includes contributions to gym memberships and preventative health measures, underlining a focus on wellness. Additionally, it covers legal expenses, psychotherapy, and children's dental corrections. All aspects of the coverage are personally tailored to meet the client's individual needs, providing a truly customized insurance experience.
What are the benefits of hospital supplementary insurance?
One of the key restrictions with basic health insurance is that it doesn't provide the option to choose your treating physician or to stay in a semi-private or private ward. Your choice of hospital is also limited to those within your canton, which may be particularly restrictive for those living near cantonal borders or those desiring specialized care from a specific institution.
This is where supplementary hospital insurance becomes invaluable. It grants you the freedom to opt for semi-private or private wards, which generally offer more comfort and privacy, including fewer beds in a room and often the choice of your doctor. This additional comfort can make a significant difference in your overall hospital experience.
In terms of choice of doctors, supplementary insurance allows for continuity of care. If you've been seeing a particular specialist and would like them to oversee your hospital treatment, supplementary insurance can make this possible. This assurance can be incredibly important for patients dealing with complex or long-term health issues.
To learn more about the coverage that basic health insurance provides, click here. For more information on which services you can gain access to with supplementary insurance, click here. For a personal consultation, you can contact the insuris team.
