Health insurance in Switzerland

from Wikipedia, the free encyclopedia

In Switzerland , health and accident insurance has been mandatory for everyone since 1996. There are defined benefits that are covered in this so-called basic insurance. Insurance companies that offer basic insurance must insure every person staying in Switzerland; there is an obligation to contract . In the past there was also an obligation to contract with service providers. This is regulated in the Health Insurance Act (KVG). Additional private insurance is also possible. Such contractual relationships are subject to the Insurance Contract Act (VVG).

The health insurance covers clarifications, treatments and drug costs in the event of illness, accident, childbirth and abortion. On the other hand, she is only responsible for dental treatments in special exceptional cases. In general, insured persons first pay for the services they have used themselves and then contact the health insurance company for reimbursement. Hospitals often arrange direct processing with the health insurance company.

Insured persons

All people who are in Switzerland must have health insurance. In special cases, a foreign insurance is accepted; all other persons are subject to compulsory health insurance (basic insurance). There is no co-insurance of family members; each person must be insured individually. Health insurance companies offer different benefit models depending on the age and situation of the insured. Policyholders are free to choose from the more than 90 approved health insurers (as of 2016), provided the insurance they want is active in their canton. In the basic insurance, the fund can be changed every year on December 31st. Notice of termination must be given by November 30th. In the voluntary supplementary insurance, the notice period is based on the contractual provisions. For people with a decent deductible, there is also the option of changing basic insurance on June 30th. In contrast to Germany, the employer does not contribute to health insurance for employees. Insured persons in modest economic circumstances receive a premium reduction from their canton of residence . The procedures that regulate the entitlement to purchase and the calculation of the premium reduction vary from canton to canton.

Contribution amount

The premiums for basic insurance can be freely set by the health insurance company, taking into account several legal restrictions. In principle, an income-independent unit premium (head premium) applies within the premium regions and age groups defined by the Federal Office of Public Health . Small cantons consist of one premium region, large cantons have up to three premium regions. There are currently 43 premium regions. The age groups are divided into children (up to 18 years), young adults (19 to 25 years of age) and adults (from 25 years of age). The premiums must be approved by the responsible Federal Office of Public Health. Various insurance models are offered with which the insured can reduce their contributions, for example HMO , family doctor and bonus models.

For 2015, it was decided that the nine cantons ZH, ZG, FR, AI, GR, TG, TI, VD and GE will receive an amount of around 800 million francs back by 2017, as the residents of these cantons compared to other parts of the world have paid too much to Switzerland. "The allocation to the cantons is based on the amount by which their premiums were too high in the past."

The premium also includes a fee of CHF 4.80 per year, which is paid out to Health Promotion Switzerland. However, a large part of the money goes into the administrative costs of the foundation, in 2016 even more than half. At that time, 10.32 million was spent on administrative costs and only 9.67 million on projects. The foundation justified the high expenditure with future “additional tasks and the resulting activities that had to be prepared in recent years”. In 2017, the situation improved somewhat in favor of the financed projects. The administrative costs fell slightly to 10.14 million to 13.55 million which were spent on projects.

Deductible

For all health insurance in Switzerland applies the basic insurance deductible , which is composed of a franchise and a deductible :

  • The deductible is an annual fixed amount below which all costs are to be borne by the insured person. For adults over the age of 18, the lower limit is legally stipulated by the ordinary deductible of CHF 300 per year; no deductible is required for children and young people. In any case, the policyholder can choose a higher franchise, which reduces the monthly insurance premium accordingly. The possible higher franchise values ​​are stipulated by law at CHF 500, 1000, 1500, 2000 and 2500 for adults and CHF 100, 200, 300, 400, 500 and 600 for children and young people.
  • The deductible is a proportionate share of the costs incurred after deducting the deductible amounting to 10 percent of the invoice amount, but up to a maximum of 700 francs per year (children and young people up to 18 years: 350 francs). Since 2006 , an increased deductible of 20 percent has applied to original pharmaceutical preparations for which generics would also be available.
Adults Children and young people
Selected franchise, each minimum / maximum value [CHF] 300 2500 0 600
Deductible 10%, but a maximum of [CHF] 700 350
therefore maximum deductible [CHF] 1000 3200 350 950
maximum deductible is achieved for medical expenses from [CHF] 7300 9500 3850 4100

In the case of inpatient treatment , single persons who do not live in the same household with one or more people with whom they have a family law relationship must pay a daily fee of CHF 15 for an unlimited period of time.

The benefits in the event of maternity from the 13th week of pregnancy to eight weeks after the birth as well as specially designated preventive measures are excluded from any deductible .

See also

literature

  • Daniel Biedermann (Ed.): Health Insurance and Health Care - What Next? Huber, Bern 1999, ISBN 3-456-83203-6 .
  • Verena Nold: health insurer . In: Willy Oggier (Ed.): Healthcare Switzerland 2015–2017 - A current overview . 5th edition. Hogrefe Verlag, Bern 2015, ISBN 978-3-456-85441-0 (e-book ISBN 978-3-456-95441-7 (PDF)) pp. 205-216.
  • Peter Indra, Reto Januth, Stephan Cueni: Health insurance . In: Willy Oggier (Ed.): Healthcare Switzerland 2015–2017 - A current overview . 5th edition. Hogrefe Verlag, Bern 2015, ISBN 978-3-456-85441-0 (e-book ISBN 978-3-456-95441-7 (PDF)) pp. 217–241.

Web links

Individual evidence

  1. ^ Bernard Degen: Health Insurance. In: Historical Lexicon of Switzerland . October 20, 2008 , accessed June 12, 2019 .
  2. ↑ Models of Swiss health insurance companies. Retrieved July 29, 2020 .
  3. ↑ news.admin.ch
  4. ↑ Gian Signorell: The administration is funded above all . In: Observer . No. 3 , February 1, 2019, p. 7 .
  5. ↑ Insurance premium, deductible and deductible