The benefits of basic insurance: What do health insurance providers cover in Switzerland?
The same benefits for everyone across Switzerland
If you compare Swiss health insurers, you’ll find that the standard benefits are the same across all basic insurance models. This is stipulated by the Federal Law on Sickness Insurance (KVG). That’s why, when you change your health insurer and come to Sympany, we cover all the benefits under compulsory health insurance.
The same applies if you live in an EU/EFTA country but work in Switzerland as a border commuter. With the euroline health insurance plan from Sympany, you have access to all the benefits of Swiss basic insurance in line with the Federal Law on Sickness Insurance (KVG).
Please note that the benefits of basic insurance are limited. Check the overview of benefits for our recommended ways to extend your health insurance cover.
Cost contribution under basic insurance
You are required by law to pay a small proportion of the costs for any medical treatment each year (excess and deductible). You will pay 100% of the excess costs yourself. The excess can be selected each year and amounts to at least CHF 300 per year for adults. Only if the costs surpass the excess will the basic insurance take over – minus your deductible of 10% (up to a maximum of CHF 700 for adults and CHF 350 for children per year). More information on cost contribution >
Tip: If you increase your excess, you will still have access to the same benefits. However, your health insurance premium will drop drastically. Save on your insurance premium >
The benefits of compulsory basic insurance
Compulsory basic insurance covers the costs incurred if you are ill, injured or pregnant in accordance with statutory provisions.
Basic insurance covers the costs of hospital treatment and inpatient stays in a psychiatric clinic or rehabilitation clinic – in a general ward (multiple- occupancy room) at a hospital or clinic on the list of hospitals for your canton of residence.
► You can take out hospita supplementary hospital insurance with Sympany to receive additional benefits.
Basic insurance covers treatment provided by doctors, chiropractors, podiatrists and other medical practitioners (speech therapists, occupational therapists and physiotherapists) with a federally recognised diploma in line with the applicable tariffs provided that the treatment has been prescribed by a doctor. Medical and psychological psychotherapy prescribed by a doctor is also covered in line with the applicable tariff. Psychotherapists whose services are covered by basic insurance can be found in the Psyfinder >
Depending on the insurance model, you should contact your designated first point of contact in the event of illness to save money on your premium. Compare Sympany’s basic insurance policies >
Medication is covered if it is prescribed by a doctor and on the statutory list of medicines. If a branded preparation is not specifically prescribed, pharmacies can also supply a cheaper generic product containing the same active ingredient. This will save you even more money. If you choose a branded preparation despite a generic option being available, the deductible will be 40%, while the deductible for the cheaper generic option will only be 10%.
► The supplementary outpatient insurance policies from Sympany cover the costs of more medication prescribed by a doctor.
Basic insurance covers the costs of acupuncture, anthroposophic medicine, traditional Chinese medicine (TCM) pharmacotherapy, classic homoeopathy and phytotherapy performed by doctors who have completed the relevant training.
► The plus and premium supplementary outpatient insurance policies contribute to lots of other types of complementary medical treatment.
In the case of an emergency abroad, outpatient treatment and hospital stays on a general ward are covered. Within the EU/EFTA, benefits are provided in accordance with the social tariff for the specific country you’re in. In countries outside of the EU/EFTA, a maximum of double the costs that would have been incurred in Switzerland will be covered.
► With Sympany supplementary insurance, you can have all the costs of emergency outpatient treatment abroad covered.
Children under the age of 18 receive up to CHF 180 for glasses and contact lenses per calendar year under basic insurance. For adults aged 18 and over, compulsory basic insurance only covers changes in eyesight resulting from illness and serious eye illnesses. Other essential medical aids prescribed by a doctor will be covered in accordance with the statutory list of medical supplies and devices.
► You can receive higher contributions by taking out supplementary outpatient insurance with Sympany.
Basic insurance provides CHF 10 a day for spa treatments prescribed by a doctor up to a maximum of 21 days a year.
► The plus and premium supplementary insurance policies also contribute to visits to thermal spas that have been prescribed by a doctor.
Basic insurance covers the costs of a birth at home, in hospital or at a maternity clinic (in a multi-occupancy room and according to the list of hospitals for your canton of residence).
Other statutory maternity benefits provided under basic insurance include:
- seven check-ups
- two ultrasounds
- CHF 150 towards antenatal courses (provided by midwives)
- a follow-up check six to ten weeks after the birth
- three breastfeeding support sessions
- hospital care for healthy newborns
Good to know: No cost contribution is required in the form of an excess or deductible for many special benefits provided during pregnancy, delivery and the post-partum recovery period.
► The plus and premium supplementary insurance policies contribute more to prenatal courses and a breastfeeding allowance.
► The hospita supplementary insurance policy provides you with a higher level of cover in hospital.
Costs are covered by the health insurance provider in line with the applicable tariffs. As per the Federal Law on Sickness Insurance (KVG), basic insurance covers treatment and care in recognised care homes and treatment and care at home that has been prescribed by a doctor (Spitex) and is carried out by a recognised service provider.
The costs of screenings designed for early detection of diseases are covered for people in certain at-risk groups under basic insurance. Vaccinations are covered in line with the Federal Law on Sickness Insurance (KVG) if they are part of the current Swiss vaccination plan. The first two annual gynaecological check-ups are covered. After that, basic insurance covers the costs of a gynaecological check-up every three years.
► Further benefits relating to preventative measures are provided with supplementary outpatient insurance from Sympany. This also includes the Sympany sports contribution.
50% of the costs of transport required for medical reasons are covered under basic insurance (up to CHF 500 per calendar year). Basic insurance also provides for 50% of rescue costs in Switzerland (up to CHF 5,000 per calendar year).
► Return transport and search and rescue costs can also be covered with supplementary insurance from Sympany.
Basic insurance covers the costs of dental treatment in the case of serious illness (e.g. jaw illness/inflammation, tumours, cysts). Treatment on a tooth damaged in an accident is covered for policyholders with accident cover.
► With supplementary dental insurance from Sympany, you receive contributions to dental treatments, lab work, prophylaxis and check-ups.
The overview of benefits and Terms and Conditions of Insurance (TC) provide a summary of the benefits of basic insurance.
Sympany basic insurance models
Would you rather choose your own doctor or save on your insurance premium? Whether you opt for a standard model or savings scheme, you can rest assured that you’ll always receive the best treatment. Your health is in good hands! The benefits (e.g. during pregnancy or in hospital) will still be the same. It’s just that your first point of contact in the event of illness or an accident will differ.