Basic insurance is compulsory in Switzerland, and it is not taken out automatically. It is up to the person arriving, or their legal representative, to choose an insurer and join. The law allows three months to do so, and provides for consequences if the deadline is missed.
Who must take out insurance, and by when
Anyone domiciled in Switzerland must take out insurance for healthcare in the event of illness, or be insured by their legal representative, within three months of taking up residence or of being born in Switzerland. The Federal Office of Public Health (FOPH) states that parents have the same deadline to insure their newborn. The deadline is not extended while you are settling in: it runs from the date you take up residence, even if housing, the permit or work are still being arranged.
Foreign nationals holding a short-term permit or a residence permit valid for at least three months are also required to take out insurance. So are those whose short-term permit is valid for less than three months, where they do not have equivalent insurance cover for treatment in Switzerland. For them, the three-month deadline runs from their registration with the residents' registration office.
Insuring on time: retroactive cover
When you join within the deadline, the insurance takes effect from the date you took up residence, or from the date of registration for people holding a permit. Treatment received in the first few weeks is therefore covered, even if the contract was concluded later, provided you stay within the three months.
The choice of insurer is free, and no insurer may refuse a person who is required to take out basic insurance. Basic insurance benefits are the same everywhere; only the premium, the deductible and the model differ. Comparing premiums for your canton before choosing is therefore the most useful decision of these three months.
For someone who works, a saving is often possible from the start. Basic insurance also covers accidents, whereas an employee is generally already insured against accidents through their employer. The accident cover of the health insurance can then be suspended, on request and with proof of that cover; the insurer reduces the premium accordingly. Accidents are covered by the health insurance again as soon as the employer's cover ends, wholly or in part.
What a delay costs
If you join late, the insurance only takes effect from the date you join: treatment received before that remains payable by you. If the delay is not excusable, a premium surcharge is due. The ordinance sets it at between 30 and 50% of the premium, charged for a period equal to twice the delay, but for no more than five years. No surcharge is charged when social assistance pays the premiums.
The cantons ensure that the obligation is respected. The cantonal authority automatically enrols anyone required to be insured who has not done so in time: the insurer is then chosen by the canton, not by the person.
The possible exemptions
The ordinance provides for exceptions, always on request. Those who may be exempted include: people who are compulsorily insured against illness under the law of another state, where they have equivalent cover for treatment in Switzerland; people staying in Switzerland for education or further training, such as students, pupils and trainees, for three years at most; and posted workers exempted from AHV/AVS and IV/AI contributions under an international agreement.
People who live in a European Union state may also be exempted, insofar as the agreement on the free movement of persons allows it, as may certain people without gainful employment who hold a residence permit under that agreement or the EFTA agreement, on the conditions set by the ordinance.
An exemption may also be granted where joining the Swiss insurance would lead to a clear deterioration in insurance protection. In every case, it is the authority of the canton of residence that decides, and the foreign cover must be equivalent to what Swiss law requires.
The first steps, in order
- Register with the residents' registration office of your commune: the registration date sets the start of the deadline for people holding a permit.
- If you have foreign cover, check without delay whether an exemption is possible, and submit the request within the cantonal deadline.
- Otherwise, compare premiums for your canton, deductible and model, and join an insurer within three months.
- Insure each child, including a child born in Switzerland, within three months of the birth.
- Keep the certificate of registration with the residents' office and the confirmation of membership: these two dates prove that the deadline was met.
Complementary insurance, for its part, is in no way compulsory and is subject to no deadline: it can be taken out later, with its own conditions and its own health questionnaire.