Guide to Health Insurance in Switzerland

As a general rule, everyone residing in Switzerland must take out compulsory health insurance.

Anyone moving to Switzerland has three months from the date on which they become resident to take out insurance. The same period applies to parents registering a newborn child. Where registration takes place within this period, cover applies retroactively from the date of birth or the date on which residence began.

Every member of a family is insured individually. There is therefore no single family policy: adults and children each have their own insurance policy and each pay a separate premium.

Some categories of people may be subject to special rules or may apply for an exemption, including:

• certain foreign students temporarily residing in Switzerland
• certain cross-border workers
• certain people employed in a country of the European Union, the European Free Trade Association or the United Kingdom
• certain international civil servants or members of diplomatic missions
• certain people temporarily posted abroad

These situations must be assessed individually by the competent authority in the canton of residence.

Basic insurance

Basic insurance is governed by the Swiss Federal Health Insurance Act, known as the LAMal.

Its main characteristics are as follows:

• it is compulsory
• the insured benefits are defined by law
• insurers must accept anyone who is subject to compulsory insurance
• health, sex and medical history do not determine admission
• individuals may freely choose an insurer operating in their region
• the insurer may not exclude a pre-existing condition from compulsory cover

For an identical insurance model and deductible, the statutory benefits provided by basic insurance are the same with every insurer. A higher premium therefore does not mean that an insurer covers more compulsory medical benefits than another. Compulsory insurance provides access to a range of benefits defined uniformly by law.

Differences between insurers mainly concern:

• the premium
• the insurance models offered
• administrative organisation
• reimbursement procedures
• digital tools
• the quality of customer service and claims handling

Supplementary insurance

Supplementary insurance is optional and is mainly governed by the Swiss Federal Insurance Contract Act, known as the LCA.

Unlike basic insurance, a supplementary insurer may:

• ask questions about an applicant’s health
• request medical information
• accept the application without restrictions
• apply exclusions or reservations
• propose different terms
• refuse admission

Benefits are not standardised. Two products with similar names may offer very different cover, limits, exclusions and conditions.

The Swiss Financial Market Supervisory Authority, FINMA, supervises insurers operating in the supplementary health insurance market, particularly in relation to solvency, product information and the justification of premiums.

Existing supplementary insurance should therefore never be cancelled before written and final acceptance has been received from the new insurer.

Basic insurance covers benefits recognised by law where they meet the criteria of effectiveness, appropriateness and cost-effectiveness.

Subject to the applicable legal conditions, it notably covers:

• medical consultations and treatments
• treatment prescribed by a doctor
• certain medicines included on the official lists
• approved laboratory tests
• physiotherapy, occupational therapy and other prescribed treatments
• psychotherapy provided under the conditions set out in the regulations
• certain forms of home care
• certain medical aids and devices
• hospital treatment in the general ward
• maternity-related benefits
• certain preventive measures
• certain complementary medicine services provided by qualified doctors

Healthcare providers authorised to charge compulsory health insurance include doctors, pharmacists, chiropractors, midwives, physiotherapists, occupational therapists, psychological psychotherapists, nurses and several other recognised categories.

Complementary medicine

Compulsory insurance may cover certain services involving acupuncture, anthroposophic medicine, traditional Chinese medicine pharmacotherapy, classical homeopathy and herbal medicine.

However, these services must be provided by a doctor with the required medical qualifications and additional training.

Treatment provided by non-medical therapists is generally not covered by basic insurance. It may potentially be covered by supplementary insurance.

Preventive care

Basic insurance does not automatically cover every check-up, screening test or preventive examination requested by an insured person.

It covers examinations and preventive measures expressly provided for by the regulations, particularly where they are recommended for certain groups or prescribed under the required conditions.

Since 1 January 2026, vaccinations covered by compulsory insurance have been exempt from the deductible. The co-payment nevertheless remains applicable.

Basic insurance provides extensive medical cover, but it does not reimburse every type of expense.

It generally does not cover, or covers only to a limited extent:

• routine dental treatment
• standard dental check-ups
• ordinary orthodontic treatment
• spectacles and contact lenses for adults, except in particular medical circumstances
• alternative medicine treatment provided by non-medical therapists
• private or semi-private hospital rooms
• complete freedom to choose the hospital doctor
• certain medicines not included on the official lists
• treatment deliberately planned abroad
• the full cost of ambulance transport and rescue services
• comfort-related services
• care or treatment that does not meet the legal conditions for reimbursement

Dental care is covered by compulsory insurance only in specific situations provided for by law, for example where treatment is necessary because of a defined serious illness or its treatment.

Under compulsory insurance, the premium does not depend on income or health.

It varies mainly according to:

• the canton and premium region in which the person lives
• age category
• insurer
• insurance model
• chosen deductible
• whether accident cover is included

The age categories are generally:

• children up to the age of 18
• young adults aged 19 to 25
• adults aged 26 and over

Within the same premium region, compulsory insurance may not charge different premiums according to sex.

For 2026, the average monthly premium in Switzerland is CHF 393.30, representing an average increase of 4.4% compared with 2025. This national average does not necessarily reflect the premium paid by a particular person, as there may be significant differences between cantons, regions, deductibles and insurance models.

The official Priminfo calculator allows users to compare premiums approved by the Federal Office of Public Health for each municipality, deductible and model.

The deductible is the annual amount that the insured person must pay before basic insurance begins contributing towards medical expenses.

The deductible applies per calendar year. It therefore starts again on 1 January, even where the insured person reached the deductible shortly before the end of the previous year.

Deductibles for adults

The standard deductible is CHF 300.

The optional deductibles are:

• CHF 500
• CHF 1,000
• CHF 1,500
• CHF 2,000

CHF 2,500.

Deductibles for children

The standard deductible is CHF 0.

The optional deductibles are:

• CHF 100
• CHF 200
• CHF 300
• CHF 400
• CHF 500

CHF 600.

Insurers are not required to offer every optional deductible.

Low or high deductible?

A higher deductible reduces the monthly premium but increases the amount that the insured person must pay in the event of medical expenses.

The choice depends in particular on:

• expected medical expenditure
• the existence of regular treatment
• the ability to meet an unexpected expense
• the precise premium reduction
• family circumstances
• foreseeable changes in health

For an adult, the maximum annual personal cost directly resulting from the deductible and co-payment is generally:

• with a CHF 300 deductible: CHF 1,000, comprising the CHF 300 deductible and up to CHF 700 in co-payments
• with a CHF 2,500 deductible: CHF 3,200, comprising the CHF 2,500 deductible and up to CHF 700 in co-payments

Any hospital contribution is added to these amounts.

The highest deductible is therefore only appropriate where the premium saving justifies the additional risk and the insured person can meet the cost promptly in the event of illness or accident.

The deductible may only be changed for the beginning of a new calendar year.

Once the deductible has been reached, the insured person generally pays 10% of any additional costs.

This co-payment is normally capped at:

• CHF 700 per year for an adult

CHF 350 per year for a child.

Certain original medicines may be subject to a 40% co-payment where a cheaper, interchangeable generic or biosimilar medicine is available. In such cases, the total amount actually paid may exceed the ordinary CHF 700 ceiling.

During an inpatient hospital stay, a contribution of CHF 15 per day may be payable in addition to the deductible and co-payment.

The day of discharge is not counted.

Those exempt from this contribution include:

• children
• young adults in education up to the age specified by the regulations
• women receiving maternity-related benefits under the applicable rules

This contribution reflects living costs that are considered to have been saved during the hospital stay.

The chosen model affects both the premium and the way in which healthcare is accessed.

Standard model

The standard model offers the broadest choice of authorised healthcare providers.

The insured person may generally consult a doctor or specialist directly, subject to the applicable medical and tariff rules.

It is often the most expensive model.

Family doctor model

The insured person chooses a family doctor or designated practice.

In the event of a medical problem, the insured person must generally consult this first point of contact before seeing a specialist.

Exceptions are usually provided for, for example in relation to:

• emergencies
• gynaecology
• ophthalmology
• certain paediatric treatments
• other situations specified in the contract

HMO model

The insured person first contacts a specified medical centre or care network.

The centre then coordinates any specialist treatment that may be required.

Telemedicine model

The insured person must generally contact a telephone or digital medical service before consulting a doctor.

Depending on the product, the recommendations provided may be compulsory or may simply be intended to guide the insured person.

Pharmacy or healthcare-network models

Some insurers offer other forms of initial contact, for example:

• a partner pharmacy
• a medical application
• a specific network of doctors
• a system combining telemedicine with a family doctor

Alternative models generally reduce the premium in return for a more limited choice or a defined care pathway.

Check the rules before choosing

Commercial names can be misleading. Two products described as telemedicine models may impose different obligations.

Before choosing a model, it is important to check:

• who must be contacted first
• whether the recommendations must be followed
• which exceptions apply
• which doctors or centres are authorised
• what happens if the required care pathway is not followed
• whether the model is compatible with doctors already being consulted

Basic insurance may include or exclude accident cover.

Employees working at least eight hours per week for the same employer are compulsorily insured by their employer against both occupational and non-occupational accidents.

They may therefore ask their health insurer to suspend accident cover under their basic insurance, which reduces the premium.

Anyone not covered by compulsory accident insurance must retain accident cover under basic insurance. This notably includes:

• children
• students without sufficient paid employment
• people who are not employed
• homemakers
• retired people
• certain self-employed people
• employees working fewer than eight hours per week for the same employer

Whenever employment begins or ends, it is important to check immediately whether accident cover should be removed or reinstated.

What basic insurance covers

Compulsory insurance covers inpatient treatment in the general ward of approved hospitals.

An insured person may generally choose a hospital appearing:

• on the hospital list of the canton of residence
• on the list of the canton in which the hospital is located
• or, in certain cases, among establishments with a corresponding agreement

However, where the insured person chooses a more expensive hospital outside the canton without a medical reason, reimbursement may be limited to the tariff that would have applied at a listed hospital in the canton of residence. The difference may remain payable by the insured person or by supplementary insurance.

General, semi-private and private wards

Basic insurance covers the general ward.

Supplementary hospital insurance may notably provide:

• semi-private accommodation
• private accommodation
• a wider choice of doctors
• a wider choice of hospitals
• broader cover outside the canton
• certain comfort-related benefits
• particular services before, during or after hospitalisation

However, semi-private and private cover should not be reduced to the number of beds in the room. The true value of a product depends on freedom of medical choice, the hospital network, reimbursement conditions and contractual limitations.

Compulsory insurance covers the specific maternity benefits provided for by law.

Depending on the applicable conditions, these notably include:

• check-ups
• childbirth
• assistance from a doctor or midwife
• home birth
• delivery in an approved hospital or birth centre
• certain consultations and services after childbirth
• certain breastfeeding-related benefits

Specific maternity benefits are exempt from cost sharing.

From the thirteenth week of pregnancy until eight weeks after childbirth, general medical treatment in the event of illness is also exempt from the deductible and co-payment, even where it is not directly related to the pregnancy.

Supplementary insurance may nevertheless be relevant for choices that are not covered by basic insurance, such as private or semi-private accommodation, depending on the benefits and waiting periods provided.

It is generally preferable to consider such cover before pregnancy, as a later application may be refused or restricted.

Every child must have their own basic insurance.

A newborn must be registered within three months of birth. Where registration takes place within this period, cover begins from birth.

For children, the main points to consider are:

• the deductible
• the healthcare model
• accident cover
• possible dental or orthodontic insurance
• benefits for spectacles
• alternative medicine
• transport and rescue
• cover abroad
• admission conditions for supplementary insurance

Dental and orthodontic insurance may involve a health questionnaire, a dental examination or an age limit for admission. The conditions should therefore be examined before treatment is recommended or an abnormality has already been identified.

Basic insurance does not cover ordinary dental care such as:

• routine check-ups
• ordinary tooth decay
• scaling
• crowns
• implants
• standard orthodontic treatment

It covers only certain dental treatments associated with specific situations provided for by law.

Supplementary dental insurance may cover part of the cost, but often includes:

• a reimbursement percentage
• an annual limit
• a waiting period
• age restrictions
• an examination before admission
• exclusion of treatment already recommended or started
• specific rules for treatment abroad

The total premium over several years should be compared with the amount that may realistically be reimbursed. Dental insurance is not automatically financially advantageous in every situation.

For adults, basic insurance generally does not reimburse ordinary spectacles and contact lenses.

Exceptions exist for certain illnesses, medical circumstances or particular prescriptions.

For children, a contribution may be available under the conditions defined by the regulations.

Outpatient supplementary insurance may offer periodic contributions towards:

• spectacles
• contact lenses
• certain examinations
• in some cases, refractive surgery

The amount, frequency of reimbursement and relationship between the premium and the benefit should be checked.

Basic insurance does not necessarily cover the full cost of medical transport and rescue.

It generally covers:

• 50% of medically necessary transport costs, up to CHF 500 per calendar year

50% of rescue costs in Switzerland, up to CHF 5,000 per calendar year.

These limits may be insufficient in the event of a major intervention, particularly in mountain regions or where specialist transport is required.

Supplementary insurance may provide higher limits or cover abroad.

In the European Union, EFTA and the United Kingdom

The European Health Insurance Card generally appears on the reverse of the Swiss insurance card.

During a temporary stay in a country of the European Union, EFTA or the United Kingdom, it provides access to medically necessary treatment under the rules of the public healthcare system in the country being visited. The insured person is generally entitled to the same benefits as people insured in that country.

However, costs may remain payable under local law.

Outside the EU, EFTA and the United Kingdom

In the event of a medical emergency during a temporary stay in another country, basic insurance generally covers the cost up to twice the amount that would have been reimbursed for the same treatment in Switzerland.

For hospital treatment, reimbursement may be limited to 90% of the amount the stay would have cost in Switzerland, because of the cantonal contribution that applies to hospital treatment in Switzerland.

In countries where healthcare is significantly more expensive than in Switzerland, this cover may be insufficient.

Supplementary travel insurance or international medical cover may therefore be necessary, particularly for:

• the United States
• Canada
• certain countries with expensive private hospitals
• repatriation
• search and rescue
• expenses not covered by the LAMal

Planned treatment abroad

Treatment deliberately chosen abroad must not be confused with an emergency occurring while travelling.

Reimbursement for planned treatment abroad is limited and, in some cases, requires prior authorisation. Written confirmation should be obtained before treatment begins.

Compulsory health insurance premiums are not calculated according to income.

However, the cantons grant individual premium reductions to people with limited financial means. Eligibility criteria, amounts and procedures vary by canton.

Depending on the canton:

• entitlement may be assessed automatically
• an application may be required
• a deadline may apply
• the determining taxable income may be taken from an earlier year
• a significant change in circumstances may justify reassessment

The information provided by the canton of residence should therefore be consulted directly.

A person may change insurer for basic insurance without changing supplementary insurance.

The supplementary insurer may not cancel the supplementary policy solely because the basic insurance has been transferred to another insurer.

Change on 1 January

To change basic insurer on 1 January, the cancellation must reach the current insurer by 30 November at the latest.

The relevant date is the date of receipt, not the date of posting.

It is therefore advisable to send the cancellation in good time and retain proof of receipt.

The new insurer must confirm the new affiliation to the former insurer. The change becomes effective only when this confirmation has been provided.

Outstanding debts

A change may be blocked where the insured person has unpaid premiums or cost-sharing amounts that have been subject to a formal reminder within the applicable periods.

Change during the year

In certain specific circumstances, a change on 1 July may be possible, particularly with the standard model and the standard deductible.

The precise conditions should be checked before any action is taken, as this possibility does not apply to alternative models or optional deductibles.

The deductible may only be changed for the beginning of a calendar year.

To increase the deductible, the request must generally reach the insurer before the beginning of the new year.

Stricter deadlines may apply when reducing the deductible.

The insurance model may also be changed for the beginning of the following year, subject to the conditions and deadlines communicated by the insurer.

These steps should not be left until the final days of December.

Choosing supplementary insurance should not begin with a list of products.

The first step is to identify which needs are not sufficiently covered by basic insurance.

The main categories of supplementary insurance notably concern:

• hospital treatment
• alternative medicine
• spectacles and contact lenses
• dental treatment and orthodontics
• medicines not covered by basic insurance
• transport and rescue
• benefits abroad
• prevention and physical activity
• certain outpatient treatments
• assistance and additional services

Important questions

Before taking out insurance, the following points should be checked:

What precise need is to be covered?

What is the maximum amount reimbursed?

What percentage of the cost is covered?

Is there a waiting period?

Are certain illnesses or situations excluded?

Does cover decrease with age?

Are benefits restricted to certain providers?

Is a medical prescription required?

Must treatment be provided in Switzerland?

May the insurer alter the premium according to age or tariff category?

What is the contractual term?

What is the cancellation period?

Is there a list of recognised therapists, hospitals or centres?

Does the product genuinely supplement the LAMal, or does it duplicate existing cover?

Health declaration

Answers given in a health questionnaire must be complete and accurate.

An omission or incorrect answer may have serious consequences, including reduced or refused benefits, alteration of the contract or cancellation within the limits provided by law.

Where a question is unclear, written clarification should be requested rather than interpreting its scope without guidance.

The deadlines for supplementary insurance are not the same as those applying to basic insurance.

Following the revision of the Insurance Contract Act, an insured person notably has the right to cancel a contract at the end of the third insurance year, even where a longer term was originally agreed. A notice period of three months generally applies, unless the contract provides more favourable conditions.

The insurance year does not always correspond to the calendar year. The policy and general terms and conditions should therefore be checked.

Two mistakes should also be avoided:

• assuming that cancellation of basic insurance automatically cancels supplementary insurance
• cancelling supplementary insurance before final acceptance of replacement cover has been obtained

There is no obligation to take out basic and supplementary insurance with the same insurer.

Keeping them together may simplify:

• administrative procedures
• use of the insurance card
• handling of certain invoices
• contact with the insurer

Keeping them separate may, however, make it possible to:

• choose a cheaper basic insurer
• retain supplementary cover that would be difficult to replace
• select each type of cover according to its individual merits

Basic and supplementary insurance should therefore be assessed separately.

Choosing solely on the basis of premium

A low premium may correspond to a highly restrictive model or a medical network that does not suit the insured person.

Choosing too high a deductible

A high deductible may become problematic where the insured person does not have sufficient funds to meet an unexpected treatment cost.

Confusing basic and supplementary insurance

Changing basic insurer does not mean that supplementary insurance must also be changed.

Cancelling supplementary cover too early

A new application may be refused, subject to exclusions or accepted on different terms.

Failing to comply with the care model

Consulting a specialist directly where the policy requires a first point of contact may affect reimbursement.

Assuming that a benefit is covered

A medical recommendation does not automatically mean that basic or supplementary insurance must reimburse the treatment.

Taking out supplementary insurance for a single reimbursement

An attractive annual contribution is not enough to assess a product. The premium over several years and all applicable conditions must be considered.

Forgetting accident cover

Following a change in employment, accident cover may be removed or reinstated incorrectly.

Overlooking needs abroad

Basic insurance may be insufficient in countries where healthcare is particularly expensive.

A useful comparison should consider more than the premium.

The following should be examined:

• the annual premium
• the deductible
• the healthcare model
• approved doctors and centres
• the rules applying in emergencies
• accident cover
• invoice handling
• the mobile application or online account
• available languages
• service quality
• reimbursement procedures
• compatibility with ongoing treatment

The official Priminfo tool allows users to compare approved premiums. It does not, however, replace careful reading of the rules governing each insurance model.

A simple method is to place benefits into three categories.

Essential

A potentially significant expense that the insured person would be unable or unwilling to bear personally.

Possible examples include:

• private or semi-private hospital treatment
• high medical risk abroad
• transport and rescue
• significant orthodontic treatment for a child

Useful

A benefit that is used regularly and may provide genuine financial value.

Examples include:

• alternative medicine
• spectacles
• medicines not included on official lists
• certain outpatient treatments

Comfort

A benefit that may be appreciated, but whose absence would not expose the insured person to a significant financial risk.

Examples include:

• contributions towards certain activities
• extended preventive benefits
• assistance services
• wellbeing benefits

This distinction helps avoid accumulating little-used cover while overlooking the most significant risks.

Each autumn, it may be useful to review the following:

• the new basic insurance premium
• the healthcare model
• the deductible
• accident cover
• approved doctors
• medical expenditure during the year
• treatment planned for the following year
• possible entitlement to a premium reduction
• changes in employment
• the birth or departure of a family member
• orthodontic needs
• planned travel
• existing supplementary insurance
• cancellation deadlines
• possible duplication of cover

An annual comparison of basic insurance is sensible, but supplementary insurance should not be changed automatically every year.

The first step is to request a written explanation from the insurer.

For basic insurance, the insured person may request a formal decision where a benefit has been refused. This decision may then be challenged by way of an objection and, where appropriate, an appeal under the applicable procedure.

For disputes involving a health insurer or supplementary insurer, the Health Insurance Ombudsman may also act as a mediation body.

It is important to retain:

• invoices
• benefit statements
• prescriptions
• medical reports
• correspondence
• insurance terms and conditions
• written confirmation of important telephone discussions

The Swiss health insurance system becomes easier to understand when each decision is considered separately.

For basic insurance

• statutory benefits are the same with every insurer
• the premium depends mainly on residence, age, deductible, insurance model and accident cover
• the insurer must accept anyone subject to compulsory insurance
• the healthcare model should reflect the person’s usual medical arrangements
• a high deductible requires sufficient financial capacity
• premiums should be compared regularly

For supplementary insurance

• benefits and conditions vary considerably
• admission may depend on health
• an application may be refused
• existing cover should not be cancelled before final acceptance of the new cover
• the product should meet an identifiable need
• exclusions, limits and waiting periods matter more than the commercial name of the product

The Swiss system provides broad access to healthcare, but it requires several individual decisions.

Basic insurance should be selected by considering a combination of factors: premium, deductible, healthcare model, accident cover and quality of administration.

Supplementary insurance must be assessed differently. Its purpose is not to replace basic insurance, but to cover additional needs that genuinely matter to the insured person.

The best solution is therefore not necessarily the one offering the largest number of benefits or the lowest premium. It is the one that corresponds to the insured person’s circumstances, priorities and financial capacity.

This guide presents the general rules of the Swiss health insurance system. It does not replace an individual assessment, an insurer’s contractual terms or a decision issued by a competent authority.

The amounts, deadlines and rules referred to reflect the information available in July 2026 and may change.