Choosing the Right Health Insurance

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If You Live in France:

You have two options when moving to France or starting a new job in Switzerland: the French national health insurance scheme (CPAM) or mandatory basic health insurance (AOS), regulated by the Swiss Federal Law on Health Insurance (LAMal) in Switzerland.

While your choice of health insurance is crucial to ensure you are properly covered, your choice of supplemental health insurance is equally important. Several factors need to be taken into account before choosing your health insurance.

The table below summarizes the advantages and disadvantages of these different types of health insurances.

If You Want to Take Out French Health Insurance

Health insurance is offered as part of the overall French social security scheme. Its main task is to protect your health, both at home and at work, and covers:

• illness, maternity, disability, and death, with coverage of your healthcare costs, daily allowance benefits in the event of sick leave, and a pension in the event of disability,
• workplace accidents and illness, with full coverage for care, incremental daily allowance benefits in the event of sick leave, and a pension for your beneficiaries in the event of death.

It provides mandatory health protection by guaranteeing access to care, regardless of your resources, situation, or health status.

Healthcare costs are covered up to an agreed rate per procedure. You will therefore either need to pay any costs in excess of that amount or, alternatively, a private health insurance provider can pay.

Depending on the coverage provided, the private health insurance provider covers some or even all of the costs that are not reimbursed by the health insurance scheme, including:

• patient’s contributions, corresponding to the outstanding amount to be paid by you after reimbursement by health insurance,
• extra billing, corresponding to the portion of the consultation or care costs that exceeds the French social security system’s reimbursement rate, or care that has limited or no coverage from French social security (costs relating to dental care, hearing care, eye care, orthodontics, alternative medicine, etc.)

As a result, you will be covered in France. In the event of a life-threatening emergency, you may receive care in a Swiss public hospital without prior agreement.

If You Want to Take Out Swiss Health Insurance 

The Swiss LAMal scheme (mandatory health insurance) offers an alternative health insurance option to people working in Switzerland and living in France. This health insurance allows them to receive care in either Switzerland or France. In both cases, reimbursement is subject to the legislation in force in the country providing the care. Swiss mandatory health insurance is personal, and all family members of the Swiss worker living in France need to be insured under the same health insurance scheme as the worker (except for family members who have to be insured in France, e.g., a partner who works in France and is therefore insured under the French general health insurance scheme).

PLEASE NOTE: 

You need to decide whether to take out Swiss or French health insurance within the first three months of starting employment. If you have not chosen your health insurance after this time, you will be automatically registered to LAMal and you will not be able to cancel (unless there is a change in your legal status). This is an administrative deadline. As soon as you start working in Switzerland or move to France, you no longer have health insurance coverage, you therefore need to choose your health insurance as quickly as possible!

In summary, if you want access to the Swiss healthcare system, you need to choose the Swiss health insurance model for both mandatory basic health insurance (LAMal) and supplemental health insurance ((anchor link)). Likewise, if you want to receive care in France, the French healthcare system is best for you.

If You Live in Switzerland:

Swiss health insurance for people living in Switzerland is very specific. Here is some useful information to help you gain a better understanding.

Mandatory Health Insurance (LAMal) for Swiss Residents

As a Swiss worker or a foreign national in Switzerland you are required to take out mandatory basic health insurance (LAMal). This requirement applies to those with a work permit longer than three months (B, L and C work permits) and to Swiss nationals.

Mandatory basic health insurance (LAMal) for residents covers:

• treatments by a physician and prescribed medications
• treatment costs in a general hospital ward
• maternity costs in a general maternity ward
• other benefits under certain conditions (e.g., vaccines, home care services, etc.)

There is no coverage for dental treatments, including orthodontics, except for certain special cases (e.g., serious chewing problems). There is also no coverage for orthopedic braces and eye care is very rarely reimbursed. In most cases, foreign workers will need to get insurance, except in rare cases (e.g., employees of international organizations, diplomatic missions, etc.). If this applies to you, you should talk to your employer. With respect to deadlines, a foreign national who moves to Switzerland needs to take out health insurance when they arrive and provide proof of health insurance coverage to their local authorities within three months of employment at the latest.

Mandatory Health Insurance (LAMal) Prices

There are numerous price comparison websites which you can use to compare the various health insurance schemes available. Remember to check that the information provided is reliable and impartial. The official website of the Swiss Government has an independent price comparison website, Priminfo.ch, and we recommend using this if you want to compare offers.

These health insurance providers all offer the same coverage, regardless of the health insurance scheme you have used to take out your mandatory basic health insurance (LAMal). The price difference is mainly due to the services offered, such as a third-party payment system (the health insurance provider pays the healthcare provider directly upon receiving the bill and then bills you for the outstanding amount) or a 24-hour helpline. If these services are not important to you, it is best to choose the health insurance scheme that offer the least expensive mandatory health insurance.

Swiss mandatory health insurance has an insurance premium payment, an annual deductible, and a contribution to treatment costs (percentage). (website link)

You choose your annual deductible yourself. This amount will not be reimbursed for your healthcare costs during the year. The amount depends on the type of policy that you have taken out with your insurance company. In most cases, the higher a plan’s deductible, the lower the premium. If you have several children and they are insured under the same health insurance scheme, the maximum annual deductible that you will have to pay is 700 Swiss francs for all children.

For adults, the following deductibles are available:

300; 500; 1,000; 1,500; 2,000; and 2,500 Swiss francs.

Deductibles and contributions to costs are set by the Swiss government: this means that they are the same for all health insurance companies.

Once your deductible has been used up, you will continue to pay 10% of your treatment costs (regardless of the deductible you agreed to pay). This percentage applies to all costs relating to medical consultations, medication prescriptions, and hospitalization charges.

It does not apply to maternity expenses. The maximum annual rate is 700 Swiss francs for adults and 350 Swiss francs for children.

Supplemental Health Insurance in Switzerland

Basic health insurance in Switzerland offers great coverage but it does not cover additional or complementary services. In particular, in the event of hospitalization, numerous healthcare providers, including Hôpital de La Tour, offer more advanced services, which require more investment in terms of safety and quality of life than those reimbursed by basic health insurance.

You can take out supplemental health insurance to top up coverage offered by your mandatory health insurance. Please note, these are directly dependent on your health status when you purchase the health insurance. Premiums can vary considerably between health insurance schemes and may increase as you get older. Each product has its own framework conditions and, as a result, there are as many situations as there are policies.

In terms of reimbursement, it is more straightforward to have your LAMal health insurance and your supplemental health insurance with the same health insurance provider.

Here are some examples of coverage and benefits within the framework of supplemental health insurance:

• Coverage throughout Switzerland
• You are free to choose the facility and physicians
• Faster and preferential access to cutting-edge medicine in Switzerland
• Partial coverage of gym membership

If the benefits appear attractive, many health insurance providers try to limit them in order to reduce their costs. That’s why you need to be on the lookout for traps!

To help you, here are some of the main pitfalls to watch out for:

Checklist of traps to avoid:

• The price of mandatory health insurance is not a determining factor: do not fall into the trap of thinking that, just because the health insurance is more expensive, it must have more benefits; the additional cost usually corresponds to more services (e.g., helpline, third party payment system).
• Although one of the main reasons for choosing supplemental health insurance is being free to choose the facility and physicians, health insurance providers are introducing more and more hidden exclusions clauses into policies. Check if the facilities and physicians are limited to a list by the health insurance provider or if you have free choice. A set list means that the health insurance provider has the right to limit the facilities and physicians you can access. It is important to carefully review any terms where these changes may be made because some health insurance providers make these changes without prior notice, giving you no chance to object.
• If you want to switch your supplemental health insurance, check the details in advance because your age and medical history may mean your new health insurance provider refuses to insure you.
• When you sign your health insurance policy, remember to also check the notice period for your supplemental health insurance, in the event you want to change it. Make sure that you also find out about how it can change in the future, for example, if your health deteriorates. Health insurance providers often hold their customers captive by not leaving them any alternative.
• Health insurance companies are constantly developing new products, often with high deductibles (for example, myFlex by CSS) and hidden exclusions. Make sure that you do your research because they want you to think that you are fully covered when in reality you may still need to pay for some of the costs yourself.
• Look into other supplemental health insurance on the market (e.g., glasses, dental care, etc.).

Other solutions may be available!

Your medical history is a key factor. There are also the options of international health insurance and alternative solutions, such as those we can offer at Hôpital de La Tour. Finally, not all private healthcare facilities offer the same things. Make sure that you do your research before choosing your health insurance because you may not have access to your trusted private healthcare facility or the expertise of the best specialist teams.