The compulsory healthinsurance system
Guide

Prestations

Guide

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The compulsory health insurance system

Contents
Definitions

2

Preface3

Insurance coverage 	

4Benefits 	5Premiums and co-payment

13

Ways of reducing costs

15

What can I do if a dispute arises?

19

Addresses

20

Sample letters

25

Further information

27

Keywords / Index

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The compulsory health insurance system

Definitions
Health insurance fund: An organisation that provides basic healthinsurance under the compulsory health insurance system. Health insurance funds are non profit organisations and have to be recognisedby the Federal Office of Public Health (FOPH). They may also offer
supplementary insurance.
Compulsory health insurance under the Health Insurance Act :This insurance – explained in this booklet – ensures universal accessto comprehensive, high quality healthcare. It offers the same range ofservices and benefits to all insured people.

Definitions

Supplementary insurance: This optional insurance covers a higher
level of comfort (e.g. care in a semi-private or private hospital ward) or
additional services and benefits (naturopathy, osteopathy, routine
dental treatment, etc.). Premiums are risk-based. The health insurance
fund may refuse to insure certain people or may attach conditions to
the insurance policy because of the individual’s state of health.

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The compulsory health insurance system

Dear Reader,This booklet answers the questions mostfrequently asked about compulsory healthinsurance. It provides a general overview
of the legal requirements as of 1 January
2024. For specific queries, please contact
your health insurer.
Preface3

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The compulsory health insurance system

Do I have to have insurance?
	Yes, health insurance is compulsory in
Switzerland.

Insurance coverage

You need health insurance:– if you are resident in Switzerland, irrespective of your nationality.
All the members of your family, both adults and children, require
insurance;– if you have a Swiss residence permit valid for three months or longer;– if you are working in Switzerland for less than three months
and do not have equivalent insurance cover from another country;– if you have come to Switzerland intending to take up residence;– if you are a Swiss national or a national of an EU/EFTA country, or
the UK, are working in Switzerland and are resident in a member
state of the EU, in Iceland, in Norway or in the UK. This also applies
to any members of your family who are not employed;– if you are a Swiss national or a national of an EU/EFTA country or
the UK whose only source of income is a Swiss pension or unemployment benefit and you are resident in a member state of theEU, in Iceland, in Norway or in the UK. This also applies to any
members of your family who are not employed;– if you are an employee and are temporarily posted abroad byyour Swiss employer. This also applies to any members of yourfamily who are not employed.

	However, there are certain exceptions from therequirement to take out compulsory health insurance, or situations where you may be exempted.
In some cases, you do not need health insurance even though you are
resident in Switzerland, e.g.:– if you work in an EU/EFTA state or in the UK;– if you exclusively receive a pension from an EU/EFTA state or fromthe UK;– if you are a member of a diplomatic or consular mission, or if you
are an employee of an international organisation enjoying privileges
under international law.
Furthermore, some people may request exemption from compulsory
health insurance if they have equivalent insurance cover, e.g.:– if you come to Switzerland temporarily to study;– if you are a cross-border commuter or a pensioner resident, for example, in Germany, France, Italy or Austria, and therefore have theoption of taking out health insurance in your country of residence.
Applications for exemption from compulsory health insurance must
be sent to the cantonal authority responsible (see pp. 22–23) within
three months after the requirement begins. Pensioners resident in an
EU/EFTA member state or in the UK should contact the Common
Institution (www.kvg.org).

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The compulsory health insurance system(A practical guide to social insurance for SMEs is available online inFrench, German and Italian: https://www.bsv.admin.ch/bsv/de/home/
publikationen-und-service/broschueren.html)

Where can I obtain insurance?
Compulsory health insurance can be obtained from any of the roughly
50 health insurance funds operating in Switzerland. Not all of these
health insurers can offer insurance to people who are resident in an
EU country, in Iceland, Norway or the UK. The cantonal authorities
responsible can provide further information on the requirement totake out health insurance, as well as possible exemptions(for addresses, see p. 22).

When do I have to take out insurance?

What will my health insurance cover?
Services provided by a physician
Compulsory health insurance will generally cover all treatments
carried out by a physician. However, physicians must inform theirpatients whether services to be provided are covered.
Also covered are services prescribed by a physician and provided byother health professionals [physiotherapy, nursing care at home
(Spitex) or in a nursing home, advice on nutrition or diabetes management, speech therapy, occupational therapy, neuropsychology andpodiatry], as well as examinations (e.g. analyses, X-rays) ordered by aphysician. The reimbursement of psychotherapeutic services provided by doctors and psychotherapeutic services prescribed by doctors
and provided by psychologists (since 1 July 2022) is subject to more
stringent conditions. If you are in any doubt about whether a particulartreatment is covered, you should ask your physician or health insurer.

5

Benefits

Provided that you take out health insurance in good time (i.e. within
three months after taking up residence or after the birth of a childin Switzerland), the health insurer will reimburse you retrospectively
for expenses incurred from the starting date onwards.
Premiums will also have to be paid retrospectively from the start ofcoverage.
If you wait longer than three months after taking up residence
or after the birth of your child in Switzerland, you will have to pay asurcharge and expenses already incurred will not be reimbursed.

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Complementary medicine– acupuncture– anthroposophical medicine– traditional Chinese medicine (TCM) pharmacotherapy– classical homeopathy– phytotherapy
The above treatments will be covered if they are provided by aqualified medical specialist who has also been trained in the relevant
discipline of complementary medicine.
Appropriately qualified physicians are listed in the Register of Medical
Professions (MedReg) at: www.medregom.admin.ch/EN.
The medicines prescribed will be reimbursed if they are includedin the List of Pharmaceutical Specialties or the List of Medicines withTariffs (see p. 7).
Further information is available online in French, German and Italian:https://www.bag.admin.ch/bag/de/home/versicherungen/krankenversicherung/krankenversicherung-leistungen-tarife/Aerztliche-Leistungen-in-der-Krankenversicherung/Aerztliche-Komplementaermedizin.
html

Benefits

Hospital treatment
You can choose a hospital from the Hospital List of your canton ofresidence, or of the canton where you wish to be treated (listed
hospital). The Hospital List can be obtained from your health insurer
or from the cantonal health department. If you wish to be treatedat a listed hospital not included in the Hospital List of your canton ofresidence, the costs of accommodation and treatment on the generalward will be covered only up to the amount that would be charged
at a hospital on the Hospital List of your canton of residence. However,if the treatment has to be carried out at a hospital not included in
the Hospital List of your canton of residence for medical reasons(emergency, specialised treatment), the costs of accommodation andtreatment on the general ward of that hospital will be fully covered
under compulsory health insurance.
You will be liable for additional expenses arising from admission toa private or semi-private ward unless you have taken out appropriate
supplementary insurance.

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Medicines
Compulsory health insurance covers the costs of all medicines prescribed by a physician which are included in the List of Pharmaceutical
Specialties (see p. 27). Around 3000 medicines are currently covered,and this list is continuously updated. Also covered are extemporaneous
preparations (usually produced at the pharmacy), as long as the ingredients are included in the List of Medicines with Tariffs (see p. 27).
Pharmacists may dispense generic products instead of branded
medicines unless the physician has specifically prescribed a branded
product. Generics are copies of branded products which are of equivalent quality, contain the same active ingredients and are generally
less expensive (see p. 27).

Preventive measures

Important
All these measures are designed to prevent illness and are coveredby compulsory health insurance even if no disease is currently7

Benefits

Compulsory health insurance covers the costs of the following preventive measures:– Various vaccinations, that are listed in Article 12a of the Health
Insurance Benefits Ordinance and with vaccines authorised by
Swissmedic. We recommend that you discuss with your doctor thevaccination recommendations in the Swiss Vaccination Plan
https://www.bag.admin.ch/bag/de/home/gesund-leben/gesundheitsfoerderung-und-praevention/impfungen-prophylaxe/richtlinien-empfehlungen-impfungen-prophylaxe.html–	Not covered, however, are travel-related vaccinations or preventive
measures, such as yellow fever or malaria prophylaxis.
–	Eight examinations to monitor the health and development ofchildren of preschool age.
– Gynaecological screening examinations (including Pap smears):
examinations are covered for the first two years, and subsequently(if the results are normal) once every three years; otherwise as
required.
– Mammography to detect breast cancer:–	Digital mammography, breast MRI in women with a moderate tohigh familial or personal risk of breast cancer.
–	Screening mammography once every two years for women over
50, when the examination is carried out under a cantonal orregional screening programme that meets certain quality assurance requirements. Further information may be obtained fromyour doctor or online at: www.swisscancerscreening.ch). No
deductible is payable for screening mammography.
–	Screening for cancer of the colon in men and women aged 50
to 69. Examinations to detect the presence of faecal occult bloodonce every two years, including the necessary laboratory analyses,
or a colonoscopy every ten years. No deductible is payable if theexamination is carried out as part of early-detection programmes.

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The compulsory health insurance systemsuspected. If signs of disease are detected, your physician is free tocarry out any examinations deemed necessary, and these will becovered by the health insurer.

Maternity

Benefits– Pregnancy: Compulsory health insurance covers the costs of sevenroutine antenatal and two ultrasound examinations (between the
12th and 14th week and between the 20th and 23rd week of pregnancy) carried out by a physician or midwife. In high risk pregnancies, insurance will cover as many examinations (including ultrasound) as are necessary.
– Also covered is the first-trimester test to assess the risk of Down’s,
Edwards’ or Patau’s syndrome (trisomy 21, 18 or 13) based on
ultrasound measurement of nuchal translucency (between the 12thand 14th week), the determination of certain factors in the mother’s blood, and other fetal and maternal factors (such as age).
– Non-invasive prenatal testing (NIPT) will be covered from the 12th
week of pregnancy if the fetus has an elevated risk (at least 1:1000)of Down’s, Edwards’ or Patau’s syndrome. Positive NIPT results
should be confirmed by amniocentesis.
– Compulsory health insurance pays CHF 150 towards the costs ofindividual or group antenatal classes run by a midwife or midwives’ association, or towards the costs of a consultation with a
midwife or midwives’ association.
– Childbirth: Compulsory health insurance covers the costs (including the services of a physician or midwife) of a birth at home, or ata hospital or birthing centre, provided that the latter institutions
are included in the Hospital List of your canton of residence (see p.
8 on hospital treatment).
– After childbirth, compulsory health insurance covers:–	one check-up carried out by a physician or midwife between the
6th and 10th week after childbirth;–	three breastfeeding consultations provided by a midwife or midwives’ association or specially trained nursing staff;–	the aftercare provided by a midwife or midwives’ associationand consisting of home visits to provide care and monitor themother’s and baby’s health. Up to 16 home visits are covered
during the 56 days following a premature, multiple or first birth,or a Caesarean section, and up to 10 home visits in all othercases. In the 10 days following the birth, the midwife or midwives’ association may additionally make a second home visit
on a maximum of 5 days. A medical prescription is required forother additional home visits during the 56 days after childbirth,or thereafter.
–	One check-up after miscarriage or medically indicated termination of pregnacy from the 13th to the completed 23rd week ofpregnacy.

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Hospital care for the newborn
The hospital and routine care costs incurred for a healthy newborn
during the mother’s hospital stay are included in maternity benefits,
i.e. they are covered by the mother’s health insurance (no co-payment). However, if the newborn is ill, the costs are covered by thebaby’s insurance (with co-payment).

Physiotherapy
Compulsory health insurance covers physiotherapy if it is prescribed bya physician and carried out by a registered physiotherapist. The physician can prescribe up to 9 sessions, with the first taking place within
five weeks after being prescribed. Further therapy can be prescribed
if necessary.
In contrast to physiotherapy, treatment provided by a chiropractor iscovered even if it is not prescribed by a physician.

Spectacles and contact lenses

Aids and appliances
Medically prescribed aids and appliances (e.g. bandages, dressings,
inhalers and respiratory therapy devices or incontinence aids) which
are included in the Aids and Appliances List (MiGeL, see p. 27) arecovered up to a specified limit. Like any other benefits, these contributions are subject to co-payment requirements (see p. 13).

Dental treatment
Compulsory health insurance only covers dental treatment if it isnecessitated by a serious disorder of the masticatory system, if suchtreatment is required to support and ensure the success of medical
treatment for a severe general disorder (e.g. leukaemia, heart-valve
replacement), or if it is required after an accident and treatment costs
are not covered by another insurance. Compulsory health insurance
does not cover the costs of, for example, fillings for decayed teeth ororthodontic treatment (e.g. braces).

9

Benefits

Compulsory health insurance will contribute up to CHF 180 per year
towards spectacle and contact lenses prescribed by an ophthalmologist
for children and adolescents up to the age of 18.
In the case of serious visual impairment or certain illnesses (e.g.
disease-related refraction abnormalities, postoperative alterations or
corneal disease), compulsory health insurance will, regardless of age,make higher contributions towards medically prescribed spectacle
and contact lenses. Further information can be provided by your healthinsurer or your ophthalmologist.
Like any other benefits, these contributions are subject to co-payment
requirements (see p. 13).

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The compulsory health insurance system

Accidents–	If you work at least 8 hours per week for the same employer, you
are coverd by that employer against work-related and non-work-related accidents under the Accident Insurance Act. In the event ofan accident, benefits will be provided under this insurance.
–	If you do not have compulsory accident insurance (under the Accident Insurance Act), you will need to take out accident insurancewith your health insurer. Your premium will therefore be slightly
higher. In the event of an accident, your health insurer will thenprovide the same benefits as in the case of illness.

Spa treatments
Compulsory health insurance contributes CHF 10 per day (for up to
21 days per year) if a spa treatment is prescribed by a physician andis carried out at a registered spa (ask your health insurer for more
information). Additional costs for medical treatment, physiotherapy or
medication are reimbursed separately.

	Nursing care at home (Spitex) or in a nursing home
Benefits

If, because of an operation or illness, you require nursing care at homeor in a nursing home, compulsory health insurance will contribute towards the costs of physician-prescribed care (e.g. injections, changing
dressings, cleaning and treating wounds, checking pulse and bloodpressure, advice on taking medication and using medical devices, footcare for diabetics).
You usually have to bear a limited amount of the care costs yourself,with any remaining costs being covered by the canton or commune.
Further information may be obtained from the local authorities or
your Spitex organisation or nursing home.
Like any other benefits, contributions to the costs of nursing care aresubject to co payment requirements (see p. 13).
However, compulsory health insurance does not cover the costs ofdomestic help (cooking, cleaning, shopping), nor does it cover board
and lodging in a nursing home; these costs are to be borne by the
insured person.
Pensioners on a low income can apply for supplementary benefits(see leaflets 5.01 and 5.02 issued by the AHV/IV Information Office,available from your Compensation Office or online at: https://www.
ahv-iv.ch/de/Merkblätter-Formulare/Merkblätter/Ergänzungsleistungen-zur-AHV-und-IV).

Medical transport and rescue– Special transport (e.g. an ambulance) may be needed so that you canaccess treatment. Compulsory health insurance covers half the costsof this kind of transport, up to a maximum of CHF 500 per year.

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The compulsory health insurance system– Compulsory health insurance also covers half the costs of rescue inthe event of a risk to life (e.g. after a mountaineering accident or aheart attack), up to a maximum of CHF 5,000 per year (in Switzerland only).

	Essential treatment in an EU/EFTA country andthe UK	Emergency treatment in a country outside the
EU/EFTA and the UK
If you require emergency treatment in a country that is not the UK or
is not a member of the EU or EFTA – for example, if you become illwhile on holiday – compulsory health insurance will cover costs up to
twice the amount that would be reimbursed for the same treatment
in Switzerland. However, in the case of inpatient treatment, this meansthat the insurer will only cover up to 90% of the costs that would
have arisen for hospitalisation in Switzerland (this is because, forhospital treatment in Switzerland, at least 55% of the costs are borneby the cantons, which is not the case for hospitalisation abroad).
Additional travel insurance may be necessary for certain countries (e.g. the US, Australia
and certain Asian countries) where treatment and medical transport
is more expensive than in Switzerland. More information can be obtained from your health insurer.
Compulsory health insurance will cover 50% of the costs of medicallynecessary transport, up to a maximum of CHF 1,000 per year.

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Benefits

In EU/EFTA countries and in the UK, insured persons presenting a
European Health Insurance Card are entitled to reimbursement forany medical treatment considered essential in view of the type ofservice and the expected length of their temporary stay. Compulsory
health insurance will cover the same medical (e.g. physician, hospital,transport) services as would be provided for a resident of the country
in question.
Depending on the country, either the treatment costs will be paid forby the local organisation and then invoiced to your health insurer in
Switzerland, or you will be asked to pay for treatment and can subsequently request reimbursement:
https://www.bag.admin.ch/bag/en/home/versicherungen/krankenversicherung/krankenversicherung-leistungen-tarife/Leistungen-im-Ausland/Behandlungen-im-Ausland-fuer-Versicherte-mit-Wohnsitz-in-derSchweiz.html
Insured people who are resident in an EU country, in Iceland, in Norway or in the UK can find more information online at: https://www.
bsv.admin.ch/bsv/en/home/informations-for/faq.html?faq-url=/en

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The compulsory health insurance system	If you live in an EU/EFTA member state or the UK
If you are insured in Switzerland and are resident in an EU/EFTA mem
ber state or in the UK, then you have the right to choose the placeof treatment, i.e. you have the option of being treated in yourcountry of residence or in Switzerland.

Benefits

Important
All the treatments mentioned above are covered by compulsory
health insurance, with no need for supplementary insurance. This
list of benefits and service providers is not exhaustive: to find out
whether treatments not included in this list are covered, please ask
your health insurer.

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What costs do I have to bear myself?
Premiums

Co-payment
A proportion of treatment costs is paid by the insured. This copayment consists of two elements:–	a standard deductible of CHF 300 per year, from which children
and adolescents up to the age of 18 are exempt;–	a retention fee of 10% of the remaining invoiced amount, up toa maximum of CHF 700 per year (CHF 350 for children and adolescents). Exception (medicines): the retention fee is 40% for medicines if an equivalent medicine exists which costs less (by a defined
margin). Branded products or generics may be subject to an increased
retention fee. Your physician or pharmacist can provide further
information.
The standard co-payment is therefore a maximum of CHF 1,000 per
year for adults and CHF 350 for children and adolescents.
N.B.
This amount will vary if an optional deductible is selected.

13Premiums and co-payment

Premiums are paid per capita and do not depend on income. They are
generally payable monthly, in advance.
According to a Federal Supreme Court ruling (valid from 3 December2015), premiums are to be calculated on a daily (not monthly) basis
for the beginning and end of insurance cover.
Health insurance funds offer reduced premiums for children andadolescents (up to the age of 18) and for young adults (aged 19–25).
Premiums are not dependent on income, but they may vary from one
health insurance fund to another, from canton to canton, and fromcountry to country for people resident in an EU country, in Iceland, in
Norway or in the UK. Health insurance funds may apply up to threedifferent regional levels within a single canton, within a single EU/
EFTA country or within the UK. All insurance providers are bound by
the standard definition of cantonal premium regions determined by
the Federal Office of Public Health.
Individuals on a low income are entitled to health insurance premiumsubsidies (see p. 20).

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ExampleThe total cost of the treatment you receive in the course of a year
(physician, hospital, medicines, etc.) is CHF 2,000. You pay a deductibleof CHF 300 plus 10% of the remaining amount, i.e. CHF 470 in total(CHF 300 + 10% of CHF 1,700 = CHF 470). CHF 1,530 is reimbursed
by your health insurer.
Maternity
Co-payment is not applicable to maternity-related services (see p. 8).
In addition, from the 13th week of pregnancy until 8 weeks afterchildbirth, women are exempt from co-payment for general medical
services. This includes the costs of treatment for non-pregnancyrelated illness.
Mammography
No deductible is payable for mammography carried out under a cantonal or regional breast cancer screening programme (see p. 8). Ask
your physician or health insurer for more details.

Premiums and co-payment

Screening for cancer of the colon
No deductible is payable if the examination is carried out under a cantonal screening programme (see p. 8).
Hospitalisation
A contribution of CHF 15.00 is payable for each day spent in hospital. As of 1.1.2022, no contribution is payable for the final day of thehospital stay or for days during hospitalisation on which the patientis away from the hospital. This does not apply to children under 18,
young adults (up to the age of 25) in training, or women receiving
maternity services. No ceiling is defined for these contributions.

ImportantServices provided in an EU country, in Iceland, in Norway or in the
UK are subject to the local co-payment requirements.

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How can I save on insurance premiums?
Compare health insurance funds
As all health insurers provide the same benefits under compulsory
health insurance, you will not suffer any disadvantages if you change
from one health insurance fund to another that is better suited toyour needs. There may be differences in the quality of service they
provide. In addition, some health insurers require policyholders to
pay for medication themselves before obtaining reimbursement. No
health insurance fund can refuse to insure you.
Overview of premiums
Every October, the FOPH publishes an Overview of premiums forcompulsory health insurance in the following year, for each canton,
for EU countries, and for Iceland and Norway. The Overview is available free of charge from the FOPH or can be downloaded from thewebsite (see p. 27).

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Ways of reducing costs

Notice periods–	If you have a basic health insurance policy with the standard deductible of CHF 300, you can cancel it with three months’ noticeat the end of June or December. This means that your healthinsurer must receive your notice of cancellation by 31 March or 30
September (see sample letter, text 1, p. 26).
–	If you have a basic health insurance policy with a higher deductible,
or with a restricted choice of physicians/hospitals (e.g. HMO/GP
model), it can only be cancelled at the end of the year, with threemonths’ notice; i.e., your health insurer must receive your notice ofcancellation by 30 September (see sample letter 1, text 1, p. 26).
–	If your health insurer notifies you of a new premium, you cancancel your policy and change to another insurance provider withjust one month’s notice, with effect from the end of the month
preceding the month in which the new premium applies. This ispossible irrespective of whether the new premium approved by the
FOPH is more expensive, or whether you have an insurance policy
with an HMO/GP or telemedicine model, or an optional deductible.
Your health insurer must inform you of the new premium at least
two months in advance, also indicating your right to cancel the policy (see sample letter, text 1, p. 26).
–	You can only change to a different deductible or to a different typeof insurance (HMO/GP model or telemedicine) with effect from the
beginning of the year (see sample letter, text 2, p. 26).
–	If you wish to change from an optional deductible to the standard
deductible (CHF 300) or to a lower optional deductible, you must
notify the insurer by 30 November at the latest. A change to ahigher deductible, on the other hand, can be notified up to theend of December. A change of insurance model must be requested
by 30 November.

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ExampleIf you wish to change to a different health insurer with effect from 1
January, your existing health insurer must receive your notice of cancellation by 30 November, irrespective of whether your premium has
been increased, or whether you have a particular type of insurance(health network, HMO/GP model, telemedicine, optional deductible,
bonus insurance). Your health insurer must, however, have notified
you by 31 October of the new premium approved by the FOPH.
N.B.
Make sure you cancel your existing insurance in good time (seesample letter, text 1, p. 26). Irrespective of the postmark, yournotice of cancellation must be received by your insurer by the
specified deadline. It is advisable to send your notice by mid-Marchor mid-November by registered mail. Your insurance will not betransferred until the new insurer has informed the existing insurerthat coverage will be continued without interruption; only thenwill the change take effect.

Review your supplementary insuranceWays of reducing costs

Compulsory health insurance ensures comprehensive, high-quality
healthcare for everyone. So compare what your supplementary insurance offers with the benefits to which you are automatically entitledunder compulsory health insurance.
Important
Never cancel a supplementary insurance policy without first obtaining detailed information from other health insurers about theconditions under which they would offer supplementary insurance.
Insurers can refuse to provide such insurance, set premiums on
the basis of age and sex, or impose restrictions according to yourstate of health. Compare the range of benefits offered under
supplementary insurance; they can differ significantly from one
health insurer to another.

Notice period
Check the terms and conditions of your policy. In general, thenotice period for supplementary insurance differs from that forcompulsory health insurance.

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Choose a special type of insurance
If you choose one of the following types of insurance, your premium
will be reduced (see the Overview of premiums issued by the FOPH,
p. 27).
Restricted choice of physicians and hospitals
You can save on premiums by opting for an HMO model (Health
Maintenance Organisation), or for a GP model, whereby you always
first consult your GP, who will decide whether or not to refer you forspecialist or hospital treatment. You thus give up the right to a freechoice of physicians and hospitals (except in an emergency). For more
information, please consult the terms and conditions of insurance(see the list of insurance providers in the Overview of premiums issued
by the FOPH, p. 24).
Reductions apply to the premium for standard insurance with accident cover. If this is combined with an optional deductible, reductions
may be limited because of the regulations concerning the minimum
premium (see below).

Premium reductions for optional deductibles– Health insurers must charge a minimum premium amounting to
50% of the standard premium, including accident cover, applicablefor the policyholder’s age group and premium region. The premium must not be less than this amount, even if the insurance
excludes accident cover or if the optional deductible is combinedwith a model restricting the choice of service provider.
– In addition, the reduction must not exceed 70% of the risk additionally assumed by the policyholder, as shown in the table below.
The full reduction can only be offered if the resulting premium
does not fall below the minimum premium.

AdultsChildren

Deductible (CHF)

500

1000 1500 2000 2500

100

200

300

400

500

600

Maximum annual
reduction (CHF)

140

490

70

140

210

280

350

420

840

1190 1540

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Ways of reducing costs

Optional deductible
Your premium will be reduced if you choose a deductible higher than
the standard CHF 300. The deductible can only be increased with effect from 1 January and for at least one year. The reduction depends
on the level of the deductible and is limited by law.
For adults, the optional deductibles are CHF 500, 1000, 1500, 2000
and 2500; for children, they are CHF 100, 200, 300, 400, 500 and
600. Health insurers are not obliged to offer all these levels. They may
offer different deductibles for young adults (aged 19–25).

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Bonus insurance
Premiums are progressively reduced for each year in which no claims
for reimbursement are submitted. The initial premium is 10% higher
than the standard premium. After 5 years, the reduction can reach
45% of the initial premium.
Other insurance models
Several insurers offer other insurance models (e.g. telemedicine or
combined insurance). For further details, please contact the healthinsurers concerned.
N.B.
The special types of insurance are not available to individuals resident in an EU country, in Iceland, in Norway or in the UK.

	Exclusion of accident coverWays of reducing costs

If you work at least 8 hours per week, you are insured through youremployer against work-related and non-work-related accidents underthe Accident Insurance Act. You can therefore request exclusion of
accident cover (see sample letter, text 3, p. 26).

	Refund of health insurance premiums duringextended military service
Health insurance can be suspended for periods of military, civilian
or civil protection service lasting more than 60 consecutive days.
During these periods, illness and accident risks are covered by military insurance.

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What can I do if a dispute arises?
Ask for an explanation
Health insurers have a legal obligation to answer any queries you may
have.

Contact the ombudsperson
The health insurance ombudsperson or a consumer advice organisation may be able to help you (for addresses, see p. 24).

Ask for a decision in writing
You can ask your health insurer to send you a written decision,
including a justification and information on your right of objection(see sample letter, text 4, p. 26).

You can lodge an objection to the health insurer’s decision within 30
days (preferably in writing; see sample letter, text 5, page 26).
The health insurer is then required to send a response to the objection,
including a justification and information on your right of appeal.

Consider an appeal
You can lodge a written appeal against the health insurer’s responseto the objection with the Cantonal Insurance Court within 30 days.
You can also appeal if the health insurer fails to send a written decision
or a response to the objection.
N.B.
For disputes relating to benefits, this procedure is free of charge.
You can only appeal to the Cantonal Insurance Court if you havealready formally objected (orally or in writing) to the health insurer.

As a last resort …
If you are not satisfied with the decision of the Cantonal Insurance
Court, you can lodge a written appeal, within 30 days, with theSocial Law Division of the Federal Supreme Court in Lucerne. The
decision of the Federal Supreme Court is final.

19

What can I do if a dispute arises?

Consider an objection

Guide

The compulsory health insurance system

Addresses
Institutions responsible for premium subsidies
1. Cantonal offices
CantonAG
AargauAI
Appenzell
Innerrhoden
AR
Appenzell
Ausserrhoden
BE
Bern

BL
Basel-Landschaft

Addresses

BS
Basel-Stadt

FR
Fribourg

GE
GenevaGL
GlarusGR
Graubünden

JU
Jura
LU
LucerneNE
Neuchâtel

NW
Nidwalden

OW
Obwalden20

Address
SVA Aargau
Kyburgstrasse 15
5001 Aarau
Gesundheitsamt
Hoferbad 29050 Appenzell
Sozialversicherungen Appenzell
Ausserrhoden
Neue Steig 159102 Herisau
Amt für SozialversicherungenPrämienverbilligung
Forelstrasse 13072 Ostermundigen
SVA Basel-Landschaft
Hauptstrasse 109
4102 Binningen
Kanton Basel-Stadt
Amt für Sozialbeiträge
Prämienverbilligung
Grenzacherstrasse 624005 Basel
Ausgleichskasse des Kantons Freiburg
Impasse de la Colline 1
Case postale 176
1762 Givisiez
Service de l’assurance maladie
Route de Frontenex 62
1207 Genève
Kantonale Steuerverwaltung
Abteilung IPV
Hauptstrasse 118750 Glarus
SVA Graubünden
Ottostrasse 24
7000 Chur

Contact
T 062 836 81 81
info@sva-ag.ch
www.sva-ag.ch/pv
T 071 788 92 50
info@gsd.ai.ch
www.ai.ch
T 071 354 51 51
www.sovar.ch

T 031 636 45 00
asv.pvo@be.ch
www.asv.dij.be.ch
T 061 425 25 25
F 061 425 25 00
info@sva-bl.chwww.sva-bl.ch
T 061 267 87 11
F 061 267 86 44
asb-pv@bs.ch
www.asb.bs.ch
T 026 426 77 00
www.caisseavsfr.ch

T 022 546 19 00
sam@etat.ge.ch
www.ge.ch
T 055 646 61 55
ipv@gl.ch
www.gl.ch

T 081 257 41 11
F 081 257 42 22
info@sva.gr.ch
www.sva.gr.ch
Caisse de compensation du canton du Jura T 032 952 11 11Case postaleamal@ecasju.ch2350 Saignelégier
www.ecasjura.ch
WAS Wirtschaft Arbeit Soziales
T 041 209 01 51
Ausgleichskasse Luzern
ipv@was-luzern.ch
Würzenbachstrasse 8
www.was-luzern.ch/ak
Postfach
6000 Luzern 15
Service de l‘action sociale
T 032 889 85 02
Espace de l’Europe 2
F 032 889 60 89
Case postale 752
Service.ActionSociale@ne.ch
2002 Neuchâtel
www.ne.chAusgleichskasse Nidwalden
T 041 618 51 00
Stansstaderstrasse 88
F 041 618 51 01
Postfach
info@aknw.ch6371 Stans
www.aknw.ch
Volkswirtschaftsdepartement
T 041 666 63 05
Prämienverbilligung
praemienverbilligung@ow.ch
St. Antonistrasse 4
www.ipv.ow.ch
6060 Sarnen

Guide

The compulsory health insurance system

SG
St Gallen
SH
Schaffhausen
SO
Solothurn
SZ
SchwyzTG
Thurgau

TI
Ticino

UR
Uri
VD
Vaud
VS
Valais

ZH
ZurichT 071 282 61 91
www.svasg.ch/ipv
T 052 632 61 11
www.svash.ch
T 032 686 22 00
info@akso.ch
www.akso.ch
T 041 819 04 25
ipv@aksz.ch
www.aksz.ch
T 058 345 68 40
gesundheit@tg.ch
www.gesundheit.tg.ch

T 091 821 93 11
F 091 821 92 99
sussidi@ias.ti.ch
www.ti.ch
T 041 875 22 42
praemienverbilligung@ur.ch
www.ur.ch/praemienverbilligung
T 021 557 47 47
www.vd.ch/ovam
T 027 324 91 11
subvention@avs.vs.ch
www.avs.vs.ch
T 041 560 47 00
info.ipv@akzug.ch
www.akzug.ch/ipv

Addresses

ZG
Zug

SVA St. Gallen
Brauerstrasse 54
9016 St. Gallen
SVA Schaffhausen
Oberstadt 98200 Schaffhausen
Ausgleichskasse des Kantons Solothurn
Allmendweg 64528 Zuchwil
Ausgleichskasse Schwyz
Abteilung Leistungen (KVG)
Postfach 53
6431 Schwyz
Commune of residenceorAmt für Gesundheit
Promenadenstrasse 16
8510 Frauenfeld
Ufficio delle prestazioni
Servizio sussidi assicurazione malattia
Viale Stazione 28a
6500 Bellinzona
Amt für Gesundheit
Klausenstrasse 46460 Altdorf
Office vaudois de l‘assurance-maladie
Rte des Plaintes-du-Loup 11014 Lausanne
Ausgleichskasse des Kantons Wallis
Av. Pratifori 22
1950 Sitten
Ausgleichskasse Zug
Baarerstrasse 11
Postfach
6302 ZugSVA Zürich
Röntgenstrasse 17
Postfach8087 Zürich

T 044 448 53 75
www.svazurich.ch/ipv

2. Common Institution under the Federal Health Insurance Act
The Common Institution is responsible for premium subsidies forpolicyholders who are resident in a member state of the EU, in Iceland,
Norway or in the UK, and who receive a Swiss pension, and for membersof their family who are insured in Switzerland (Art. 66a KVG).
Institution

Address

Contact

Gemeinsame
Einrichtung KVG

Industriestrasse 78
4609 Olten

T 032 625 30 30
pv@kvg.org
www.kvg.org

21

Guide

The compulsory health insurance system

Cantonal offices responsible for exemption from compulsory
insurance.
CantonAddress

Contact

AG
AargauGemeinsame Einrichtung KVG
Industriestrasse 78
4609 Olten
Gesundheits- und Sozialdepartement
Hoferbad 29050 Appenzell
Gemeinsame Einrichtung KVG
Industriestrasse 78
4609 Olten

T 032 625 30 30
info@kvg.org
www.kvg.org
T 071 788 92 50
info@gsd.ai.ch
www.ai.ch
T 032 625 30 30
info@kvg.org
www.kvg.org

Amt für Sozialversicherungen
Forelstrasse 13072 Ostermundigen
Gemeinsame Einrichtung KVG
Industriestrasse 78
4609 Olten

T 031 636 45 00
asv.vp@be.ch
www.asv.dij.be.ch
T 032 625 30 30
F 032 625 30 90
info@kvg.org
www.kvg.org
T 032 625 30 30
info@kvg.org
www.kvg.org
T 026 305 29 13
F www.fr.ch/ssp

AI
Appenzell
Innerrhoden
AR
Appenzell
Ausserrhoden
BE
Bern
BL
Basel-Landschaft

BS
Basel-Stadt

Addresses

FR
Fribourg

GE
GenevaGL
GlarusGR
Graubünden
JU
Jura
LU
LucerneNE
Neuchâtel

NW
Nidwalden

OW
ObwaldenSG
St Gallen
SH
Schaffhausen

22

Gemeinsame Einrichtung KVG
Industriestrasse 78
4609 Olten
Commune of residence or work
(cross border commuters)
Frontier commuters:
Amt für Gesundheit
Route des Cliniques 171700 Fribourg
Service de l’assurance maladie
Route de Frontenex 62
1207 Genève
Gemeinsame Einrichtung KVG
Industriestrasse 78
4609 Olten
Commune of residence or work
(cross border commuters)
Caisse de compensation du Jura
Case postale
2350 Saignelégier
WAS Wirtschaft Arbeit Soziales
Ausgleichskasse Luzern
Würzenbachstrasse 8
Postfach
6000 Luzern 15
Office de l‘assurance maladie
Espace de l’Europe 2
Case postale 716
2002 Neuchâtel
Ausgleichskasse Nidwalden
Stansstaderstrasse 88
Postfach
6371 Stans
Gemeinsame Einrichtung KVG
Induestriestrasse 78
4609 Olten
Commune of residence or work
(cross border commuters)
SVA Schaffhausen
Oberstadt 98200 Schaffhausen

T 022 546 19 13
sam@etat.ge.ch
www.ge.ch
T 032 625 30 30
info@kvg.org
www.kvg.org

T 032 952 11 11
www.caisseavsjura.ch
T 041 375 05 05
kv@was-luzern.ch
www.was-luzern.ch/ak

T 032 889 66 30
F 032 722 03 66
ocab@ne.chwww.ne.ch
T 041 618 51 00
F 041 618 51 01
info@aknw.ch
www.aknw.ch
T 032 625 30 30
info@kvg.org
www.kvg.org

T 052 632 61 11
www.svash.chGuideSO
Solothurn
SZ
SchwyzTG
Thurgau

TI
Ticino

UR
Uri
VD
Vaud
VS
ValaisZG
Zug
ZH
ZurichThe compulsory health insurance system

Gemeinsame Einrichtung KVG
Industriestrasse 78
4609 Olten
Ausgleichskasse Schwyz
Abteilung Leistungen (KVG)
Postfach 53
6431 Schwyz
Commune of residence or work
(cross border commuters)
Amt für Gesundheit
Promenadenstrasse 16
8510 Frauenfeld
Ufficio dei contributi
Settore obbligo assicurativo
Via Ghiringhelli 15a
6500 Bellinzona
Gemeinsame Einrichtung KVG
Industriestrasse 78
4609 Olten
Office vaudois de l‘assurance-maladie
Rte des Plaintes-du-Loup 11014 LausanneCommune du lieu de domicile, de résidence
ou de travail (frontalier/ière)
Gemeinsame Einrichtung KVG
Industriestrasse 78
4609 Olten
SVA Zürich
Röntgenstrasse 17
Postfach8087 Zürich

T 032 625 30 30
info@kvg.org
www.kvg.org
T 032 625 30 30
info@kvg.org
www.kvg.org
T 058 345 68 40
gesundheit@tg.ch
www.gesundheit.tg.ch

T 091 821 91 11
F 091 821 92 99
obbligo@ias.ti.ch
www.ti.ch
T 032 625 30 30
info@kvg.org
www.kvg.org
T 021 557 47 47
www.vd.ch

T 032 625 30 30
info@kvg.org
www.kvg.org
T 044 448 88 90
svazurich.ch

Addresses

23

Guide

The compulsory health insurance system

List of health insurers
The current Overview of premiums issued by the Federal Office of
Public Health includes a list of registered health insurers (see p. 27);
the list is also available online at www.priminfo.ch.

List of HMO centres/GP network areas
The current Overview of premiums issued by the Federal Office of
Public Health includes a list of HMO centres and GP network areas(see p. 27).

Other useful addresses

Addresses–	
Office of the health insurance ombudsperson, Postfach 519,
6002 Luzern; phone 041 226 10 10 (German), 041 226 10 11(French) and 041 226 10 12 (Italian)(advice and mediation in disputes; no general advice on insurance).
Website: www.om-kv.ch.
–	
SPO Patientenorganisation (Swiss Patients’ Organisation), Nordstrasse 31, 8006 Zürich; phone 044 252 54 22). Website: www.spo.
ch.
–	
Stiftung für Konsumentenschutz (Foundation for Consumer
Protection), Nordring 4, 3001 Bern; advice hotline for non-members
031 370 24 24. Website: www.konsumentenschutz.ch.
– Schweizerisches Konsumentenforum kf (Swiss Consumer
Forum], Belpstrasse 11, 3007 Bern; advice hotline for members 031
380 50 34.
Website: www.konsum.ch.
–	Dachverband Schweizerischer Patientenstellen (Association of
Swiss Patient Representation Offices), Hofwiesenstrasse 3, Postfach, 8042 Zürich; phone 044 361 92 56. Website: www.patientenstelle.ch.

24

Guide

The compulsory health insurance system

Sample letters
			
			
			

1

Maria Everywoman
Spitalweg 63000 Bern			

2

Insurance number: 12.3456789.0

By registered post3

Krankenkasse Sanissima
Postfach
3000 Bern

Sample letters

Bern, 15 October [year]
Re: Compulsory health insurance: change of insurer.
Dear Sirs,

4

I hereby cancel my compulsory health insurance with effect from 31
December [year]; after this date I will be insured in compliance with the
Health Insurance Act by a different insurance provider.
Yours faithfully,

M. Everywoman

Enclosures: ...

1

Your name and your address

3

Name/address of your health insurer

2

insurance number (shown on yourhealth insurance card)

4

Use text 1 to 5 as required25

Guide

The compulsory health insurance system

Use text 1 to 5 as required:
1 Compulsory health insurance: change of insurer
I hereby cancel my compulsory health insurance with effectfrom [date]; after this date I will be insured in compliance with the
Health Insurance Act by a different insurance provider.
2 Compulsory health insurance: change of deductible e
Please note that from 1 January [year] I would like to change thedeductible for my compulsory health insurance to CHF [amount].
3 Request to cancel accident cover (according to Art. 8 Health
Insurance Act)
Please cancel the accident cover in my compulsory health insurance.
I am enclosing confirmation from my employer that I am insured
against work related and non-work-related accidents in compliancewith the Accident Insurance Act.
Enclosure: Confirmation from employer

Sample letters

4 Request for written decision
Further to your letter dated [date] I would be grateful if you could
send me a written decision in accordance with Art. 51 para. 2 of theFederal Act on the General Part of Social Insurance Law (ATSG).
Enclosure: Copy of the letter [not essential]
5 Objection
I hereby object to your written decision dated [date] in accordancewith Art. 52 para. 1 of the Federal Act on the General Part ofSocial Insurance Law (ATSG). The reasons are as follows: [list yourarguments].
Enclosures:– Copy of the decision [not essential]– If available: evidence in support of your case26

Guide

The compulsory health insurance system

Further information
Overview of premiums
Every October, the FOPH publishes an Overview of premiums forcompulsory health insurance in the following year, for each canton,
for EU countries, and for Iceland and Norway. You can obtain thisOverview free of charge by sending a self-addressed adhesive label(no envelopes please!) to the following address:
Bundesamt für Gesundheit
Prämien-Service
3003 Bern
The Overview of premiums is also available online at: www.priminfo.ch.

Health Insurance Act“List of Pharmaceutical Specialties” including genericsand List of Medicines with Tariffs
The lists of medicines covered by compulsory health insurance (“Listof Pharmaceutical Specialities” including generics, and the “List of
Medicines with Tariffs”) are available online https://www.bag.admin.
ch/bag/en/home/versicherungen/krankenversicherung/krankenversicherung-leistungen-tarife/Arzneimittel.html

Aids and Applicances List
The Aids and Appliances List is available online in French, German
or Italian: https://www.bag.admin.ch/bag/de/home/versicherungen/krankenversicherung/krankenversicherung-leistungen-tarife/Mittel-und-Gegenstaendeliste.html

27

Further information

The Federal Health Insurance Act and the associated Ordinances areavailable online in French, German or Italian: https://www.bag.admin.
ch/bag/de/home/gesetze-und-bewilligungen/gesetzgebung/gesetzgebung-versicherungen/gesetzgebung-krankenversicherung/kvg.html.
The Act can also be ordered from the Federal Office for Buildings andLogistics (FOBL) at the following address (order no. 832.10.F, D or I):
FOBL, Publications, 3003 Bern. Website: www.bundespublikationen.
admin.ch

Guide

The compulsory health insurance system

Index/keywords
Abroad 4, 12
Accident cover 17, 18, 26
Accidents 10
Aids and appliances 10, 27
Antenatal classes 8
Appeal 19
Birth 5, 8, 9Bonus insurance 16, 18
Breastfeeding consultations 8
Chiropractor 9
Compulsory health insurance 5,
6, 7, 8, 9, 10, 11, 12, 15, 16
Contact lenses 9
Co-payment 13

Index / keywords

Deductible 7, 8, 13, 15, 17
Dental treatment 10
Doctor 8
Emergency treatment 6, 12
Essential treatment 11
EU/EFTA/UK 4, 11, 12, 13
Generics 7, 13, 27
GP model 15, 17
Health Insurance Act 27
HMO 15, 16, 17, 24
Hospital 6, 8, 9, 11, 12, 14, 15, 17
List of Pharmaceutical Specialties
6, 7, 27
Mammography 7, 8, 14
Maternity 8, 9, 14
Medicines 6, 7, 13, 14, 27

28

Newborn 9
Notice period 15, 16
Nursing home 5, 10, 11
Objection

19, 26

Physician 5, 6, 7, 8, 9, 10, 11, 13,
14, 15, 17
Physiotherapy 5, 9, 10
Postnatal check-up 8, 9
Premiums 5, 13, 15, 16, 17, 18	Overview of premiums 15,
17, 24, 27
Premium reductions 17
Premium subsidies 13, 20
Prevention 7, 8
Psychotherapy 5
Rescue 11
Retention fee

13

Spa treatment 10
Spitex 5, 10, 11
Supplementary insurance 6, 12,16Transport

11, 12

Vaccinations

7

Publication details
Publisher
Federal Office of Public Health FOPH
Division Insurance Supervision
Contact
Federal Office of Public Health FOPH
MailboxCH-3003 Berne
KV@bag.admin.ch
https://www.bag.admin.ch/bag/en/home/versicherungen/krankenversicherung.html
Publication dateFebruary 2024
Order address
FOBL, Publications, CH-3003 Bernewww.bundespublikationen.admin.ch
Order number: 316.950.e
Language versions
This publication is available in English, French, German and Italian.
Digital Version
All language versions of this publication are available as PDF at https://www.
bag.admin.ch/bag/en/home/versicherungen/krankenversicherung/krankenversicherung-das-wichtigste-in-kuerze.html.