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HEALTH INSURANCE

What isn’t covered by Switzerland’s compulsory health insurance?

Switzerland’s basic health insurance is among the most expensive in the world, but there are certain services it doesn’t pay for. Here are some of the benefits the scheme won’t cover in full.

What isn't covered by Switzerland’s compulsory health insurance?
Basic insurance: You will have to share your hospital room with other patients. Photo: Pixabay

Basic insurance — KVG in German and LaMal in French and Italian —  is compulsory in Switzerland. It doesn’t come cheap, but it is quite comprehensive and includes coverage for illness, medications, tests, maternity, physical therapy, preventive care, and many other treatments.

It also covers accidents for those who do not have accident insurance through their workplace.

Basically, whatever the doctor orders is covered by KVG / LaMal, at least partially.

READ MORE: Everything you need to know about health insurance in Switzerland

However, there are some treatments the basic insurance won’t pay for.

Experimental treatments

Any experimental treatments or drugs — that is, those not approved by the Swissmedic regulatory agency or the Federal Office of Public Health (FOPH) will not be covered.

This exclusion is not specifically Swiss; insurance schemes is most countries won’t cover unauthorised medical treatment either.

Dental care

In most cases, services such as teeth cleaning, dental fillings, root canals, tooth extractions, and orthodontic braces, are not included under basic insurance.

The only exceptions, according to the Federal Office of Public Health (FOPH), are dental interventions “necessitated by a serious disorder of the masticatory system, or if such treatment is required to support and ensure the success of medical treatment for a severe general disorder (e.g. leukaemia, heart-valve replacement)”.

Most dental treatments are not covered. Photo by Pixabay

Eyeglasses and contact lenses

Compulsory health insurance will contribute up to 180 francs per year towards glasses and contact lenses prescribed by an ophthalmologist for children up to the age of 18.

No such benefit exist for adults. However, “in the case of serious visual impairment or certain illnesses (e.g. disease-related refraction abnormalities, postoperative alterations or corneal disease), compulsory health insurance will, regardless of age, make higher contributions towards medically prescribed spectacle and contact lenses”, FOPH says.

READ MORE: Reader question: Can Swiss health insurance exclude me if I have pre-existing conditions?

Ambulance

Emergency vehicles that transport you to a hospital can be quite expensive — depending on the canton, the costs can range from 900 to 2,000 francs per trip. 

Basic health insurance will contribute a certain amount  to the cost of emergency transportation, but only if it is a medical necessity — a serious accident, an illness, or a life-threatening situation. But if the patient could have travelled by private car or public transport, basic health insurance policies will pay nothing.

Insurance will cover some of the cost of ambulance transport only in emergency. Photo by Fabrice COFFRINI / AFP

Private hospital room

While the cost of your hospitalisation will be fully covered, the basic insurance does not pay for a private room.

You will be accommodated in a room with other patients.

Depending on a medical facility — whether it’s a small hospital or a large, university medical centre, you could end up with just one other person or possibly four or five, the latter being common in teaching hospitals.

If you insist on a private accommodation, you will have to pay for it out of your own pocket.

Reader question: Can Swiss health insurance exclude me if I have pre-existing conditions?

Vaccines

Immunisations outlined by FOPH  will be paid for by insurance, as will the Covid vaccine.

Not covered, however, are travel-related vaccinations or preventive measures, such as against yellow fever or malaria.

Treatment abroad

Outside Switzerland, only emergency care is covered  — double the amount that the same treatment would cost in Switzerland.

Usually, basic health insurance will not cover transportation costs back to Switzerland, except in case of emergency, when it will cover 50 percent of the total cost of transportation to the nearest hospital abroad — but no more than 500 francs per year. 

If you only have a basic insurance policy and travel abroad often, especially to the United States, you should take out a travel insurance that will cover you for illness and accidents in foreign countries above and beyond what your Swiss carrier will pay.

And if you want to upgrade your treatment options, consider taking out a supplemental insurance or, if you can afford it, private one.

READ MORE: Should you buy supplemental health insurance in Switzerland?

You can find out more about what KVG / LaMal will and will not cover here.

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For members

HEALTH INSURANCE

Why getting rescued in the Swiss Alps could cost you thousands

With holidays just around the corner, many mountain enthusiasts will be heading for the Alpine peaks. An important thing to remember is that even in the summer, accidents can happen and mountain rescue in Switzerland can come at a high price.

Why getting rescued in the Swiss Alps could cost you thousands

It is true that statistically most mishaps in the mountains are related to winter sports — skiing, snowboarding and the like.

About 50,000 accidents a year are recorded in the Swiss Alps each winter, “the vast majority of which are linked to skiing and snowboarding, the two disciplines that also generate the highest costs”, according to Swiss National Accident Insurance Fund (SUVA).

While summer mountain activities seem to be less risky, accidents can — and do — happen nevertheless. Again according to SUVA, such popular activities as base jumping, rock climbing, or hiking on unsteady surfaces can result in accidents.

In fact, the mere fact of just hiking can prove dangerous: every year, some people are attacked by cows while strolling in the mountains. One such case involved two hikers who were knocked to the ground by a cow in Nidwalden — an incident which inflicted bruises and shock on the hikers (the cow was fine).

But you don’t have to be an extreme sports enthusiast or approach cattle to sustain injuries in the mountains — just ask David, a UK national living in Vaud.

In July 2021, David rode his mountain bike near Arosa, Graubünden, when he hit a rock and fell into a metre-deep crack, breaking his foot in the process. Passersby called for help.

“A helicopter came and three people got me out of the ditch, stabilised me ,and airlifted me to the nearest hospital”, he said

The final bill just for the rescue amounted to 3,200 francs.

While it may seem like a steep price for a service that “took one hour tops”, this sum is not exorbitant or even unreasonable.

What you should know

Mountain rescues are generally provided by air ambulance services such as Rega, Air Glaciers or Air Zermatt. All three work on a subscription model, meaning people can become donors, which could, in certain cases, lower the cost of a rescue.

As Rega, the largest of the three services, noted on its website, it can, “at its own discretion and within the bounds of its resources, waive or reduce the costs of any emergency services”.

This was not the case for David who had no subscription, but has taken out one since the accident.

READ MORE: Rega: What you need to know about Switzerland’s air rescue service

Mountain biking can sometimes be dangerous. Photo by Tim Foster on Unsplash

The exact cost of the rescue varies according to three criteria, Rega spokesperson Emilie Pralong told Le Temps newspaper in an interview.

These criteria are “the duration of the mission, the transport costs (pilot, paramedic, helicopter), and the services of the emergency doctor”.

At a rate of around 100 francs per minute of flight, the bill can quickly skyrocket but in the easily accessible mountain area (as was the case for David) ranges from 2,500 to 3,500 francs charged to the patient.

Does health insurance bear at least part of these costs?

Unlike its Alpine neighbour Austria, where public health insurance will pay for mountain air rescue only if the patient is in danger of death, things are a bit different in Switzerland, where health insurance is private.

In Switzerland, the mandatory accident insurance paid by the employer covers the cost of rescues, even if you are not physically injured, according to Moneyland.ch consumer website.

On the other hand, for children, pensioners or people without professional activity, “the compulsory health insurance will cover half of rescue costs up to the maximum amount of 5,000 francs per calendar year,” said Pascal Vuistiner, spokesperson for Groupe Mutuel’s Romandie.

There are also additional insurance policies that will cover unpaid costs, including those incurred abroad, especially as the basic Swiss plan only covers rescues in Switzerland.

For instance, many supplemental health plans include some coverage for search and rescue costs, medical transportation, and repatriation.

Coverage for search and rescue operations is typically limited, ranging between 10,000 and 100,000 francs. Many (but not all) Swiss supplemental health insurance offers include unlimited coverage for ambulance transportation and repatriation to Switzerland for medical care.

READ MORE : Should you buy supplemental health insurance in Switzerland?  

Coverage for search and rescue and/or emergency medical transportation is also part of many travel insurances.

However, “with very few exceptions, coverage for search and rescue operations is limited. Maximum benefits can be as low as just 5,000 francs, or as high as 60,000 francs”, according to Moneyland.

In David’s case, most of the costs of his airlift, surgery, hospital stay and post-op physical therapy were covered by the above-mentioned insurance policies. The only thing hurt in the long run is his pride, as this was the only fall the experienced mountain biker has suffered in his life.

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