Health insurance in Switzerland: All you need to know

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ETH Zurich, Academic Services

Health insurance in Switzerland:

All you need to know

25 February 2016 | International Master and Exchange Students

25.2.2016 Annina Wanner / Sandra Zweifel 1

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ETH Zurich, Academic Services Annina Wanner / Sandra Zweifel 25.2.2016 2

Today’s Programme Presented by

Health insurance in Switzerland – important basics Annina Wanner

Exemption from the Swiss health insurance obligation

- Who can get an exemption? - How to proceed?

Annina Wanner

Questions / Answers (regarding exemptions)

You need a new insurance in Switzerland?

- 3 options

- How to proceed?

Sandra Zweifel

What to do in case of illness?

- Where to go / how to find a doctor? - Payment / refunding

Sandra Zweifel

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Download this presentation and sample letters from authorities at:

www.ethz.ch/health-insurance-for-students

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 Health insurance is mandatory for everybody who is staying in Switzerland

for more than 90 days!

 After arrival, you have 3 months to

- apply for an exemption OR

- get a Swiss health insurance plan

 Full coverage from the day you entered Switzerland!

 Do not miss the 3 months deadline! Otherwise, you will be assigned a health

insurance plan by the authorities -> this can become very expensive!

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 KVG – VVG: What’s the difference?

 KVG = Abbreviation for “Krankenversicherungsgesetz”, the law that determines

the basic health insurance benefits. Its formulation ensures that all health insurance companies offer identical basic health coverage.

-> mandatory to have this or equivalent coverage!

 VVG = Abbreviation for “Versicherungsvertragsgesetz”,

the legal basis for insurance policies under private law. In the health insurance

area, supplemental insurances fall into this category. -> not mandatory

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 The coverage provided by the mandatory basic insurance (KVG) is usually sufficient for young and healthy people.

 Important: Dental treatment is NOT covered!

 Accident coverage is needed if you

 do not work at all

 do not work more than 8 hours/week

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 EU/EFTA citizens legally

insured by their state who own a «European Health Insurance Card»

 Citizens of any country (EU/EFTA or other) with a private insurance that

meets the Swiss requirements (i.e.: covers exactly the same as a Swiss basic

insurance according to the KVG law -> this is extemely rare! -> rather choose

a Swiss insurance right from the beginning!)

 You can get an exemption for max. 6 years in total. Afterwards, you will have to

get a Swiss health insurance.

Exemption for students holding an insurance from an EU or

Non-EU country

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Exemption: Step-by-step guidelines:

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 For those living in the city of Zurich: Once your application for an exemption has

been received by the «Städtische Gesundheitsdienste», they will send you a

letter saying that you obviously have no KVG insurance and that your application is forwarded to the «Gesundheitsdirektion des Kantons Zürich»

 -> this is the normal procedure since the «Gesundheitsdirektion des Kantons Zürich» makes the final decisions – you can thus ignore this letter!

 If you have any doubts, please come and ask us!

 Download example letters from authorities:

https://www.ethz.ch/content/dam/ethz/main/education/internationales/pdf-en/sample-letters.pdf

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Exemption procedure

Communication flow for an exemption request in the City of Zurich

Student Städtische Gesundheitsdienste

Stadt Zürich (SG)

Gesundheitsdirektion Kanton Zürich (GD)

Responsible to ensure that every person living longer than 90 days in Switzerland is legally insured. It is this office which will e.g. forcefully insure you

Responsible for KVG exemption confirmation 1 2 4 3

SG sends you a letter and asks you to take out a Swiss health insurance OR apply for an exemption.

You send your application for an exemption to SG (according to our instructions). SG informs you that your insurance is not a KVG insurance and that they forward your application for an exemption to GD for decision.

SG forwards your exemption request to GD for decision.

Legend: 1 2 4 5 5 3

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 In case your application for an exemption has been refused by the Health

Department of the Canton of Zurich («Gesundheitsdirektion»), you MUST come

and see us IMMEDIATELY!

 Once you have received the refusal letter, your immediate reaction will be

extremely important in order to avoid that you will be forcefully insured!

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Get a Swiss health insurance: 3 options

1) Academic Care 2) Swisscare 3) Any insurance plan

− Monthly premiums:

CHF 80 (CHF 500 deductible) CHF 90 (CHF 100 deductible) CHF 95 (CHF 0 deductible) − No cost contribution!

− Payment mode: monthly, every 3 months, every 6 months, annually

− 2 offices in Zurich in case you need advice/support

− Not accepted in the cantons:

Aargau, Neuchâtel

− VVG insurance! -> exemption from KVG obligation required − Monthly premiums: CHF 65 (CHF 1000 deductible) CHF 83 (CHF 500 deductible) CHF 99 (CHF 300 deductible) − 10% cost contribution

− Payment mode: every 3 months, every 6 months, annually

− communication by email/phone only

− Not accepted in the cantons:

Aargau, Neuchâtel, Ticino

− VVG insurance! -> exemption from KVG obligation required

− Monthly premius:

approx. CHF 200-500

(CHF 300-2500 deductible)

− it’s expensive, but you can get a

premium reduction!

− application for a premium reduction is rather complicated -> you should be fluent in German to be able to handle all this yourself!

− KVG insurance («normal» Swiss basic insurance)

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Deductible («Franchise») & «cost contribution»

Doctor’s bill

treatment & medication CHF 2000

You have to pay:

Deductible CHF 300

Cost contribution: 10% of the rest (CHF 1700) CHF 170

CHF 470

Your insurance company has to pay: CHF 1530

• To be paid once per calendar year.

• You choose your personal deductible when you sign up for your health insurance.

• The higher the deductible, the lower the premiums!

• In addition to the deductible: You pay 10% of the remaining costs yourself (max. CHF 700/year)

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 Visit www.ethz.ch/health-insurance-for-students

 Scroll down to the step-by-step instructions and follow them very carefully!

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Academic Care/Swisscare: Communication flow

Student Städtische Gesundheitsdienste

Stadt Zürich (SG)

Gesundheitsdirektion Kanton Zürich (GD)

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Your insurance company

1 2

4

3

SG sends you a letter and asks you to take out a Swiss health insurance OR apply for an exemption.

You apply for an insurance according to the instructions. Part of this application is «form A», a confirmation of matriculation and a copy of your residence permit.

You decide on which insurance you are going to choose (Academic Care or Swisscare) and return the letter from SG to them with the name of your insurance company.

SG informs you that your insurance is not a KVG insurance and that they forward your application for an exemption to GD for decision.

Legend:

5 The insurance company forwards «form A», your confirmation of _{matriculation and the copy of your residence permit directly to GD.} 3 6 5 1 2 4

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 To cancel your insurance you will need the «Abmeldebestätigung/deregistration confirmation» of the city hall (outside the city of Zurich: the municipal administration office). -> Deregistration is possible 30 days before departure at the earliest.

 Inform your insurance company around one month prior to your departure about the exact departure date as well as the actual bank/post account and hand in the above mentioned deregistration confirmation.

 Both Swisscare and Academic Care will refund unused (full) insurance months.

 The refund can be made to your Swiss bank/post account (agree with your bank/post to only close the account once refunds are made).

 If the refund has to be made to your foreign account you will bear the transaction costs – this can become expensive.

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 Minor medical problems (e.g. common cold, cough):

-> go to pharmacy and ask for the appropriate medication

 Medical problems that require a doctor:

− www.doctor.ch -> check for «General med. practitioner» -> choose a doctor near your home -> call for an appointment -> bring your Swiss or European health insurance card with you.

− «Permanence» www.permanence.ch: medical clinic in the main station and in Oerlikon, open 365

days, 7 am – 10 pm -> no appointment needed, but you may have to wait up to 2 hours

 Important: the emergency ward of a hospital is reserved for − severe illnesses / severe accidents / life-threatening conditions

 If you are unsure whether a treatment is covered by your health insurance: double check with your insurance company!

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1. Wait for the doctor’s bill (usually comes a few weeks after the treatment) which

includes:

− bill (including a payment slip; payable within 30 days)

− reimbursement certificate («Rückforderungsbeleg»)

Usual billing procedure when seeing a general practitioner

(doctor)

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Doctor’s name and address

Law (KVG or VVG) Duration of treatment

Detailed list of

treatment & medicine

(for each day of treatment)

Reimbursement certificate

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2. Pay the bill to the doctor within 30 days.

3. Send the reimbursement certificate («Rückforderungsbeleg») to your insurance

company.

-> Swisscare: online procedure under «claims» on the Swisscare website

4. Wait for the money to be paid to your account.

Important: If your insurance company is too slow with the reimbursement and you are unable to pay the doctor’s bill -> call the doctor’s practice and ask them to stop any legal proceeding!

Usual billing procedure when seeing a general practitioner

(doctor)

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 Hospitals (and sometimes even doctors!) send their bills directly to your health

insurance company

-> In this case you will receive the bill for the deductible/cost contribution directly from your health insurance company.

 If the bill comes directly from your health insurance company: you have to pay

that bill and cannot claim anything back! 

Billing procedure for hospital treatments (practiced by all

insurance companies)

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 Important: Do not deal with your insurance company at home if you are insured by the law in an EU/EFTA country and have an exemption in Switzerland!

 «Gemeinsame Einrichtung KVG» coordinates the billing of the treatment costs with your health insurance abroad!

 Have a look a their website: www.kvg.org All important information can be found

there

 There is no fixed deductible and 10% contribution, but:

− cost contribution: CHF 92 within a treatment period of 30 days

− Hospital stays: CHF 15 per day (for people over 25 years)

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1. Wait for the doctor’s bill

2. Pay the bill within 30 days

3. Send the following to the «Gemeinsame Einrichtung KVG»

− original doctor’s bill (without payment slip) incl. «Rückforderungsbeleg»

− copy of your «European Health Insurance Card» (backside)

− exemption confirmation - Final letter (Verfügung) from the «Gesundheitsdirektion des Kantons Zürich»

− «confirmation of matriculation» from ETH Zurich

− your bank information (IBAN, BIC, bank’s name/address, your name/address)

4. Wait for the money to be paid to your account

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 If the bill comes from the «Gemeinsame Einrichtung KVG», this means: the

doctor/hospital sent the bill directly to «Gemeinsame Einrichtung KVG» that now bills you for the cost contribution.

 You have to pay this, you cannot claim anything back! 

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Thank you!

Download this presentation and sample letters from authorities at:

www.ethz.ch/health-insurance-for-students

Further, very useful information can be found on the website of the

Federal Office of Public Health (2 pdf’s).

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