Swiss health insurance made simple

Swiss health insurance: what you need to know

If you live in Switzerland, you need to take out cover with a health insurer. The key points:

• Basic insurance is mandatory. It covers the basic benefits for illness, accident and maternity.
• Supplementary insurance is voluntary. It closes gaps, such as choice of hospital, alternative medicine or corrective dentistry.
• The premium, deductible and retention fee determine how much you pay each month and how much you pay out of your own pocket if you fall ill.
• Knowing the rules of Swiss health insurance helps you avoid high costs and ensures you’re well protected in an emergency.

How your health insurance works

The Swiss health insurance system is made up of two parts:

• mandatory basic insurance
• voluntary supplementary insurance

Basic insurance is regulated by law. The rules are set out in the Federal Health Insurance Act (Krankenversicherungsgesetz, KVG). All health insurers have to offer the same basic benefits.

Supplementary insurance is voluntary. It is subject to the Insurance Contract Act (Versicherungsvertragsgesetz, VVG). Each health insurer has its own range of products and services. That allows you to adapt your cover to your own needs.

Basic insurance is mandatory

So that they don't have to bear all the costs themselves if they fall ill, everyone living in Switzerland has cover with a health insurer like CSS. Mandatory basic insurance ensures that everyone in Switzerland has access to comprehensive, high-quality primary healthcare. Health insurers are not permitted to turn anyone down: They are required to accept everyone wishing to take out insurance and must offer the same services and benefits to all insured persons.

Basic insurance covers illness, accident and maternity

All health insurers pay the same benefits for illness, accident and maternity. The monthly premium for basic insurance depends on where you live and your age, insurance model and deductible. Notice of cancellation for basic insurance can be given by the end of November each year, or in exceptional cases at the end of March.

Save on premiums with the right model

Telemedicine, family doctor model or doctors' network: The Multimed, Family Doctor, HMO and Telmed alternative insurance models let you save on premiums while still enjoying the same benefits. Choose the insurance that’s right for you.

Deductible and retention fee in a nutshell

The deductible is your share of the treatment costs under basic insurance. You choose the deductible yourself. Each year you pay:

• at least CHF 300
• at most CHF 2'500

A high deductible means a lower premium: The higher a deductible you choose, the more you save on premiums. But if you fall ill, you then have to pay more of the costs yourself.

Choose the right deductible

Check how much you spend on healthcare each year:

• Under CHF 2'000? Choose a deductible of CHF 2'500.
• Over CHF 2'000? Choose CHF 300.

You can change your chosen deductible each year, regardless of your medical history.

• Lowering it is possible until the last working day of November.
• Increasing it is possible until the last working day of December.

When do you pay a retention fee?

Once the deductible amount has been reached, your health insurer pays a share of all further costs above this. You then only pay the retention fee and the contribution to hospital costs. Together, they make up the co-payment. All health insurers charge the same retention fee for basic insurance.

• Adults: 10%, up to a maximum amount of CHF 700 a year.
• Children: 10%, up to an amount of CHF 350 a year.

With Multimed, you benefit from a reduced retention fee of no more than CHF 400. For children, the maximum amount is always CHF 350.

Close gaps easily with supplementary insurance

In Switzerland, voluntary supplementary insurance rounds out the benefits covered by basic insurance. Because basic insurance doesn’t cover all the costs, Swiss health insurers offer different forms of insurance and cover.

Costs commonly covered include

• stays in hospital or stays abroad
• specialists
• alternative medicine
• preventive examinations
• orthodontic treatment
• vaccinations

Basic insurance doesn’t cover all your healthcare costs

From alternative medicine to the Zilgrei method: Supplementary insurance from CSS provides you with comprehensive cover. Helping you avoid high bills that you would otherwise have to pay yourself. When applying for supplementary insurance, you need to answer questions about your health.

Private, semi-private, general – free choice in hospital

If a period of hospitalisation is called for, hospitalisation insurance is very valuable. Before being admitted, you choose whether you’d like to stay in a general, semi-private or private ward. Hospitalisation insurance enables you to:

• free choice of hospital throughout Switzerland
• contributions for births at home or in a birth centre
• protection against the additional cost of emergencies abroad

Good to know: Children under 18 and adults under 25 who are still in education don't pay a retention fee on their stay in hospital.

What payments does health insurance cover?

All Swiss health insurers pay the same contributions under basic insurance – including CSS. Benefits under supplementary insurance vary from one health insurer to another.

Have you ever asked yourself whether or not your insurance covers a particular benefit? myCSS lets you see right away what CSS pays: fitness, massage, acupuncture, dental braces and more.