It might be easy to assume that all European countries fund and deliver their healthcare services in a similar way, but Switzerland’s health insurance system is a good reminder that expats need to fully plan all areas of their relocation if they want to avoid unexpected bills.Switzerland is a modern, economically successful country whose residents enjoy high standards of living. It spends 11.5 percent of its GDP on healthcare services, which is well above the European and OECD average. Life expectancy in Switzerland is 83.4 years, second highest in the world, behind only Japan.
The government has implemented a health insurance system which aims to provide high-quality healthcare within controlled costs, while also offering a safety net to those who cannot afford it.
The federal law which governs this system is called LAMal. It requires you to purchase an annual health insurance plan for you and every member of your family. It also regulates the insurance providers; checks ensure the insurers are in respectable financial health and that no one is turned away for cover because of health issues.
Despite the government’s efforts to control health costs, in recent years the increases have been well above inflation. This has forced the costs of health insurance policies to rise.
Although most residents in Switzerland pay their health insurance premiums without state help, the costs of delivering care means that each regional government also pays for services out of general taxation. This can be 10-15 percent or more of their total budget.
Compulsory Cover Plans
A standard policy for compulsory cover will offer insurance for both illnesses and accidents.
Some employees receive accident cover through their employers, in which case they can opt out of the accidental cover elements of the health insurance plan. This will reduce the amount they pay for insurance premiums.
However, a compulsory cover plan must be purchased each year, by law. Insurance companies cannot reject you based on your age or your health.
If you need to access local, basic healthcare or need to stay in hospital, your policy will pay for 90 percent of the costs. However, there will be many healthcare services you will not have access to, since compulsory healthcare plans are focused on emergency and mainstream medical help.
Some insurance providers will pay the medical costs directly and bill you for the remaining 10 percent. Others expect you to pay 100 percent of the costs when you receive healthcare and will then refund you the 90 percent.
If you are obtaining medicines from the pharmacy, you must again pay 10 percent of the cost. However, if a generic brand is available and you will only accept the more expensive branded product, then you will be obliged to pay 20 percent of the cost.
Pregnant women are not charged for care related specifically to their pregnancy. Once they reach the 13th week of the pregnancy, they will be exempt from the 10 percent charge until they have given birth.
Your health insurance provider will send a European Health Insurance Card (EHIC), which will mean you can access emergency care in any country inside the EU and EEA. However, if you stay in hospital, insurance cover will only provide up to 90 percent of what the care would have cost in your local Swiss hospital. Contact your insurance provider before travelling to check what you are covered for and where.
Complementary/Supplementary Health Insurance Cover
For those who want additional cover and can afford the increase in healthcare insurance premiums, complementary or supplementary policies are a popular choice. These are bought in addition to the compulsory cover plan, not as a replacement.
Some of the services that can be accessed using a complementary insurance plan include:
• Prenatal care
• A wider range of hospital treatments
• Alternative medicines
• Mountain rescue
• Travel insurance
• Loss of earnings
As with compulsory cover plans, your insurance provider may require you to pay the full bill and then reclaim your insured element or may just bill you for the outstanding 10 percent. Check the terms of your policy carefully before you buy.
Insurance providers are allowed to ask for your health history and base their premiums on it. They may also reject your application for coverage.
Finding A Healthcare Provider
There is a register of health insurance providers who have been officially approved to provide compulsory cover plans in Switzerland. You can find this on the website for the federal public health office. You can also use websites such as Priminfo to compare the various insurance provider plans.
If you have lived in Switzerland for more than three months and have not purchased a compulsory cover plan, your regional government (canton) will arrange one. They will choose the provider, and the bill will be sent to you. You will not be able to dispute the choice of provider or the price charged. The policy is backdated so you are charged for cover from your first day living in Switzerland.
There are very few exceptions; being able to prove you have a better existing healthcare insurance plan purchased from an overseas insurer is one. However, for all exceptions, it is the individual’s responsibility to prove their case officially. If this is not done, the individual must purchase the compulsory cover plan through a listed provider.
Each year, your insurer will send out the new year’s insurance premium by 31st October. You have until 30th November to tell them if you are moving your business elsewhere. If you don’t cancel, the policy will be renewed.
The amount you pay for health insurance and the healthcare covered by your policy will depend on where in Switzerland you live. Some cantons, or regional government areas, receive more generous funding to run their healthcare services. Other areas may have lower premiums as the average level of health is better than elsewhere.
Reducing The Cost
Investigate the range of providers and assess what you really need from your policy. There is no point taking out the most expensive options if they offer services you never envisage needing.
Secondly, find out how a higher excess, or deductible, affects the premium. The excess is the initial amount you will pay for any healthcare bill; anything over that is due for the 90 percent insurance cover. By taking on a higher excess, you are likely to have a lower health insurance policy. However, if you need medical attention regularly, it makes more sense to pay the extra for the insurance cover.
Insurance policy providers will allow you to pay annually or in monthly installments. However, they often give a discount if you pay the full amount at the time you arrange the policy. Should you find this a difficult cost to cover in one go, you could try setting up a savings account for small monthly deposits, so the balance is ready when you need to pay the next year’s premium.
If you’ve got a health insurance product that works for you and meets official approval in Switzerland, you can continue using it without worry. If you don’t, the Swiss system means you will find cover easily.
You might find the insurance premiums a bump in expenditure, especially if you are providing for your family too, but these are upfront costs you can investigate. In many ways, it is clearer than the national insurance wage deduction systems present in most other European countries.
Finally, the health service of Switzerland is the envy of the world, enjoying a reputation for keeping its citizens alive and healthier for longer than almost every other country on the globe.
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