How are consultations, medical treatments and rehabilitations covered?
The Swiss basic health insurance includes the cost of consultations with doctors such as general practitioners, specialists, and chiropractors. It also provides for diagnostics, treatments, and necessary medical procedures. Whether you need a routine check-up or a consultation with a specialist for a specific medical condition, your basic health insurance has you covered.
Hospital stays are also covered, but only in the general ward of a hospital in the canton of your residence. In certain circumstances, the insurance can cover treatment by psychotherapists, physiotherapists, and other paramedical practitioners in the fields of homeopathy, acupuncture, and traditional Chinese medicine.
Rehabilitation costs, as part of this basic coverage, are also given considerable attention. If a doctor determines and prescribes that rehabilitation is medically necessary for a patient, the insurance covers these costs. The types of rehabilitation covered can include physical therapy, occupational therapy, and speech therapy, among others. It's important to note that coverage often requires prior approval from the insurance company, and the rehabilitation must be carried out in a recognized institution by licensed professionals.
Medications
The mandatory health insurance in Switzerland fully reimburses the costs of medications, provided two criteria are met. Firstly, the medications must have been prescribed by a licensed doctor. Secondly, only those drugs listed in the so-called "Specialties List" can be billed. This list, which is regularly updated to reflect the latest advancements in medical research, currently includes around 2,500 medications that are compulsory for insurance coverage.
The reimbursement also applies to all compounded prescriptions, but only if the ingredients used for production are listed with a tariff in the pharmaceutical list. In lieu of the original drugs, the pharmacy may provide you with generic versions, which are usually cheaper and contain the same active ingredients. The only exception is if the doctor explicitly prescribes the original drug - in this case, you are to receive only that.
Will I receive maternity care?
The basic health insurance provides comprehensive pregnancy and postpartum care. This covers routine antenatal check-ups, two ultrasound scans conducted in specific weeks, additional examinations for high-risk pregnancies, and first-trimester screenings. It also includes non-invasive prenatal testing (NIPT) for elevated risks and a CHF 150 contribution towards antenatal classes or midwife consultations. Birth-related costs at home or at listed hospitals are also covered.
Postnatal care includes a check-up in the 6th to 10th week post-childbirth, three breastfeeding consultations, and necessary home visits for aftercare. The insurance covers up to 16 visits for cases like premature or cesarean births and up to 10 visits in other situations. Extra visits require a medical prescription. It also covers a check-up after a miscarriage or medically indicated pregnancy termination during the 13th to 23rd weeks.
What preventive measures are available?
Preventive care is a big part of the Swiss medical system, and certain preventive measures are covered under the basic health insurance. These include general vaccinations recommended by the Swiss Federal Commission on Immunization, health check-ups for very young children, gynecological examinations, mammography screenings, and screenings for cancer of the colon in those aged 50 to 69.
While all these measures are designed to prevent illness and are covered by the compulsory health insurance even if no disease is currently suspected, you should be aware of certain limitations that may apply to your risk group or age range. The Federal Office of Public Health provides detailed information on these conditions.
Who pays for medical transportation?
In Switzerland, the basic health insurance will only cover half the cost of an ambulance ride or emergency rescue by helicopter, and even then, yearly limits apply, which may further push the expenses towards the patient.
If you have a condition requiring frequent medical transportation, these costs can quickly add up. Supplementary health insurance policies can bridge the gap, offering comprehensive transportation coverage. This can alleviate financial stress, allowing you to focus on recovery rather than worrying about the cost of getting to the hospital.
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 office. 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.
That concludes our overview of the most important services of Switzerland’s compulsory health insurance. For our guide on worthwhile supplementary insurance coverage, click here. For a personal consultation with experts from insuris, click here.
