What Does Basic Health Insurance Cover in Switzerland?

In Switzerland, basic health insurance (Grundversicherung) is a mandatory part of the healthcare system for all residents. It forms the foundation of medical coverage and guarantees access to high-quality healthcare services for everyone. While it represents the minimum level of coverage, the range of services included is remarkably comprehensive.

Core Principles

• Mandatory coverage: Every person residing in Switzerland must be insured.
• Uniform benefits: Regardless of the insurance provider chosen, the scope of coverage is the same.
• Freedom of choice: Individuals can choose their insurer and the insurance model.
• Mandatory acceptance: Health insurers are obligated to accept all applicants.

What Does Basic Insurance Cover?

Basic insurance covers costs related to illness, maternity, and — unless separately insured by the employer — accident treatment.

Medical Services:

• Visits to general practitioners
• Specialist consultations with a referral
• Online consultations (depending on the model)

Hospitalization:

• Treatment and accommodation in the general ward of a public hospital in your canton of residence
• Emergency care anywhere in Switzerland

Medication:

• Medications listed in the official Specialties List (SL)
• Essential prescription drugs

Diagnostics and Therapy:

• Laboratory tests, X-rays, ultrasounds, MRIs, etc.
• Physiotherapy, occupational therapy, speech therapy (with a medical referral)
• Outpatient psychotherapy (limited)

Maternity and Childcare:

• Pregnancy check-ups and delivery assistance
• Consultations with gynecologists
• Preventive examinations for newborns
• Postnatal care by midwives

Prevention:

• Vaccinations recommended by the Federal Office of Public Health (FOPH)
• Vision and hearing tests for children
• Cancer screenings under certain conditions

What Is Not Covered by Basic Insurance?

• Dental treatments (except for severe jaw conditions)
• Medical treatments abroad (except emergencies within the EU)
• Stays in semi-private or private hospital wards without supplementary insurance
• Alternative medicine (only partially, e.g., acupuncture by certified doctors)
• Cosmetic procedures

Additional Conditions

• Deductible (Franchise): Insured individuals must pay an annual amount themselves (minimum 300 CHF).
• Co-payment (Selbstbehalt): After reaching the deductible, 10% of further costs must be paid, up to 700 CHF per year.
• Choice of model: Standard, HMO, family doctor, or Telmed — each affects the monthly premium.

Conclusion

Basic health insurance in Switzerland ensures that all residents have access to essential and high-quality medical care. It covers core services such as doctor visits, medication, diagnostics, therapies, and maternity care. For additional comfort or extended services, individuals can purchase optional supplementary insurance.