Compulsory Coverage and Costs
Swiss are required to purchase basic health insurance, which covers a range of treatments detailed in the Federal Act. It is therefore the same throughout the country and avoids double standards in healthcare. Insurers are required to offer this basic insurance to everyone, regardless of age or medical condition. They are not allowed to make a profit off this basic insurance, but can on supplemental plans.
Regulations also restrict the allowable policies and profits that a private insurer may offer, as noted by healthcare economics scholar Uwe Reinhardt in a review in the Journal of the American Medical Association:
"To compete in the market for compulsory health insurance, a Swiss health insurer must be registered with the Swiss Federal Office of Public Health, which regulates health insurance under the 1994 statute. The insurers were not allowed to earn profits from the mandated benefit package, although they have always been able to profit from the sale of actuarially priced supplementary benefits (mainly superior amenities).
Regulations require "a 25-year-old and an 80-year-old individual pay a given insurer the same premium for the same type of policy.... Overall, then, the Swiss health system is a variant of the highly government-regulated social insurance systems of Europe... that rely onostensibly private, nonprofit health insurers that also are subject to uniform fee schedules and myriad government regulations."
The insured person pays the insurance premium for the basic plan up to 8% of their personal income. If a premium is higher than this, the government gives the insured person a cash subsidy to pay for any additional premium.
The universal compulsory coverage provides for treatment in case of illness or accident (unless another accident insurance provides the cover) and pregnancy.
Health insurance covers the costs of medical treatment and hospitalization of the insured. However, the insured person pays part of the cost of treatment. This is done by these ways:
- by means of an annual excess (or deductible, called the franchise), which ranges from CHF 300 to a maximum of CHF 2,500 as chosen by the insured person (premiums are adjusted accordingly);
- and by a charge of 10% of the costs over and above the excess. This is known as the retention, and is up to a maximum of 700CHF per year (excluding medication).
In case of pregnancy, there is no charge. For hospitalisation, one pays a contribution to room and service costs.
Insurance premiums vary from insurance company to company (Ger. Krankenkassen, Fr. caisses-maladie, It. casse malati), the excess level chosen (franchise), the place of residence of the insured person and the degree of supplementary benefit coverage chosen (dental care, private ward hospitalisation, etc.).
In 2010, the average monthly compulsory basic health insurance premiums (with accident insurance) in Switzerland are the following:
- CHF 351.05 for an adult (age 26+)
- CHF 293.85 for a young adult (age 19–25)
- CHF 84.03 for a child (age 0–18)
Read more about this topic: Healthcare In Switzerland
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