Illness or Accident Abroad: What Does the Insurer Pay?
Illness or accident abroad can quickly become expensive. Compando explains what basic insurance, accident insurance and supplementary insurance cover abroad and where the typical coverage gaps are.
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1. Sick abroad: what does the insurer pay?
Basic insurance takes effect abroad only in case of a medical emergency. An emergency exists when an immediate treatment is necessary and a return to Switzerland is medically unreasonable.
How much the insurer reimburses depends above all on the travel country. Simplified applies: in EU/EFTA states and UK, basic insurance bills according to local practice. In third countries, it pays at most twice the Swiss tariff.
EU/EFTA states and United Kingdom
Insured persons receive the same benefits as locals. The local cost participation arises on site and is not credited to Swiss deductible and co-payment. With inpatient stays, the Common Institution KVG foundation handles the billing between foreign hospital and Swiss insurer.
Example Austria: An emergency treatment in the hospital of CHF 8'500 is billed according to Austrian practice. The local co-payment of around CHF 1'200 arises on site, basic insurance covers the remaining CHF 7'300.
Third countries (USA, Thailand, Australia, Canada, others)
Outside the EU/EFTA zone, basic insurance reimburses emergency treatments only up to twice the Swiss tariff. For hospital stays, additionally at most 90 percent of the Swiss costs, because the cantons do not cover the missing hospital cost share.
Example USA New York: An emergency treatment costs CHF 45'000. The comparable treatment in Switzerland would cost CHF 8'000, twice the Swiss tariff lies at CHF 16'000. Basic insurance covers at most these CHF 16'000, the difference of CHF 29'000 is borne by the insured person themselves.
With a reasonable return to Switzerland, basic insurance covers no treatment costs at all.
Contrast insurer and supplementary insurance
Basic insurance covers only the emergency abroad. Return transport, private clinic and additional costs in third countries remain open. In comparison, you recognise the gaps and the suitable supplement more quickly.
2. Where are there restrictions for doctor and hospital?
In EU/EFTA states, clear restrictions apply: the mandatory health insurance KVG and the accident insurance UVG do not reimburse treatments in private clinics or with private doctors without contract tariff.
Covered:
- Public hospitals
- Doctors with social insurance tariff
- Emergency departments in the public health system
Frequently not or only partly covered:
- Private hospitals and private clinics
- Private doctors without contract tariff
- Treatments outside the social insurance system
Check European Health Insurance Card before every trip
The European Health Insurance Card (EHIC) is on the back of your Swiss insurer card. It opens in EU/EFTA states and UK access to public hospitals and contract doctors. Check the expiry date before every trip. Without a valid EHIC, the treatment must be pre-financed on site.
Example France: A treatment in a Parisian private clinic is usually not or only partly covered because the billing does not run via the local social insurance system. In a public hospital, the treatment is covered according to French practice.
Does the insurance model play a role?
Basic insurance participates in emergency treatments outside Switzerland regardless of the chosen model. Also with the family doctor or HMO model, in case of an emergency abroad, there is no obligation to contact the first point of contact in advance. After the emergency, insured persons inform their insurer.
3. Who pays for rescue and repatriation in emergency?
For rescue, recovery and return transport, the trigger decides on coverage: accident goes to UVG, illness to basic insurance. The amount of reimbursement differs dramatically.
For accident: accident insurance UVG
The accident insurance UVG reimburses the medically necessary costs for rescue at the accident site, patient transport to the nearest suitable hospital and return transport to Switzerland. According to Art. 20 UVV, the maximum lies at CHF 29'640 (one fifth of the insurable maximum amount).
For illness: basic insurance
Basic insurance does not participate in principle in rescue operations outside Switzerland or in return transports there. For medically necessary transports to the nearest suitable hospital, basic insurance only covers 50 percent of the costs, maximum CHF 500 per year. These rules also apply for accidents if the accident coverage was concluded via basic insurance instead of via UVG.
For comparison: a patient transport within Switzerland costs depending on the canton between CHF 900 and CHF 2'100. With a return transport from overseas by ambulance flight, quickly several tens of thousands of francs own costs arise that are without supplementary coverage to be borne in full by the insured person.
4. What do medications and planned treatments abroad cost?
For medications and planned treatments abroad, strict rules apply. Basic insurance follows the territorial principle and reimburses only in narrowly defined exceptional cases.
Medications and drugs
Medications obtained abroad are only reimbursed if they are needed during a temporary stay in case of acute illness or accident. Stock purchases or chronic medications for a longer time are not covered.
A private person may only import medications in small quantities (about one month's need) to Switzerland. Anyone who imports larger quantities risks customs problems and bears the costs themselves. For chronic medications, a confirmation of the Swiss family doctor is recommended before the trip to avoid delays at the border.
Planned treatments
Planned and elective treatments abroad are not covered by basic insurance. Decisive is the territorial principle: insured is only what is treated in Switzerland.
Exceptions only exist if:
- the illness is life-threatening,
- the treatment is not available in Switzerland, or
- the waiting time in Switzerland is too long.
The treating doctor must in such cases submit an application to the medical advisor of the insurer. The insurer then decides on the cost commitment.
The following treatments basic insurance does not cover abroad:
- Dental treatments and implants
- Eye treatments and laser operations
- Glasses and contact lenses
Various supplementary insurance provides a cost participation for visual aids or other planned treatments abroad.
5. Who pays in case of an accident abroad?
In case of an accident abroad, the accident insurance is in the lead. The accident coverage itself is mandatory in Switzerland, but depending on the gainful employment status runs via different insurers:
- Employees from eight weekly hours with one employer: accident insurance UVG via the employer.
- Non-gainfully employed persons and self-employed without UVG: accident coverage in basic insurance KVG.
- Children, students and other non-gainfully employed: basic insurance KVG with restricted benefits.
Abroad, the same country rules apply as for illness: in EU/EFTA states and UK, the accident insurance pays according to local billing practice and only in public hospitals or doctor's practices with basic tariff. In third countries, the treatment costs are limited to at most twice the Swiss tariff.
Persons insured via the employer UVG pay, unlike with the accident coverage of basic insurance, no cost participation for treatment abroad.
6. When is a supplementary insurance for abroad coverage sensible?
A supplementary insurance with abroad coverage is always sensible when the residual cost risk in case of emergency abroad remains incalculable without supplementary coverage. Which supplementary insurance is sensible also depends on your travel profile. Three profiles benefit particularly strongly:
- Trips to countries with high healthcare costs: USA, Canada, United Arab Emirates, Australia, Japan and other third countries with tariffs far above the Swiss level.
- Sabbaticals, world trips and longer stays abroad: Here the UVG accident insurance of the employer can rest during unpaid leave or completely expire. For longer stays abroad, basic insurance can additionally be suspended.
- Ski holidays and outdoor activities in mountain regions: Helicopter rescues from alpine terrain quickly cost several tens of thousands of francs; basic insurance bears nothing of this.
A supplementary insurance typically closes the repatriation gap and covers treatments in private clinics as well as additional costs in expensive travel countries. Note when signing possible waiting periods until the travel coverage takes effect.
Choose travel coverage matching the travel profile
Whether weekend trip to Milan, USA tour or sabbatical in Bali: choose a supplementary insurance that suits your travel profile. Check waiting periods, upper limits and repatriation benefits before the first trip.
