Introduction
One of the biggest differences when moving to Switzerland is that healthcare does not work as "automatic social security". Basic medical coverage is contracted with a private insurer, but is regulated by law: the LAMal (KVG in German). Simply put: is mandatory, private and standardized in coverage.
How the system works
1) Basic insurance (LAMal) vs complementary insurance (LCA)
The basic insurance covers the essentials and its coverage is identical by law in all insurers. Complementary insurance (LCA/VVG) covers extras (for example, dental, semi-private/private room, glasses, etc.), but is not mandatory: they may ask for a medical questionnaire, impose exclusions or reject.
2) What you pay: premium, deductible and co-payment
In Switzerland, being insured does not mean "all inclusive". The cost is made up of:
- Monthly premium: fixed payment (varies by canton/municipality, age and model chosen).
- Deductible: annual amount you pay before the insurance begins to reimburse.
- Copayment (quote-part): after the deductible, you pay a percentage (with an annual limit).
- Hospital contribution: in case of hospitalization, a daily amount is usually applied (adults).
To understand well and choose strategy (franchise 300 vs 2500, etc.), read: Franchise and copayment.
3) Models (free choice, GP, telemedicine, HMO)
A decision that changes your premium a lot is the model. In some models you must first call telemedicine or go to your family doctor before a specialist. If you don't follow the model rules, you may lose refunds. For many newcomers, the cheap model works well… if you are disciplined.
4) Choose and change insurer (when to do it)
In LAMal, basic insurance is renewed and can be changed with calendar rules. The usual thing is to compare premiums in the fall for the following year and process the change within the deadlines. The exact dates and conditions depend on the product and year, so always follow the official instructions and conditions of your insurer.
5) Billing: why you sometimes "pay first"
It is very common for you to receive bills from the doctor or hospital. Depending on the billing system, you may have to pay yourself and then seek reimbursement, or you may bill insurance directly. In any case, if you have not reached your deductible, the cost comes out of your pocket. That's why the system feels "expensive" even paying monthly premiums.
Requirements and rules
1) Who should insure
In general, everyone residing in Switzerland must be insured. There are exceptions and specific rules (for example, some cases of borderers or students). If your case is "special", confirm in writing with your canton what applies.
2) Accidents: the most expensive mistake
If you work, you may have accident insurance paid by the employer (sometimes also for non-work accidents, depending on your day). In that case, you can usually exclude accident coverage from basic insurance and lower the premium. If you leave your job, you must reactivate accidents in your LAMal so as not to be discovered. Many people forget just at the worst moment.
3) Reduction of premiums (subsidy) and aid
There is a premium reduction system for individuals and families with modest incomes, managed at the cantonal level (the rules, thresholds and process vary by canton). If you are tight on budget, this point is key: many people do not ask for it due to lack of knowledge.
3) What does basic insurance cover
The basic covers necessary medical care according to regulations. In practical terms, it usually includes:
- General medicine and specialist consultations (according to model/referral).
- Prescribed medications included in official lists.
- Hospitalization in general ward (normally in your canton, except in emergencies or specific rules).
- Maternity with particular conditions.
4) What it does not cover (or covers to a limited extent)
- Dental: Most routine dental treatments are paid separately or complementary.
- Glasses/contact lenses: often with limits or outside the basic.
- Private/semi-private room in hospital: normally complementary.
Concrete examples
Example 1 — Healthy person who wants to pay less per month
If you usually go to the doctor infrequently, it is common to choose a high deductible to reduce the monthly premium. The "risk" is that, if you have an emergency or expensive treatment that year, you will pay more at the beginning.
Example 2 — Family with small children
With children, medical visits are more frequent. Many families prefer lower deductibles for predictability. It is also advisable to choose a model that adapts to pediatrics and emergencies.
Example 3 — You arrive and do not hire on time
If you let the 3 months pass, you do not "save" premiums: they usually bill you retroactively from day 1 and even assign you a box. Plan this procedure within first month.
Example 4 — Calculation of "annual worst case" (to decide franchise)
A practical way to choose a franchise is to calculate your "worst case." For example: if you pay CHF 350/month premium (CHF 4,200/year) and choose CHF 2,500 deductible, your worst year may look like: annual premium + deductible + maximum co-payment. This gives you a ceiling figure for your budget. Then you compare with the 300 deductible scenario (higher premium, lower deductible) and decide what gives you more peace of mind.
Common errors
- Choose only by price: without understanding the model, you may end up paying unreimbursed invoices.
- Confuse basic and complementary: dental and private room are not "included" by default.
- Wrong choice of franchise: Paying a low premium is not worth it if you have predictable medical expenses every year.
- Do not adjust accidents when changing jobs: you duplicate coverage or you are left without the correct one.
Practical Tips
- Compare on the official portal Priminfo (premiums by canton/municipality and models).
- Calculate your "annual worst case": premium + deductible + co-payment, to decide wisely.
- If you are going to hire complementary services (dental, etc.), it is usually easier to do it when you are healthy and before diagnoses.
- If your budget is tight, check the issue of premium reduction of your canton (subsidy).
- Connect this guide with deductible/copayment and cost of living.