Health insurance

Social health insurance gives everyone living in Switzerland access to adequate health care in the event of sickness, and accident if they are not covered by accident insurance.
Social health insurance is operated by a number of insurers. Only those which meet the conditions set out in Swiss legislation, and which are not profit-making, are authorized to handle social health insurance. They must apply the legal provisions in an identical manner and separate from other insurance (for example, complementary insurance according to by private insurance law). If an insurer becomes insolvent, the cost of its statutory benefits are taken over by a joint body funded by contributions made by the insurers on the basis of their social health insurance premiums.

The role of the insurers is not restricted to reimbursing the cost of services provided to insured persons. They also work together with the cantons to encourage health promotion. Insurers and cantons operate a joint body whose aim is to promote, co-ordinate and evaluate steps aimed at promoting good health and preventing illness.

 

Requirement to take out insurance

All persons domiciled in Switzerland must take out health insurance. Every family member is insured individually, regardless of age. Anyone arriving in Switzerland with the intention of staying must take out such insurance within three months. Parents are allowed the same period in which to insure their newborn children. The insured may choose any health insurer he wants, and the insurer must accept him irrespective of his age and state of health, and without any reservations or qualifying period.

 

Persons residing in Switzerland

Health insurance is compulsory for all residents in Switzerland, irrespective of their nationality. All the members of the family, both adults and children, require insurance. After taking up residence (or after the birth of a child) in Switzerland, a person has to take out insurance within three months. The health insurance fund can be freely chosen.
All persons who have a Swiss residence permit valid for three months or longer need health insurance. It’s also required for persons who are working in Switzerland for less than three months and do not have equivalent insurance cover from another country which is valid in Switzerland. Insurance is also required if a person is a Swiss national or a national of an EU/EFTA country, is working in Switzerland and is resident in a member state of the EU, in Iceland or in Norway. This also applies to any members of the family who are not employed. Furthermore, health insurance is required if a person is a Swiss national or a national of an EU/EFTA country whose only source of income is a Swiss pension and is resident in a member state of the EU, in Iceland or in Norway. This also applies to any members of the family who are not employed. If a person is receiving unemployment benefit and goes to an EU/EFTA country for three months to look for work, health insurance is also required.

Essentially, insurance coverage ceases when a person dies, or leaves Switzerland. Exceptions are made for certain groups (pensioners, unemployed, cross-border commuters, etc.) on the basis of bilateral agreements with the EU and the agreement with EFTA countries.

There are several exceptions from the exemption of the obligation to obtain insurance in Switzerland. Requests in that matter will be assessed by the competent cantonal authorities. For further information, or to obtain the necessary forms, please contact directly the competent local authority.

 

Benefits

The compulsory basic health insurance scheme covers illness, accidents and maternity, although for accidents it intervenes only when the insured person has no other compulsory or optional coverage. It also covers certain preventive measures. The principal points are explained below.
All insurers who offer compulsory health insurance must provide the same benefits, which are defined by law. They may not cover other "optional" benefits under the compulsory health insurance scheme.

The law establishes that compulsory health insurance covers only benefits that are effective, appropriate and efficient.

When a service provider (physician, physiotherapist, etc.) provides or prescribes a benefit, treatment, etc. that is not covered by compulsory health insurance, he must inform the patient of this fact.

 

Quality

The program of the Federal Office of Public Health in Berne was started shortly after the publication of the report "To err is human" (Institute of Medicine, 2005).
The Swiss federal government launched a public awareness program and organized a first conference at the University Hospital of Berne (Inselspital). A taskforce has been mandated to work out a proposal for a national program on patient safety improvement (Towards a Safe Healthcare System). Their results were presented at a second conference in April 2001. In late 2003 the Swiss PatientSafetyAgency was founded with a kick-off financing through the federal government.

“On March 13, 2005 the federal government announced to mandate hospitals to introduce clinical risk management (i.e. local critical incident systems, case analysis). Further the patient safety culture will regularly be evaluated through a hospital staff survey and a patient survey. Additionally the federal office of public health has launched the breakthrough program “CleanCare”, an improvement program to reduce infections in Swiss hospitals.”