Does your insurance policy cover specialized surgery outside of Switzerland? Can you visit a spa or deliver a baby abroad and still claim benefits? Get informed with this moneyland.ch guide.
Insurance coverage provided by Swiss compulsory health insurance is fairly far-reaching in that it gives you virtually unlimited basic health insurance coverage and is available to all residents – including the chronically ill. But the financial reach of basic health insurance in Switzerland far outpaces its geographical reach, and the international coverage provided by compulsory health insurance is a frequent point of confusion. Many policyholders assume that the benefits provided by their insurance policies apply both in Switzerland and abroad, but that often is not the case.
There are many reasons why residents seek medical care across the border, including the need for highly-specialized treatment, diagnoses which are not available in Switzerland, or specialized surgery by a renowned surgeon in another country. Foreigners residing in Switzerland may feel more comfortable undergoing major treatments or giving birth in their home country, where they can avoid language barriers and be close to friends and relatives. Here you can find information on what treatment abroad is and is not normally covered by basic Swiss health insurance.
1. Medical emergencies
Compulsory Swiss health insurance provides coverage toward medical emergencies caused by illness or maternity which occur outside of Switzerland. In European Union (EU) member countries (Germany, France, Spain, Italy and many more) or European Free Trade Association countries (EFTA) member countries (Norway, Iceland, Liechtenstein), your valid European Health Insurance Card entitles you to care in the event of a medical emergency. In other countries, you may have to front the payment yourself and then claim reimbursement from your insurance provider. Costs of treatment in non-EU/EFTA countries are covered up to a maximum of double the cost of equivalent treatment in your canton of residence.
Only actual medical emergencies are covered. If you leave Switzerland with the goal of receiving treatment abroad, the cost of the treatment will not normally be covered by your insurer. Because of this, getting a report from the foreign doctor or hospital explaining the exact circumstances of any medical emergencies which you run into while abroad is advisable. Aside from receipts and invoices, which you must present when you make a claim, other documentation (like police reports) can also be helpful in proving your case.
2. Medical treatment
Treatment by specialists outside of Switzerland, including surgical treatment, is only covered by your compulsory Swiss health insurance policy if equivalent treatment is not available in Switzerland. A simple preference for being operated on by a specific surgeon or receiving treatment at a specific hospital or clinic, for example, would not entitle you to claim insurance for treatment abroad.
However, as a general rule, treatment which cannot be provided in Switzerland is covered. This may include, for example, an operation which can only be performed by specialized surgeons in another country.
Before you seek medical care abroad, a Swiss doctor or specialist must present your case to your insurer, which will then determine whether or not equivalent treatment is available in Switzerland. Only after you receive a guarantee of payment from your insurance provider should you seek treatment abroad.
3. Medicine
If you are actually staying outside of Switzerland for a time (for studies or vacation, for example) and require medicine due to an ongoing illness or a medical emergency, the costs of the medicine will usually be covered by your basic health insurance. The prime requisite is that medicines must be included in the list of covered medicines published by the Federal Office of Public Health. However, medicines purchased abroad while you are not temporarily residing abroad, such as purchases you make at pharmacies during a cross-border day trip, are not covered.
4. Maternity
Medical checkups related to maternity and delivery itself are not normally covered when they are performed outside of Switzerland. However, prenatal or postnatal checkups abroad may be covered under very specific conditions. An unexpected premature birth, for example, would normally qualify as a medical emergency, and therefore be covered. Regular births or caesareans close to the due date, or anticipated premature births, may not be covered by your insurer and getting a guarantee of payment before leaving the country is advisable.
If you are a foreigner residing in Switzerland and your child must be born in your country of origin in order for them to gain citizenship and avoid being born stateless, the cost of the delivery will normally be covered, but make sure to get a guarantee of coverage from your insurer ahead of time.
5. Spa treatments
Your compulsory health insurance provides a benefit of 10 francs per day towards the cost of medically prescribed spa treatments in Switzerland, up to a limit of 21 days per year. However, spa treatments outside of Switzerland are not eligible for this benefit.
6. Accidents
In non-EU/EFTA countries, the compulsory accident insurance which you receive from your Swiss employer or through your health insurance provider covers treatment for injuries resulting from accidents up to a maximum of double the cost of getting equivalent treatment in Switzerland. In EU and EFTA countries, you are entitled to receive the same coverage provided to socially insured residents of those countries when you present your health insurance card.
7. Dental care
If urgent dental work is undertaken following a medical emergency or accident, the costs will normally be covered by your health insurance provider or accident insurance provider, depending on the case. However, you will normally only be eligible for coverage if you receive treatment either in the country where the accident occurred or in Switzerland.
8. Ambulance transportation
Your basic Swiss health insurance policy covers 50% of the costs of ambulatory transportation outside of Switzerland – up to a maximum of 500 francs per year. This is identical to the ambulance coverage you receive in Switzerland.
9. Cross-border workers
If you work in Switzerland but live in another country, your compulsory Swiss health insurance can provide coverage for medical care which you receive in your country of residence, but within certain limitations.
Insurance benefits will cover expenses up to a maximum of twice the cost of equivalent medical care in Switzerland, but the benefits you receive will be based in part on the social health insurance benefits offered in your home country. If data about local insurance benefits is not available, benefits will be based either on the costs of medical care in your last place of residence in Switzerland, or (if you have never lived in Switzerland) on the canton in which your insurance provider is headquartered.
10. Supplemental health insurance policies
The right supplementary insurance policy can furnish you with a lot more flexibility and coverage for treatment received abroad, as compared to basic compulsory insurance. But here too, you must exercise caution because the coverage for medical costs abroad vary widely between policies.
Many supplemental insurance policies simply complement the coverage for medical emergencies abroad which you receive from your basic insurance policy. The Sanagate Minima policy, for example, covers 90% of treatment costs and 100% of the cost of hospital stays, but only when these result from medical emergencies.
On many policies, international insurance coverage is provided through a travel health insurance rider and may be limited to a maximum time frame. For example, the KPT Health Insurance Plus policy provides solid travel health insurance, but only for up to 8 weeks per calendar year.
Some outpatient policies do not provide international coverage at all, with insurers offering travel health insurance through a separate travel insurance policy. This is often the case with low-cost insurance policies. The filter and sort functions in the comprehensive supplemental health insurance comparison tool from moneyland.ch to find policies based on the international coverage they provide. Just choose the “medical costs abroad” filter and sort options.
If you want the freedom to receive treatment abroad as you so choose, make sure to choose a policy which provides this benefit (these are the exception, not the rule). Many Helsana policies, for example, provide a daily benefit towards the cost of deliberate hospital stays abroad. Benefits range from 500 francs per day with the Hospital Eco policy to 1500 francs per day with the Hospital Comfort policies, but neither of these provide coverage for medical treatment outside of a hospital (at a doctor’s or specialist’s practice, for example). The Helsana Completa policy does cover 90% of the costs of medical care outside of hospitals, even when you specifically go abroad for the purpose of receiving treatment, but it only covers costs up to a maximum of 1000 francs.
11. Alternative insurance coverage
An alternative to getting supplementary health insurance is to take out a travel insurance policy which provides health insurance coverage ahead of your trip. For example, the Private Medical coverage from Allianz Global Assistance covers all costs of medical care abroad which are not covered by your obligatory health insurance, up to a maximum sum insured of 1 million Swiss francs.
Some credit cards provide complimentary travel health insurance as a benefit when you use them to pay for trips. For example, Libertycard Plus from Bonus Card includes Travel health and accident insurance coverage of up to 200,000 Swiss francs as a benefit. The Diners Club Classic Card provides up to 1.5 million francs of travel health insurance coverage.
However, as a rule, travel insurance only covers medical emergencies, so it is a poor choice for “medical tourists” seeking healthcare treatment abroad. This applies to the travel health insurance included in supplementary health insurance, travel insurance and credit card travel insurance benefits.
International health insurance can be a more sensible option if you expect to receive a lot of medical care outside of Switzerland. You can find more information on this insurance type in the moneyland.ch guide to international health insurance.
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