Contrary to what you might believe, having health insurance in Switzerland is mandatory, but it’s neither free, nor cheap. As American expats here, we have an inside look at what it’s like trying to figure out an unfamiliar system as a foreigner. After months of research, we finally locked down medical insurance.
So how much can a person expect to pay for coverage?
What kind of coverage do companies offer?
And how does a newly arrived expat go about finding a good company and a plan that works for their family?
For those who’ve just arrived in Switzerland, knowing the following tips might help prepare you for finding health insurance in your new host country.
1. When do new arrivals have to sign up for health insurance in Switzerland?
New arrivals have 90 days to sign up for health insurance in Switzerland. Even if you miss that deadline, it’s unlikely anything too disastrous will happen.
For us, the clock to find Swiss medical insurance started ticking on July 7th, 2014. Right after our arrival, Travis applied with Swisscare, the least expensive healthcare provider in the country. Luckily, he was immediately approved and started receiving monthly bills for premiums.
Once you’ve been approved by the insurance company, you can take the approval letter and accompanying paperwork to your local immigration office in your canton. The cantonal officials have the final authority to approve or deny someone, so once you’re approved there, you really do have medical coverage.
2. Is Swisscare a good option for medical coverage in Switzerland?
In our opinion, it’s a great place to start.
Swisscare offers insurance coverage for expats, travelers needing insurance for a Schengen Visa, for temporary workers like au pairs, and for students. It was a good option for Travis because Swisscare has historically provided low cost, basic insurance for post docs who are in country for “educational or developmental training.”
It’s pertinent to note that unlike in many countries where a couple or family is approved together, every individual has to apply for medial insurance separately. Parents even have to submit a separate application for each child.
Largely due to this, dependents of a qualified enrollee might not qualify under the same plan. For example, due to recent changes in policy, I’m not eligible to receive coverage on Travis’s Swisscare policy, even though I’m his wife and am considered a dependent.
The eligibility of post docs applying is currently a bit of a gray area, even for post docs themselves. Different cantons choose how to apply the changing policy, so Travis was lucky he applied in Fribourg. A post doc applying in Bern could be denied – or approved – while one in Zurich could be approved – or denied.
When in doubt, apply.
3. How does one choose a good health insurance company in Switzerland?
We started by checking out expat sites like Just Landed and Expatica for more information (links at end of article). We stumbled across a page on the Swiss federal website which was incredibly confusing but did provide us with a premiums calculator and a mind-numbing array of insurance providers.
You can also check sites like Comparis.ch, but we were underwhelmed with their online questionnaire. It simply wasn’t able to provide real life answers to the rather complicated questions we had, and in hindsight, their estimates for premiums were far too low.
4. Do Swiss insurance agents really do house calls?
Unlike insurance agents in the US who tend to have a reputation for being sheisty, you’ll likely find agents in Switzerland to be more personable, straightforward, and downright honest. You can either call or drop by their office to start the application process. And you might be surprised to learn that home visits are not uncommon from agents in Switzerland!
Since I wasn’t eligible for Swisscare, we ended up finding an insurer for me through a personal recommendation. We opted to sign with our landlord’s agent for renter’s insurance, which is also mandatory in Switzerland, because he spoke of him so highly. That agent in turn referred us to a company called CSS for my medical insurance.
An agent from CSS Insurance called me directly to schedule an appointment, then dropped by our house for the appointment. For 2 1/2 hours, we sat with him at our dining room tables sipping coffee while he walked us through the paperwork. He couldn’t have made it any easier or more convenient for us.
5. How much do basic monthly premiums cost?
Obviously this varies a great deal among individuals, but the base price that we’ve noted from shopping around is currently around 225 CHF per month.
Swiss francs, or CHF, are currently roughly equivalent to a US dollar and the euro.
Though providers are private, basic insurance is non-profit by law. Premiums can be based only on region, age group, and level of deductible. In general, all residents are required to have at least basic coverage, and all insurers are required to provide at least the same basic package.
Prices vary mostly in the additional add-ons you opt for in your coverage.
6. What are some things basic insurance doesn’t cover?
In addition to the basic insurance, it’ll be necessary for us to take out additional riders, or supplementary insurance, because the basic insurance is so minimal. This is typical for the majority of permanent residents in Switzerland.
For example, basic coverage doesn’t cover dental, vision, or medical services outside our canton. Our canton is only 1671 km².
To put that in perspective for folks back home, Lane County in Oregon is more than 7x the size of Fribourg Canton.
Expat Tip: Swiss cantons are similar to our counties. For family in Idaho, coverage for Shoshone County would include Coeur d’Alene, but if you needed services at Deaconess, forget it.
That means that for any travel outside Switzerland, we won’t be covered with the basic plan.
The final kicker, and biggest concern for us, is that basic accident insurance doesn’t cover activities deemed to be high risk, which could potentially include such things as – you guessed it – hiking. We didn’t see whitewater kayaking, rafting, horseback riding, or any number of other potentially “hazardous activities” we love to do on SUVA’s list.
If you care to check their list to see if your favorite hobby is excluded from coverage, be prepared. Their policies read like a murky doomsday novel, full of thou must nots and subjective this might be covered if…
7. What can two, healthy adults in their 30s expect to pay for coverage in Switzerland?
Again, this will vary, but the break down of costs for my monthly insurance with CSS comes to around 230 CHF for basic coverage. We’ll also owe an additional 50 CHF/month for two supplementary add-ons to address the “hazardous activities” we’ll be doing and to extend our coverage outside the canton of Fribourg.
Including all fees and taxes, coverage will cost about 320 CHF per month just for me, even when choosing the highest deductible, which is 2500 CHF/year.
Travis’s insurance with Swisscare is much cheaper, just 90 CHF a month.
This brings our total to about 410 CHF per month. This seemed like a lot to us at first considering it’s considerably higher than our medical premiums were in the US, but it’s actually not bad considering the average Swiss individual pays 400 CHF just for one person.
Thank you, Swisscare!
8. Is it required to physically see a doctor in Switzerland to receive a diagnosis and prescription?
As incredible as it may seem to many, the answer is NO!
In fact, my plan with CSS Insurance is called CallMed. It allows users to call in when they’re sick, describe their symptoms to a medical doctor, and receive a diagnosis directly over the phone. The doctor even calls in scripts for antibiotics and other meds to a pharmacy of your choice.
While my initial reaction was concern about how the system could easily be exploited, the first time I had a kidney infection and required antibiotics, I became a convert. Shortly after speaking with a doctor at CallMed, Travis arrived home with my prescription antibiotics. Though I was rather astounded that the pharmacy didn’t bat an eye at giving my prescription to someone other than me (this isn’t typically allowed in the US), I was grateful at how easy it all was. I definitely appreciated not having to drag my sick self into a doctor’s office while feeling like death warmed over.
9. How does health insurance in Switzerland stack up against coverage in the US?
This question is difficult to address, considering the range of health insurance options in the US and the vast numbers of uninsured.
My husband and I have lived for years without medical insurance, both as kids and as adults. Various illnesses and emergencies of varying severity have cost us thousands of dollars. Even when we’ve had coverage, we’ve spent thousands on out-of-pocket expenses that weren’t covered by our insurance companies.
That said, we’ve been lucky. We’ve never experienced a medical crisis so severe that we’ve been devastated financially. As of June 30th, 2014, we were both unemployed prior to our international relocation to Europe, rendering us briefly among the ranks of the uninsured.
Prior to that though, we were very fortunate. We’d enjoyed seven fairly steady years of pretty fantastic insurance coverage. We even had a period of years in which we were both double covered by our employers, which means that I had insurance through my employer and added Travis as a dependent while he had insurance through his employer and added me to his policy. Since that’s our most recent personal experience with medical coverage in the US, it’s what we’re comparing here with our health insurance in Switzerland.
The cost for our health insurance coverage in the US varied.
We paid $0 in premiums for us both to be covered on my plan during the first four years I worked for the Oregon Department of Human Services as a state employee. This changed in 2010 when budget cuts and contract negotiations between state employees and the Department led to a reduction in benefits for employees. Still, when I resigned in June 2014 from DHS, the monthly premium for us both to be covered was only $50 per month for excellence coverage.
During the time that we had secondary insurance coverage, it was provided through the University of Oregon where Trav was a grad student. The monthly cost for that insurance was only $75 a month, meaning the most we ever paid to have double coverage was $125 a month. Even my $2500 MRI and Trav’s $8000 dental implant were covered completely by our two insurance companies.
THAT, my friends, is incredible.
Since we were both healthy and rarely went to a doctor in seven years in Oregon, we dropped double coverage after less than a year. While we had it though, we didn’t have co-pays for doctor visits, prescriptions, or expensive tests like MRIs – we only paid monthly premiums.
I say this not to flaunt our good fortune or have eggs thrown at me (state employees will never be popular with the general public) but because I appreciate now more than ever just how good we had it.
You might be asking yourself,
Yeah, but was the insurance any good?
It was. It was really good.
Our Pacific Source and Providence plans both covered vision, dental, and full medical for just about anything under the sun. Even if we were engaged in the act of doing something really stupid or crazy and got hurt, lost, or sick, we were covered.
The great irony is that we almost never used our insurance back then.
Now, I regret that we don’t have dental coverage for regular checkups or routine fillings. We don’t have vision to cover the cost of Trav’s contacts or my glasses. Considering the high cost of these things in Switzerland, we’re not planning to visit the dentist or eye doctor until we either move back to the US or travel somewhere more affordable where we can access these services.