Health insurance on arrival in Switzerland

How the compulsory LAMal system works

The Federal Health Insurance Act (LAMal) obliges every person residing in Switzerland to hold basic health insurance, regardless of nationality, age or state of health. Insurers cannot refuse an application for basic cover and cannot apply any medical exclusion, so your health history has no bearing on acceptance or on the premium you are quoted for this part of the cover.

Basic insurance covers medically necessary treatment: consultations with doctors, hospital stays in the general ward of your canton of residence, medicines on the official specialty list, laboratory tests, physiotherapy on prescription, home care, and maternity care without any deductible or co-payment. These benefits are the same whichever insurer you pick, so switching funds never changes what is covered.

• •Enrolment is compulsory for every resident, including children
• •Cover is identical across all insurers for basic insurance
• •Insurers must accept every applicant for basic cover
• •Maternity care is covered with no deductible or co-payment
• •Emergency treatment is also covered while travelling in Europe

Your enrolment deadline and how to choose a fund

You have three months from the date you take up residence in Switzerland to enrol with a basic insurer. Once you do, cover is applied retroactively to your first day of residence, so there is no gap even if the paperwork takes a few weeks to complete. There are more than fifty authorised insurers, and premiums for identical basic cover can differ substantially between them for the same canton and age group.

Because the benefits are fixed by law, the practical choices are the insurer, the deductible, the care model, and any supplementary cover you add alongside. Comparing offers means checking premiums for your canton and age bracket, the insurer's reputation for claims handling, and whether it also offers the supplementary products you may want later.

Deductibles and co-payments: what you pay yourself

The deductible (franchise) is the amount you pay out of pocket each calendar year before the insurer starts reimbursing. Adults choose a deductible from a fixed set of options; a lower deductible means a higher monthly premium, and a higher deductible lowers the premium in exchange for carrying more of the risk yourself. Children have a separate, lower range of deductible options.

Above the deductible, you also pay a co-payment of 10 percent of further costs, capped at a fixed annual ceiling per person. Once you reach the deductible plus the co-payment ceiling in a given year, the insurer covers the rest of your basic-insurance costs in full for the remainder of that year.

Standard cover or a managed-care model

Alongside the deductible, you choose a care model. The standard model lets you consult any authorised doctor or specialist directly. Managed-care alternatives ask you to go through a gatekeeper first, in exchange for a reduced premium: a family-doctor model routes you through a general practitioner who refers you onward when needed, an HMO model directs you to an affiliated medical centre, and a telemedicine model requires an initial phone or video consultation before you see a doctor in person.

The premium reduction for each managed-care model varies by insurer and canton, so it is worth comparing the same model across a few funds rather than assuming the discount is identical everywhere. The trade-off is always the same: less freedom to choose your first point of contact, in exchange for a lower monthly premium.

• •Standard model: free choice of any authorised doctor
• •Family-doctor model: your GP acts as first point of contact and refers you onward
• •HMO model: care is coordinated through an affiliated medical centre
• •Telemedicine model: a phone or video consultation comes before any in-person visit

What basic insurance does not cover, and when to add LCA supplementary cover

LAMal leaves several areas only partially covered or excluded entirely: routine dental care, most glasses and contact lenses, many forms of complementary medicine, a private or semi-private hospital room, free choice of hospital outside your canton, and non-emergency care abroad. These gaps are filled, if at all, by optional supplementary insurance (LCA), which is a separate contract governed by ordinary insurance law rather than LAMal.

The key difference is that LCA insurers can refuse an application or apply exclusions and premium loadings based on a health questionnaire, unlike basic insurance where acceptance is guaranteed. This makes timing important: applying for supplementary cover soon after arrival, while your health situation is straightforward to declare, is generally easier than applying later once a condition has developed.

• •Outpatient extras: complementary medicine, glasses and lenses, some travel cover
• •Hospital supplements: private or semi-private room, free choice of hospital
• •Dental insurance: routine and orthodontic care, largely excluded from LAMal
• •Daily-allowance insurance: income replacement during longer illness

The annual cycle: reviewing and switching your fund

LAMal premiums are reviewed every year and take effect on 1 January. The Federal Office of Public Health (BAG/OFSP) publishes the new premiums for the following year in the autumn, and the official comparison tool at priminfo.admin.ch lets you check every authorised insurer's rates for your canton, age group and chosen deductible.

If you want to change insurer, you must give notice to your current fund by 30 November for the change to take effect on 1 January. Your current insurer cannot refuse the cancellation or make it conditional on outstanding invoices, and switching funds never affects your basic benefits, since these are identical everywhere. Checking the comparison each autumn is worthwhile, since the ranking of insurers by premium can change from one year to the next.

Premium subsidies for lower incomes

Cantons can grant an individual premium reduction (subsidy) to residents whose income falls below a threshold set by that canton. The eligibility thresholds, the amount of the reduction and the application process all vary by canton and by household composition, so there is no single Switzerland-wide figure to compare against.

Applications are made to the cantonal office responsible for premium reductions in your canton of residence, generally on the basis of your tax return. Because the rules differ from one canton to another, and because a move between cantons can change your eligibility, it is worth checking your specific situation with the cantonal authority rather than relying on figures for a different canton.