Basic Insurance: Which Benefits Does the Insurer Pay?
The benefits of basic insurance are legally defined and identical at every insurer. Compando informs about the complete benefits catalogue under KVG and shows where coverage gaps exist.
1. What does basic insurance cover?
The mandatory health care insurance (OKP) is the foundation of the Swiss health insurance system and covers for you certain medical services with cost participation. Prerequisite: the services must be effective, appropriate and economical (WZW criteria).
What your basic insurance pays is legally defined. The scope of benefits is identical at all approximately 40 authorised insurers, the premium, however, is not. When switching to a cheaper insurer, you lose no benefits. Your chosen insurance model makes a noticeable difference to the burden per year. Anyone who optimises the premium specifically often saves several hundred francs per year in saving on health insurance premiums.
The three building blocks of cost participation
You participate in your healthcare costs in three tiers:
- Deductible (CHF 300 to CHF 2'500 per year): up to this amount you bear all medical services fully yourself. Only then does basic insurance take over costs.
- Co-payment 10 %: after your deductible is exhausted, you pay 10 % of further medical costs. Up to a maximum amount of CHF 700 for adults and CHF 350 for children.
- Hospital contribution CHF 15 per day: adults pay a contribution per overnight stay in the hospital. Minors and persons under 25 in education are exempt. With low income, the premium subsidy of your canton of residence additionally relieves you.
Good to know: The deductible applies per calendar year. An operation in December with follow-up treatment in January leads to double deductible burden. Therefore bundle plannable interventions as much as possible in the same calendar year.
Find suitable basic insurance
Compando compares the premiums of all Swiss insurers with all models and deductibles. This way you find the suitable health insurance for place of residence and life situation.
2. Which benefits are included in basic insurance?
Basic insurance covers all services for the diagnosis or treatment of an illness that are laid down in the Health Insurance Act and the Health Care Benefits Ordinance (KLV). Here the twelve most important areas of benefits at a glance:
Expand coverage with supplementary insurance
Many benefits are covered in basic insurance, but not all. For more coverage and comfort such as private room in the hospital, glasses contribution for adults or extended complementary medicine, a supplementary insurance secures the gaps.
3. What does basic insurance not pay?
The coverage gaps are legally defined and therefore well predictable. Basic insurance does not cover five areas or covers them only restrictedly:
Area | Status basic insurance | Sensible supplementary insurance |
|---|---|---|
Dental treatments | Not covered (except accident) | Dental supplementary insurance |
Glasses adults | No entitlement | Outpatient supplementary insurance |
Comfort in hospital | General ward | Hospital supplementary semi-private/private |
Fitness and prevention | Not covered | Outpatient prevention modules |
Abroad coverage | Limited to 2× CH tariff | Travel or hospital supplementary |
In detail this means: caries, fillings and root treatments you pay yourself, braces for children quickly cost CHF 7'000 to 15'000 without reimbursement. For emergencies outside the EU/EFTA, basic insurance pays at most twice the Swiss reference costs. An emergency operation in the USA can quickly cost over CHF 100'000. In the semi-private model, you pay per hospital day about CHF 50 to 150 additional costs, in the private model correspondingly more. Basic insurance and supplementary insurance are legally clearly delimited.
4. When do I need supplementary insurance?
Whether a supplementary insurance is worthwhile for you depends on age, health profile and demands. This table assigns to each life situation a possible supplementary insurance:
Life situation | Profile | Possible supplementary insurance |
|---|---|---|
Young family | Children with braces | Dental supplementary children |
30-50, healthy | Hospital rarely, EU/EFTA | Outpatient supplementary insurance |
Complementary medicine fan | Acupuncture monthly | Complementary medicine supplementary |
Glasses wearer | Visual aid every 2-3 years | Outpatient glasses flat rate |
Travellers high-price country | USA/Japan/Canada several times | Hospital private or travel supplementary |
Active lifestyle | Fitness + prevention | Prevention supplementary insurance |
Compando tip: You can take out basic and supplementary insurance with different providers via splitting. Benefits remain independent of this. This way you find the cheapest basic insurance and a suitable supplementary insurance at the same time.
Calculate your savings opportunity
Which combination of basic and supplementary insurance suits your profile? Compando compares all Swiss insurers for your place of residence and shows the annual premium difference.
