Swiss mandatory health insurance: deductibles and the three-month rule

Every resident of Switzerland must hold basic health insurance under the Federal Health Insurance Act (KVG in German, LAMal in French). There is no public insurer: you buy the policy from a private health insurance fund, but the law fixes what it covers and how much you pay out of pocket. Your US plan or Medicare does not replace it. This guide explains the rules that the Federal Office of Public Health (FOPH) publishes, with the numbers you need to choose a plan.

Who must enroll and when

The FOPH guide to compulsory health insurance sets the requirement for people who come to live in Switzerland, including anyone with a Swiss residence permit valid for three months or longer. You must take out insurance within three months of taking up residence, and the same window applies after the birth of a child in Switzerland.

If you enroll within the three months, cover runs retroactively from the date you took up residence. If you wait longer, the FOPH guide is clear on the two penalties:

• you pay a surcharge on your premiums
• expenses already incurred before enrollment are not reimbursed

Every insurer that offers basic insurance must accept you regardless of age or health, and each family member is insured individually, including children.

What basic insurance covers

The FOPH states that compulsory health insurance provides benefits in the case of illness, accident and maternity. That includes examinations and treatment by doctors and in hospital, nursing, some non-medical services and medical prevention measures. According to the FOPH guide, it also covers services prescribed by a physician and delivered by other health professionals, such as physiotherapy, home nursing (Spitex), nutrition or diabetes advice, speech therapy and occupational therapy, plus examinations such as lab tests and X-rays ordered by a doctor.

Three rules shape the system:

• Identical benefits. All insurers must provide the same legally mandated benefits and treat all insured persons equally. They may not cover additional voluntary services within basic insurance.
• Effective, appropriate, cost-effective. Basic insurance covers only services that meet these criteria, assessed through the Health Technology Assessment programme.
• Doctors must tell you. A provider who delivers a service outside the mandatory benefits must inform you.

Because benefits are identical, you are choosing a price and a model, not a level of medical cover. Extra comfort, such as a private hospital room, comes from optional supplementary insurance, which follows different rules: insurers can refuse applicants or set conditions for it.

Accident cover: check your job

If you work at least 8 hours a week for the same employer, the FOPH guide says you are covered by that employer against work-related and non-work-related accidents under the Accident Insurance Act. In that case you can exclude accident cover from your health policy. If you have no compulsory accident insurance, you include accident cover with your health insurer, and the premium is slightly higher.

The deductible (franchise)

On top of premiums, you pay a fixed annual amount toward the cost of care, the deductible. The FOPH sets:

• Standard deductible: CHF 300 a year for adults, CHF 0 for children.
• Optional deductibles for adults: CHF 500, 1,000, 1,500, 2,000 or 2,500.
• Optional deductibles for children: CHF 100 to 600 in steps of 100.

A higher deductible lowers your premium, but the reduction is capped by law at 70 percent of the additional risk you take on. The FOPH publishes the maximum annual reductions for adults:

| Deductible (CHF) | Maximum annual premium reduction (CHF) | | --- | --- | | 500 | 140 | | 1,000 | 490 | | 1,500 | 840 | | 2,000 | 1,190 | | 2,500 | 1,540 |

Insurers do not have to offer every level, and they may set different deductibles for young adults aged 19 to 25. A change of deductible takes effect only at the start of a calendar year.

Co-payments after the deductible

Once the deductible is used up, you pay a retention fee of 10 percent of further costs, capped at CHF 700 a year for adults and CHF 350 for children and adolescents under 18. With the standard deductible, an adult's maximum annual cost share is therefore CHF 1,000.

The FOPH guide gives a worked example: if your treatment in a year costs CHF 2,000 and your deductible is CHF 300, you pay CHF 300 plus 10 percent of the remaining CHF 1,700, which is CHF 470 in total. The insurer reimburses CHF 1,530.

Two additions:

• Hospital stays cost CHF 15 per day, except for children, young adults up to 25 in education and maternity-related care.
• For medicines, the retention fee rises to 40 percent if a cheaper equivalent exists. Ask your doctor or pharmacist about generics.

Insurance models

The FOPH guide describes models that reduce premiums in exchange for limiting your choice:

• HMO model: you use a health maintenance organisation's doctors.
• GP model: you always see your family doctor first, who decides whether to refer you to a specialist or hospital.
• Telemedicine models: you call a medical hotline first.

In each case you give up the free choice of physicians and hospitals, except in an emergency. Since January 1, 2025, someone with an unrestricted policy can switch at any time to a restricted model with the same insurer.

Premiums

Premiums are paid per person and do not depend on income. They vary by insurer, by canton and by premium region within a canton, and insurers must charge a minimum of 50 percent of the standard premium for your age group and region. Reduced premiums apply to children up to 18 and young adults aged 19 to 25. People on low incomes are entitled to cantonal premium subsidies. The FOPH's official comparison site, priminfo.admin.ch, lists every approved premium for your place of residence.

Switching insurer

The FOPH guide sets these deadlines for basic insurance:

• Standard CHF 300 deductible, unrestricted model: cancel with three months' notice to the end of June or December. The insurer must receive your notice by March 31 or September 30.
• Higher deductible or restricted model: cancel only at the end of the year, with notice received by September 30.
• After a premium change notice: you may switch with one month's notice to the end of the month before the new premium applies. For a change on January 1, your insurer must receive notice by November 30.

The FOPH advises sending notice by registered mail around mid-March or mid-November. Never cancel supplementary insurance before another insurer has accepted you.

Common questions

How long do I have to buy health insurance after moving to Switzerland? Three months from taking up residence. Cover then applies retroactively. After that you pay a surcharge and costs already incurred are not reimbursed.

What is the cheapest deductible for an American who rarely sees a doctor? The FOPH does not rank them. A higher deductible lowers premiums by up to CHF 1,540 a year at CHF 2,500, but you pay more if you need care. Compare on priminfo.admin.ch.

Does my employer's accident insurance replace accident cover in my health plan? If you work at least 8 hours a week for one employer, you are covered for work and non-work accidents through the employer, so accident cover can be excluded from the health policy.

Can an insurer refuse me because of a pre-existing condition? Not for basic insurance; every insurer offering it must accept you. Supplementary insurance is different, and insurers can refuse or set conditions.