Health insurance

The medical benefits of basic insurance are the same for all Krankenkassen  - regardless of model, deductible and place of residence. This is stipulated by law. 

The Health Insurance Act stipulates that the services provided by doctors must be "effective, expedient and economical".

Compulsory health insurance (= basic insurance) covers the costs of examinations, treatment and necessary medication in the event of illness, accident and maternity. 

You are also entitled to medical services in emergencies, for transport and rescue operations, as well as in hospitals and day-care facilities. 

Therapeutic measures such as occupational and physiotherapy as well as preventive measures and diabetes counselling are also covered. Other benefits are also paid out for rehabilitation, care, speech therapy or treatment by a chiropractor.

The costs for medically and psychologically prescribed psychotherapies are also covered by basic insurance.

Note: Regular gynaecological check-ups are also covered by basic insurance.

Every month, you'll have to pay money for health insurance — an Versicherungsprämie .

How much you have to pay depends on:

• where you live
• how much you want to pay for possible health costs yourself
• which additional benefits you would like to insure.
  

You can add additional services such as dental treatment. These are not covered by basic insurance and must otherwise be paid separately.

The Versicherungsprämie will be cheaper if, for example, you choose the so-called Hausarztmodell . With this model, you always have to go to the family doctor's office first. Your family doctor will then refer you to a specialised practice for further treatment.

The cost of the insurance premium is expensive. The amount of the premium varies according to age group, canton of residence and Krankenkasse , but not according to income.

People and families who earn little therefore receive an individual Prämienverbilligung (IPV)  which only applies to basic insurance, but not to supplementary insurance.  

In the Canton of St.Gallen, you always have from 1 January to 31 March to register for the IPV . Please note that a new registration is required for each year.

The application should be sent to the Social Insurance Institution of the Canton of St.Gallen (SVA SG). This can be done online or via the AHV branch of your municipality of residence.

Important note: If you are moving to the Canton of St.Gallen from abroad, you can submit the IPV application at any time. 

The Franchise is the amount that you have to pay yourself before the health insurance company covers a share of the costs. Costs are incurred when visiting a doctor, buying prescription medication or staying in hospital. As a patient, you must pay for these services yourself until the amount of your Franchise  is reached. 

In each calendar year, you must therefore pay this Franchise  yourself up to the amount you have chosen.

↑ High Franchise

If you are rarely sick, then you can choose a high Franchise . This makes the monthly Versicherungsprämie cheaper.

↓ Low Franchise

If you expect a lot of doctor's visits, surgery, or medical treatments in the coming year, then it's better if you choose a low Franchise . The monthly Versicherungsprämie is then more expensive, but you pay less towards the treatment costs.

If your annual medical and treatment costs exceed the selected Franchise , the health insurance company will pay the additional costs.

However, you will continue to pay a deductible of 10% of the costs – up to an upper limit of 700 francs (children: 350 francs) per year.

In Switzerland, everyone must have accident insurance, which pays for treatment costs and loss of earnings if you have an accident. 

> Do you have a job and work there 8 hours or more a week?

Then your employer insures you against accidents. You do not have to take out accident insurance.


> Are you self-employed or work less than 8 hours a week in a job?

In this case, you must take out accident insurance yourself. This is possible, for example, with your health insurance company as a supplement.

Note: You must also take out accident insurance for the children. You can integrate this into your basic insurance.

Basic insurance for your baby

Every baby needs its own basic insurance. You can take out this insurance before the birth (and no later than 3 months after the birth).

If you want to insure your unborn child comprehensively, it is worth registering before the birth. You can also take out supplementary insurance before the birth.

Accident insurance for children

Accident insurance is mandatory in Switzerland . You can take out accident insurance for your child through basic insurance .

Supplementary dental insurance from the age of 6

Dental treatment can be expensive. Especially for children, it is worthwhile to take out supplementary dental insurance. You will save costs if you take out the insurance for your child as early as possible – preferably at kindergarten age.

Supplementary insurance for glasses

Health insurance companies contribute to the financing of children's glasses and contact lenses. 

The Patientestelle Ostschweiz offers: 

• Advice and support in the entire field of health care
• Information for patients of all ages about their rights and obligations and helps them to exercise and enforce their rights.
• Decision support before the start of treatment and before planned surgery
• Mediation in conflicts
• Advice on insurance issues, cost coverage, change of health insurance provider
• Clarification of treatment errors

> Patient Centre Eastern Switzerland