PREMIUM PRICES
Your monthly premium is not allowed to be based on pre-existing conditions, medical questionnaires or even whether or not you smoke. It is calculated using four standard factors. • Age group: children under 18, young adults 19–25 and adults over 26. Premiums for children must be lower by law but reductions for young adults are not compulsory. Senior citizens get no discounts (but get full coverage). • Deductible: the lowest annual deductible of 300Fr for adults means a higher monthly premium, so you need to weigh up the overall costs. • Insurance model: many insurers offer discounts for policies which require you to see your own family doctor first or contact a medical helpline, a health maintenance organisation (HMO) or even a pharmacy when you are sick. • Location: premiums differ from canton to canton and even between rural and urban areas in the same canton.
BASIC COVERAGE
All insurers must offer the same standard benefits in a basic policy, as defined by law. Alongside free choice of doctor, these include many other benefits. • Hospital: stay in a general ward in your canton of residence; emergency coverage and specialist care (eg transplants) in other cantons are included. • Outpatient: examinations and treatment, including physiotherapy, nursing care, occupational therapy and psychiatric therapy (with some limits) • Coverage abroad: emergency care up to twice the amount the same treatment would cost in Switzerland – enough for Europe but not for the USA or Japan • Emergency transport: half the cost of medically-necessary rescue missions (up to 5,000Fr a year); also half the cost of transport in non-life threatening situations (maximum 500Fr a year) • Alternative medicine: some traditional healing methods, including homeopathy and acupuncture, are now allowed under certain conditions. • Medication, tests and medical aids: covered according to the official list under the Health Insurance Benefits Ordinance • Maternity: minimum of seven pre-natal examinations plus costs of childbirth and post-natal care. Legal abortion is covered. For a ‘normal’ pregnancy there are no deductibles or percentage charges. • Prevention: certain preventative tests and treatments, eg shots for tetanus and hepatitis B, mammograms, pre-school check-ups, child immunisations • Dental: excluded except for severe and unavoidable diseases or after an accident (if not covered by another insurance) • Eyes: glasses and contact lenses are excluded for adults, except for medical reasons, eg diabetes; children get 180Fr a year towards the costs. Health 137