The Swiss Health Care System: how does it work!?

medicoExpats arriving to Switzerland must to solve many doubts but nothing compares knowing how the Swiss health system works: understanding the schweizer Gesundheitssystem is a necessity and also a big challenge.

In our case, we decided to consult to an expert in health insurance who explained us all regarding the Swiss health system. Do you want to know what she explained us? Find out more!

First step: understand how the System works

In Switzerland, the Healthcare System is public but private… or vice versa: the State guarantee medical assistance to all people but private insurance companies (krankenkasse auf Deutsch) is the responsible of providing assistance. Or maybe I must say “commercializing” since everybody has to pay for it (at that point Healthcare System seems more private than public, right?).

The Swiss health service is based on the existence of a mandatory health insurance (Krankenversicherungsgesetz or KVG) which every person living in Switzerland has to get and pay individually. From the moment a person is registered at the community or Gemeinde and gets the residence permit -EU citizens only can stay in the country as a tourist / without a residence permit to a maximum of 3 months- will be compelled to get the obligatory health insurance with an insurance company of his choice.

Needless to say not getting the health insurance could lead to get a fine and to be forced to pay the total of the monthly payments from the moment the person was registered at the community.

Of course, in case people living in Switzerland can´t afford the the health insurance policy’s payments, the Social Security bears it and subsidizes all the medical expenses. By this way the State guarantees medical assistance to everybody.

Obligatory health insurance: coverage, franchise and cost

According to the law, insurance companies provide exactly the same coverage to every client taking the obligatory medical insurance, even when the cost of the policy is not the same. At that point is good to know that cost changes depending on the company, the kind of insurance you take, your profile it also depends on the Canton and the number of people that are registered in you Gemeinde (gender, age, profession…) and the franchise you choose as you can read more below.

Concerning the coverage, it includes all costs derivate from medical assistance in case of sickness or maternity (accidents are covered by employers when people working), including treatments and medication.

All it with nuances. A lot of nuances.

The cost of the mandatory health insurance

In short, it is composed of:

Monthly premium or policy cost: depending on the insurance company, the profile of the insured and even the place of residence.

– Yearly franchise: in addition to the monthly premium, the insured pays a limited amount per year when he incurs medical expenses from a minimum of 300 CHF. This amount is the franchise and is very important to determinate the cost of the policy or monthly premium. A high franchise -CHF 2.000 or 2.500 per year)- reduces the monthly cost and a low franchise -CHF 300- increases significantly the costs.

– Medical expenses participation: 10% of the medical expenses –for visit a doctor, medication, any treatment or hospitalization expenses; maternity expenses exempt- will be paid yearly for the insured until a limit of CHF 700 (CHF 350 for children).

Practical example: John Doe is 35 years old and decides to get the mandatory health insurance. He chooses a franchise of CHF 2.500 per year because he usually doesn’t get sick and wants to reduce the monthly premium to be paid. The first year he visits a doctor 3 times for CHF 150 each one and, altogether, he pays CHF 450 (it doesn’t reach the limit of CHF 2.500). The next year, he is operated on for “appendicitis” and the surgery expenses plus the recovering treatment exceed CHF 10.000. In this case, John only pays CHF 2.500 CHF plus the 10% of the costs according to the limit set by law – CHF 700. The insurance company pays the rest.

4 kinds of mandatory health insurance

Insurance companies offer a variety of options which differ in the way the services are provided and, of course, the policy cost:

Standard / Basic: the basic model. The insured can visit any doctor any time, even out of his canton. He can visit specialists without visiting his family doctor before. In this case the monthly premium has no discount: it is expensive but also the best.

smaller-sick-employee TELMED: telemedicine model. The insured has to make a phone call and explain the case before visiting a doctor. The medical call center will refer him to the proper doctor or specialist, or will recommend a treatment… by phone. Personally don’t like this option so much.

Hausarzt: the insured have an assigned family doctor and he will visit him when he needs medical assistance (but emergencies).

HMO: the cheapest but not the worst. The insured account a net of health offices HMO where he can go anytime he needs medical assistance. At the practical levels, when you need to see a doctor you go to the office, explain what happen in reception and they tell you who is going to meet you. Obviously, you have no family doctor but it will be easier to get a second opinion.

In case of emergency, the process is the same: the patient goes to a hospital o healthcare office and the hospital or healthcare office charge the invoice to the insurance company so indicated.

Right but… how much really cost the obligatory health insurance?

As I told you before, the cost of the insurance depends on several factors: the insurance company, the insured profile (children and young people pay less than adults), the franchise you get and the kind of service you want to receive.

So you have an idea, a HMO model health insurance for a person without health problems who rarely visits a doctor and a franchise of CHF 2.500 per year will be of some CHF 200-300 per month.

Next chapter: Additional services (VVG)

In addition to the obligatory health insurance, people living in Switzerland use to purchase a private “complementary” insurance policy for covering all what it is not included in the basic insurance. Or, for example, to improve the standard of room and service in case of hospitalization. 

In the next post I will share with you all I know about additional services that increase the amount to pay for health coverage every month but they are highly recommendable.

I hope this first post has been understandable within the complexity of the topic.

Cheers! J

Make me happy and share with us your knowledge and own experience!

1 thought on “The Swiss Health Care System: how does it work!?

  1. Thank you so much for this, it was very useful indeed. I think for expats in Switzerland the health system is a particularly great challenge, as I don’t find it very easy to understand. Hopefully I’ll get the hang of it soon!

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