Health Insurance in Switzerland ETH

Health insurance in Switzerland:
All you need to know

18 September 2014 | International Master and Exchange Students
ETH Zurich, Rectorate
Annina Wanner / Sandra Zweifel
18.9.2014
Todays 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
You need a new insurance in Switzerland?

- How to find a cheap offer?
- How to proceed?
- 3 options
Sandra Zweifel
What to do in case of illness?

- Where to go / how to find a doctor?
- Payment / refunding
Sandra Zweifel
Questions / Answers
18 September 2014
Download this presentation:

www.ethz.ch/health-insurance-for-students
18.9.2014
Important basics 1: health insurance is

mandatory!
Health insurance is mandatory for all of you!
You have 3 months after arrival to
- apply for an exemption
OR
- get a Swiss health insurance plan
Do not miss the 3 months deadline! Otherwise, you will
be assigned a health insurance plan by the authorities
-> this can become very expensive!
Full coverage from the day you entered Switzerland
18.9.2014
Open mail from the

Gesundheitsdirektion and from
your insurance company
immediately!
Although its in German:
it may be very important!
18 September 2014
Important basics 2: What does the mandatory

insurance cover?
KVG VVG: Whats the difference?
The basic insurance (KVG) covers the following (the list is
not complete!):
All treatments carried out by a doctor
Additional treatment/therapies prescribed by a doctor (physiotherapy,
X-rays, analyses and more)
Psychotherapy (only if carried out by a doctor/psychiatrist)
Chiropractors
Costs of all medicine which is prescribed by a doctor and appears in the
List of pharmaceutical specialities (currently around 2500 medicines)
Complementary medical treatments if carried out by a physician with a
recognised degree (e.g. accupuncture, TCM, homoeopathy and more)
18.9.2014

insurance cover?
Hospital treatments: full cover of all costs (general ward) in a hospital which
is authorised to provide services under the KVG
Preventive healthcare, e.g: some basic (non-travel-related) vaccinations
Transportation costs (ambulance): 50% of the costs, max. CHF 500/year (!)
Rescue costs: 50% of the costs, max. CHF 5000/year
Coverage while travelling outside of Switzerland (double as much for
emergency outpatient and inpatient treatment as in the canton where you
live)

Basic insurance benefits are determined by law and

therefore consistent among ALL health insurers.
If an insurance benefit is not covered by the basic
insurance, the doctor is obliged to inform you about this!
18.9.2014

insurance cover?
The basic insurance (KVG) is usually sufficient for young
and healthy people
If you are unsure whether a planned treatment will be
covered by your insurance company: clarify this in
advance by contacting your insurance company!
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
18.9.2014
Important basics 3: premiums, deductibles, cost

contribution, models
Health insurance is expensive! Average prices for a basic
health insurance (KVG): CHF 200 450 per month
Different people pay different prices! The height of the
premium depends on:
Age (young adults: 17 - 24 years, adults: over 25 years)
Place of residence
Insurance provider
Franchise: annual deductible

Choose between CHF 300, 500, 1000, 1500, 2000, 2500
The higher the deductible, the lower the premiums!
No deductibles in case of maternity and accidents
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Selbstbehalt: cost contribution by the insured person
You pay 10% of the costs yourself (max. CHF 700/year)
Hospital stays: CHF 15/day (exceptions: students under 25; women
receiving maternity services)
Cost example (simplified):

Doctors bill
treatment & medication
CHF
2000
Deductible
CHF
300
10% of the rest (CHF 1700)
CHF
170
CHF
470
CHF
1530
You have to pay:
Your insurance company has to pay:

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Models
Differences / Requirements
Premium
reduction
Standard
Free choice of physicians
Family doctor
You always consult the same doctor

(Exceptions: accidents, annual gynaecological
check-up). This doctor will refer you to a specialist
if necessary.
up to 20%
HMO (Health You always consult a specified doctor based at up to 25%

Maintenance
a HMO centre (Exceptions: accidents, annual
Organisation) gynaecological check-up). This doctor will refer
you to a specialist if necessary.
Telmed
You have to call a consultation hotline for

medical advice before consulting a doctor.
up to 15%
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For further general information:

Website of the Federal Office of Public Health (FOPH):
www.bag.admin.ch -> Topics -> Health Insurance ->
Benefits
2 very informative brochures:
- Your questions, our answers
- Frequently asked questions (FAQ) about benefits
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Exemption from the Swiss health insurance

obligation: Who can get one?
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 quite rare!)
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Exemption with a European Health Insurance

Card: Procedure
1. Wait for the (German!) letter from the local authorities in
which they ask you to prove your health insurance
coverage
2. Send in the following documents to the address where
the letter came from:
the application form: download from www.gd.zh.ch/kvg
(-> Antragsformulare -> application form in English )
a copy of your student card
a copy of your European Health Insurance Card
3. Wait for the decision

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Exemption with a private insurance from

another country: Procedure
1. Wait for the (German!) letter from the local authorities in
which they ask you to prove your health insurance
coverage
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2. Send in the following documents to the address where
the letter came from:
the application form: download from www.gd.zh.ch/kvg
(-> Antragsformulare -> application form in English )
a copy of your student card
a copy of your health insurance card, if available
Form A, signed an stamped by your current insurance company:
download from www.gd.zh.ch/kvg
(-> Besttigungsformulare -> Studierende -> form A in English )
a copy of your insurance policy (in German, French, Italian or English)
3. Wait for the decision

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For those living in the city of Zurich: Once your application
for an exemption has been received by the Stdtische
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 Zrich
-> this is the normal procedure since the
Gesundheitsdirektion des Kantons Zrich makes
the final decisions you can thus ignore this letter!
If you have any doubts, please come and ask us!
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Forwarding your request: example letter
Letter from Stdtische

Gesundheitsdienste when
forwarding your exemption request
to the Gesundheitsdirektion des
Kantons Zurich for the final
decision.
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Final decision: example letter
Final letter once your exemption

request has been approved.
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Summary:
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Good to know about exemptions:

An exemption is usually given for 3 years and can be
renewed for another 3 years
If you deregister from the city of Zurich (e.g. to do an
internship abroad) and come back: the second tranche
will start! If you have any doubts about this: contact us!
After having had an exemption for 6 years you will have to
get a Swiss health insurance
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Get a Swiss health insurance: How to start

You will need a Swiss health insurance if
you are a non-EU citizen (and cannot apply for an exemption)
your request for an exemption was denied
Important: Wait for the (German!) letter from the local

authorities in which they ask you to prove your health
insurance coverage
Choose your favored insurance plan (see our
recommendations below)
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Get a Swiss health insurance: compare premiums

Compare premiums online by checking
www.comparis.ch (En, De, Fr, It) or www.priminfo.ch (De, Fr, It)
Comparis and Priminfo are Swiss internet comparison

services - you can easily compare rates and services of
health insurance providers (and more, e.g. mobile phone
rates)
Easy to handle
Not all offers appear in Comparis/Priminfo (e.g. Swisscare
doesnt!)
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Get a Swiss health insurance: 3 options

1) Swisscare
2) CSS plan
3) Any insurance plan
special health insurance

plan for international
students
normal Swiss KVG

insurance
normal Swiss KVG

insurance
its expensive in the

beginning (> CHF
200/month), but: you can
get a premium reduction!
its expensive (> CHF

200/month), but: you can
get a premium reduction!
its cheap! (< CHF

100/month)
Its a VVG insurance! ->
an exemption from the
Swiss health insurance
obligation according to
the KVG law is needed!
you get personal

guidance (even on the
premium reduction
procedure) by a CSS
insurance consultant
application for insurance

and premium reduction is
rather complicated -> you
should be fluent in
German to be able to
handle all this yourself!
weve been working with

this company for several
years -> good connections
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1) Swisscare a special package for

international students
Benefits:
cheap: CHF 89.50/month
(premiums will raise slightly as from 1 Jan 2015)
if you apply before 31 Dec 2014, you will be guaranteed the current rate
until 31 Dec 2015!
low deductible: CHF 300 (or alternatively: CHF 500)
no health check
its all in English
online application (www.swisscare.ch), no personal appointment is
required
Swisscare is not recognized by the authorities of the

following cantons: Aargau, Neuchtel, Ticino!
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Swisscare how to get it?
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As from 1.1.2015: monthly

premium will rise slightly,
unless you apply BEFORE
31.12.2014!
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Complete the 7 steps, its
very straightforward
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Click on this link to download Form A:

needed to get an exemption from the KVG
obligation! -> it is absolutely crucial to fill it
out and to follow the instructions!
Confirmation email
18 September 2014
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Swisscare
how to cancel it before you leave?
To cancel Swisscare you will need the
Abmeldebesttigung/deregistration confirmation of the city hall
(outside the city of Zurich: the municipal administration office).
Inform Swisscare at least one month prior to your departure about the
exact departure date and hand in the above mentioned confirmation.
Swisscare will refund unused 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.
18 September 2014
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Swisscare should you go for it?

Its a good option if you come to ETH for just 1 semester
(and do not want to spend more than CHF 200/month for
premiums)
Its one of the (currently) cheapest offers available
Its really easy to get: all online and completely in English
We got a few of negative feedbacks in the past
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2) CSS insurance plan

Benefits:
recognized in all Swiss cantons
you can choose among different models (Standard, Family doctor,
HMO, Telmed) and take the one that suits you best
once you get your premium reduction, your premium will be very low!
(lower than with Swisscare). However, you always pay the deductible
first and 10% cost contribution.
you get personal guidance (even on the premium reduction procedure)
by a CSS insurance consultant
you have a clear contact point in case questions/problems occur
You will have to pay a premium of more than CHF

200/month in the first few months (until your
application for a premium reduction is approved!)
18.9.2014
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CSS insurance plan how to get it?

Check www.css.ch to get an idea about the different plans
and rates
Example of a student
born in 1992. Current price
with highest deductible:
CHF 357.70!
18 September 2014
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1. Fill in the personal data sheet, save it on your computer and print it
2. Send an email to CSS (antonio.kass@css.ch) and ask for an
appointment. Attach your personal data sheet with the email
(important!). -> it is absolutely necessary to make an
appointment in advance!
3. Wait for CSS to reply and give you an appointment.
4. Visit CSS on the agreed date and time. Take with you: the German
letter from the Stdtische Gesundheitsdienste in which you were
asked to get a Swiss health insurance; the printed personal data
sheet; your passport; your ETH card.
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It is possible to go in groups of max. 4 students. If you
want to do so, you must attach the personal data sheets
from ALL of you with the email!
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3) Choose any insurance plan (any company)

Use Comparis or Priminfo to search for offers.
From the list you get: select the insurance plan you prefer
and order an offer online. Or, alternatively, go to the
website of that insurance company and order it there.
Sign it and send it back.
Once you have been living in the same canton for 3
months -> apply for a IPR (premium reduction,
information available in German only!)
18 September 2014
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Individual Premium Reduction (IPR)

Policyholders whose annual taxable income does not
exceed a certain amount (varies according to canton and
marital status) may be eligible for a reduction on their
health insurance premiums.
Who can get it? -> Everybody with a low or no income
Requirement: you can only get it once you have been
living in the canton to which you apply for at least 3
months! -> not before approx. Nov/Dec 2014
Application is rather complicated, forms and websites are
in German only!
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What to do in case of illness

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 Allgemeinrzte (general practitioners)
-> 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
If you are insured under a Family doctor, HMO or Telmed plan
-> contact the appropriate doctor, medical practice or hotline!
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What to do in case of illness

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 (e.g. a chronical disease or other regular
treatment), please do always double check with your
insurance company whether the treatment will be fully
covered!
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Permanence in the main station
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Billing procedure
Usual billing procedure when seeing a general
practitioner (doctor):
A few days/weeks after the treatment, the doctor will send
you the following:
bill (including a payment slip; payable within 30 days)
reimbursement certificate (Rckforderungsbeleg)
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Reimbursement
certificate
Doctors name
and address
Law (KVG or VVG)

Duration of treatment
Detailed list of
treatment & medicine
(for each day of
treatment)
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How to get your money back: Procedure for

students with a Swiss health insurance
1. Wait for the doctors bill
2. Pay the bill to the doctor within 30 days
3. Send the reimbursement certificate (Rckforderungsbeleg) to your insurance company.
Most insurance companies provide you with a set of stickers with your
reference number on. Stick one of these on each Rckforderungsbeleg
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 doctors bill ->
call the doctors practice and ask them to stop any legal
proceeding!
18.9.2014
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students with a Swiss health insurance
Possible billing proceedure when receiving hospital
treatment
Important: 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!
18.9.2014
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EU/EFTA students with an exemption
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 doctors bill
2. Pay the bill within 30 days
3. Send the following to the Gemeinsame Einrichtung
KVG
original doctors bill (without payment slip) incl. Rckforderungsbeleg
copy of your European Health Insurance Card (backside)
exemption confirmation - Final letter (Verfgung) from the
Gesundheitsdirektion des Kantons Zrich
confirmation of matriculation from ETH Zurich
your bank information (IBAN, BIC, banks 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!
18.9.2014
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18.9.2014
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Thank you!
Download this presentation:
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| 57

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Health insurance in Switzerland:

All you need to know

Annina Wanner / Sandra Zweifel

Health insurance in Switzerland important basics

Exemption from the Swiss health insurance obligation

You need a new insurance in Switzerland?

What to do in case of illness?

Annina Wanner / Sandra Zweifel

Download this presentation:

ETH Zurich, Rectorate

Annina Wanner / Sandra Zweifel

Important basics 1: health insurance is

Annina Wanner / Sandra Zweifel

Open mail from the

ETH Zurich, Rectorate

Annina Wanner / Sandra Zweifel

Important basics 2: What does the mandatory

ETH Zurich, Rectorate

Annina Wanner / Sandra Zweifel

Important basics 2: What does the mandatory

Basic insurance benefits are determined by law and

Annina Wanner / Sandra Zweifel

Important basics 2: What does the mandatory

ETH Zurich, Rectorate

Annina Wanner / Sandra Zweifel

Important basics 3: premiums, deductibles, cost

Franchise: annual deductible

Annina Wanner / Sandra Zweifel

Important basics 3: premiums, deductibles, cost

Cost example (simplified):

10% of the rest (CHF 1700)

You have to pay:

Your insurance company has to pay:

Annina Wanner / Sandra Zweifel

Important basics 3: premiums, deductibles, cost

Free choice of physicians

You always consult the same doctor

HMO (Health You always consult a specified doctor based at up to 25%

ETH Zurich, Rectorate

You have to call a consultation hotline for

For further general information:

ETH Zurich, Rectorate

Annina Wanner / Sandra Zweifel

ETH Zurich, Rectorate

Annina Wanner / Sandra Zweifel

Exemption from the Swiss health insurance

ETH Zurich, Rectorate

Annina Wanner / Sandra Zweifel

Exemption with a European Health Insurance

3. Wait for the decision

Annina Wanner / Sandra Zweifel

Exemption with a private insurance from

ETH Zurich, Rectorate

Annina Wanner / Sandra Zweifel

Exemption with a private insurance from

3. Wait for the decision

Annina Wanner / Sandra Zweifel

ETH Zurich, Rectorate

Annina Wanner / Sandra Zweifel

Exemption with a private insurance from

Annina Wanner / Sandra Zweifel

Forwarding your request: example letter

Letter from Stdtische

Annina Wanner / Sandra Zweifel