By now, you know what your medical needs are and what type of insurance model works best for you. Also, you’re ready to discover the fine print and select the best type of insurance for you, not necessarily the cheapest.
First, a primer on the basics of health insurance in Switzerland:
What does your health insurance cover?
By law, the basic compulsory coverage pays for most medical costs resulting from an illness. Depending on your health situation or individual needs, additional options may be required.
What does 'additional coverage' mean?
Additional coverage needs to be taken out for more specific treatment or access to a wider range of private healthcare services, such as alternative medicine, non-mandatory medications, visual aids, preventive care, dental treatment and accident insurance (coverage of treatment costs resulting from an accident).
Usually, accident insurance is covered by one‘s employer. If you are not employed or are self-employed, you will have to take out accident insurance in the form of supplementary health insurance.
Supplementary health insurance: what to pay attention to
When looking for a new provider, the offer for supplementary insurance is quite important. For various reasons, it is worth it to take out basic and supplementary insurance with the same provider. Unlike basic insurance, the supplementary ones differ in what they cover - sometimes quite considerably.
You should also know that health insurers can reject customers for supplementary insurance (unlike for basic insurance). Therefore, make sure you are enrolled in your new supplementary insurance before canceling your current one. Otherwise, you may end up unable to take out supplementary insurance with any provider.
When can I change my health insurer and what do I need to pay attention to?
If you want to change your basic health insurance you can only do so by 30 November of the following year, which means that your insurer should receive your termination letter by this date.
We recommend you also have a new insurer in mind by the same date. If you’re in the market for a new provider, you should know that the coverage for basic health insurance is the same for all providers. What differentiates between the various providers is actually their customer service and supplementary insurance offering.
We've listed below the most significant points of difference between health insurance providers and these are all questions you should ask before selecting your new insurer:
Customer service - before choosing a new insurer, look for info on how good is their customer service. How responsive are they? Is service available in English?
Online tools - check if your insurer has a good online platform for claims, invoices, etc.
Responsiveness: how fast does your insurer respond to queries? How fast do they reimburse your invoices and claims?
Is all prescribed medication covered up to 90% of the costs, or are there restrictions?
Is prescribed treatment at a spa or wellness/ fitness center included in coverage? Some insurers cover such treatments, as well as visits to a therapist.
What is covered when travelling abroad?
Are emergency ambulance costs covered?
Please note that, in Switzerland, unlike in other countries, calling an ambulance comes at a huge cost, which is why you’ll hear urban myths about Swiss people who would rather walk and bleed to the hospital rather than call an ambulance. The truth is that an ambulance ride (and the emergency treatment applied) can cost up to CHF 1000, but depending on your medical problem and your insurance type this cost should be covered by your insurer.
What costs are included for spectacles and contact lenses? If you’re wearing glasses, you’ll be happy to find out some insurers offer a yearly bonus for your new pair of glasses or contact lenses (medically prescribed, not sunglasses, of course).
Which costs are covered for dental care? This is particularly important if you have children, as orthodontics can be extremely expensive for kids.
Are extra charges likely to be incurred? If so, what are they?
What specific treatments does your policy exclude?
Look for customer satisfaction surveys, as these contain valuable information about the quality of most Swiss insurers.
When you choose a new insurer, make sure you know the answers to all the questions above. Most of them will be listed on your contract, but if that’s not the case, ask away! This is not the time to be shy or assume that things will sort themselves out. The same goes for any clauses that seem ambiguous or unclear – don’t sign your name until you’re sure you understand the entirety of your health insurance contract.
Before switching insurers, you should also think about which insurance model is best for you.
How do I choose the right health insurance type for me?
There are different types of insurance models and the differences between them are significant. The type you choose will determine whether you are free to choose your doctor at any point or limit your choice of medical provider to a pool of doctors determined by the insurance company.
If you are choosing, for instance a GP Model, you can save money on the premium side, but must respect the rules combined with the model.
Below we introduce the main insurance models available. In addition to these four, some companies offer a Pharmacy model (where, for any medical queries, you have to first contact one the insurer's partner pharmacies) or a Hospital/ doctor list model (where you can choose a doctor or a hospital from the insurer's Directory).
These are the main available models for basic health insurance:
1. The GP insurance model (GP as in General Practitioner)
This is where you choose your GP from a list of doctors provided by your insurer.
You will work with someone who knows your medical history. Your doctor can refer you to the right specialist. Perhaps the most significant argument in favor of this model is the fact that it comes with lower premiums.
You will have to visit the GP first, irrespective of the condition you suffer from. More importantly, it will have to be the same GP every time and, if they’re busy, you have no other option than to wait. If the GP cannot help you and refers you to a specialist, you still have to pay for the consultation.
2. The 'Free choice of doctor' model
This is where you choose your doctor from your insurer’s directory.
You are free to choose any doctor who is KVG-approved.
This independence comes at a cost, as this is normally the most expensive among the various insurance models.
3. The Telmed model
For any medical needs, you will first call your insurer and decide together the best course of action for you.
You get instant medical advice from a health-care professional who might be able to solve your health issues themselves or refer you to a doctor. The telemedical adviser will help you find the right therapy and specialist for you. This is another option that comes with lower premiums, but it’s important to consider if the Telmed model is ideal for you before signing on.
You have to call your insurance company’s medical service provider before you see a doctor.
4. The HMO model
With this model, you must contact a medical center approved by your insurer in case you need medical attention.
You have access to a group of certified doctors from various fields. They can refer you to other specialists if need be. Normally, this model comes with the highest premium discount.
It is possible that you will not be treated by the same doctor every time, so you will have to retell your medical history every time you visit the medical center.
Do you have more questions about Swiss health insurance for expats or need to know more about the processes of changing your insurer?
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