All insurers pay the same basic benefits
Your health insurance company will cover the costs of examinations and treatment if you are ill. It will also cover certain preventive measures to help you stay healthy. Vaccinations and check-ups are two examples here. Under the Federal Health Insurance Act (KVG) all health insurers must pay the same basic insurance benefits.
Your doctor must tell you before starting a course of treatment if basic insurance will not pay for it. If in doubt, it is worth asking your insurer. Comprehensive information on the benefits paid under basic insurance is available from the Federal Office of Public Health.
Restrictions under the family doctor model
If you have opted for the family doctor or another premium-saving model, you must follow the rules of that model when seeking medical care. With the family doctor model, for example, you must almost always go to your family doctor first.
If you want cover for additional benefits, you can take out supplementary insurance. These extra benefits may include complementary medicine such as osteopathy, or orthodontic treatment for children. Other supplementary insurance products afford you a greater level of comfort in hospital, or ensure that you have a free choice of doctor.
Deductible during pregnancy
If you are pregnant, you don't have to pay any share of the related healthcare costs that are specifically maternity-related. This means that you pay no deductible, no retention fee and no contribution to the costs of your stay in hospital. From the 13th week of pregnancy and up until eight weeks after the birth, you also pay nothing for general medical services as well as for healthcare services in the event of illness.
Benefits for the mother
The health insurance company pays for the birth, postnatal check-up, the costs of any complications, breastfeeding advice and some of the costs of antenatal classes, providing they are led by a midwife. It does not matter whether the baby is born in hospital, at a birthing centre or at home. If the hospital or birthing centre of your choice is not included in the list of authorised hospitals for your canton, you should ask your health insurer in advance if it will bear the costs.
Benefits for check-ups
Basic health insurance covers the following check-ups:
Two ultrasounds (more if the pregnancy is deemed high risk)
First-trimester screening to determine the risk of trisomies 21, 18 and 13, and
If the first-trimester test indicates a high risk, then non-invasive prenatal testing (NIFT) and if necessary amniocentesis and chorionic villus sampling.
Added to this are regular check-ups with your obstetrician/gynaecologist, which in some cases may be conducted by a midwife.
Benefits for the baby
The mother's health insurer covers all the costs of the baby's stay in hospital. If the newborn is ill and requires hospital treatment, it is covered by the child's health insurance. You must pay a share of these costs in the form of the retention fee
If you fall ill on holiday abroad, your health insurer will pay for your emergency treatment. The level of cover depends on the country you are in.
Health insurance abroad – EU
In the EU, Norway, Iceland and Liechtenstein you are entitled to the same benefits as local residents. It is important to remember that your health insurance card also serves as a European health insurance card. Always take it on holiday. Your health insurer can issue you with a temporary replacement certificate if you do not have your health insurance card with you.
Health insurance abroad – world-wide
Outside EU and EFTA countries, your health insurance company will pay for your emergency treatment only up to a certain amount. You may have to pay some of these costs out of your own pocket, especially if you are hospitalised. You can take out appropriate supplementary insurance if you would like higher cover. This may make sense before travelling to the USA or Canada, for example. Treatment is expensive in both countries.
Out-of-pocket expenses
There are medical services abroad that your Swiss health insurance company will not cover. This includes elective treatment and medication bought abroad, for example. There are also cases in which your Swiss doctor will actually send you abroad for treatment. You should then talk to your health insurer beforehand about whether it will pay. Insurance companies will often cover the costs if the treatment is not available in Switzerland.
In the event of a conflict with your health insurance company, you can contact the Health Insurance Ombudsman Service (website available in German, French and Italian). It will attempt to reach an agreement between you and your insurer. The service is free, impartial and independent. Please note that you cannot go to the Ombudsman Service if a lawyer or social service is representing your interests, or if you have legal expenses insurance.