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Health Insurance

An insurance product (KVG + complementary) with attractive conditions and premiums has been proposed by ACIDE.

If interested, you can cancel your current health insurance before December 31st, through registered letter, sent before November 30th (the cancellation letter must arrive at the latest on the last working day of November). You can sign your new ASSURA contract via ACIDE starting January.

The health insurance fund Assura Basis offer the most advantageous bounties in Switzerland. In total, the group ASSURA insure more than a million clients in 2020.

We offer 60 minutes of free advice to our members according to their need with our consultant.

Come to one of our information sessions, every Wednesday at 10am in the ACIDE office  CM 0143 or send an email to acide@epfl.ch.

Primes 2013

Health insurance in Switzerland

Health insurance in Switzerland

The health insurance system is divided into two groups:

  • Basic, compulsory health insurance and
  • Supplementary insurance.

All persons residing in Switzerland are obliged to have basic insurance, while supplementary insurance is voluntary.

Basic insurance

Basic insurance

Basic insurance is a compulsory insurance for every person residing in Switzerland (as well as for foreigners staying more than 3 months in the country) and is subject to the public law on health insurance (LAMal).

Its main characteristics are (non-exhaustive list):

  • The benefits that the health insurance company has to cover are listed in the LaMal; they basically cover all conventional medical services for outpatient treatment [with the notable exception of dental care] and stays in a public hospital in the canton of residence, as well as medicines prescribed by a doctor. As a result, all health insurance companies offer exactly the same range of benefits in basic insurance.
  • In case of illness there is still a contribution to the costs, including the following components:
    • an optional annual deductible for adults of CHF 300, 500, 1000, 1500, 2000 or 2500.
    • a 10% share of the amounts paid, up to a maximum annual amount of CHF 700.

The co-payment is the amount of health expenses (doctor, hospital and medication) that the insured must pay out of pocket. Unlike the deductible, it is impossible to decide on this amount. It corresponds to a percentage of participation in the costs, once the deductible has been fully deducted.

The deductible for children is CHF 350. If more than 2 children of the same family are insured with the same health insurance company, the deductible is limited to a total of CHF 700 for all children.

  • For single persons, a daily contribution to the accommodation costs of CHF 15 per day of hospitalization. The deductible corresponds to the part of the annual costs (the decisive date is the date on which the service was provided), covered by the basic insurance, which the insured person must pay in full.
  • Medicines: On January 1, 2006, the co-payment for an original medicine for which a generic exists was increased from 10% to 20%. The co-payment for generics remains at 10%.

 

  • Maternity: As of March 1, 2014, there is no longer a co-payment for illness in the maternity setting (e.g., complications) between the 13th week of pregnancy and 8 weeks postpartum. 
From now on, women will no longer have to contribute to the costs of medical benefits provided during the period from the 13th week of pregnancy (SG) until eight weeks (56 days) after delivery. As a result, they will no longer even have to contribute to the costs of treating illnesses that are unrelated to the pregnancy. Even a stillborn child after the 23rd week of pregnancy is considered a birth. This provision applies, with some exceptions, to all medical services that are reimbursed through compulsory health insurance (AOS). This also applies to physiotherapy, flu treatments, medication, etc. Therefore, the treatment of complications during pregnancy is also exempt from cost-sharing. As a rule, it is no longer necessary to make a distinction between specific maternity benefits and general sickness benefits.

 

  • As an exception, the following are still subject to cost-sharing (deductible, co-payment, hospital stay cost-sharing):
    • benefits for prevention, congenital disabilities,
    • treatment following an accident, non-punishable abortion, treatment benefits.

 

  • Psychotherapy: covered only if it is with a psychiatrist (=physician).
  • The health insurance companies are obliged to accept all applicants without reservation and without a health questionnaire, i.e. a health insurance company can neither refuse to insure you nor exclude from the coverage certain illnesses that you might have when you apply.
  • Premiums are the same for men and women.
  • There are only three age categories with different premiums. This means that an assistant employed at EPFL necessarily falls into the last category, even if he/she is under 25 years old.
    • children [up to 18 years old]
    • young people in training [up to 25 years old]
    • adults
  • The insurance is renewed tacitly from year to year. Cancellation deadlines depend on the deductible: with the minimum deductible, it is possible to cancel a contract on June 30 or December 31. With a higher deductible, the termination can only be done on December 31. In any case, the cancellation period is three months. If the insurer makes changes to the contract (e.g. an increase in premiums), the insured may terminate the contract within one month of the notice of the change. The annual adjustment of premiums is generally communicated in October, the deadline for terminating a contract being the end of November (date of receipt). To terminate a contract, it is necessary to send a letter in this sense to the insurer; to avoid any risk of dispute (letter not received, or out of time), this sending must be done as a “letter-signature” (formerly called registered). If you live in Switzerland, you will also have to provide your former insurer with a certificate indicating that you are newly insured with another company, but this certificate can be provided at a later date.
  • Regarding the limitations of basic insurance, the following points should be noted:
    • There is no free choice of hospital, only the public institution of the canton of residence is covered (the CHUV for Vaud residents, the HUG for Geneva residents, etc.)
    • Hospitalization can only be in a common ward (rooms with 4 to 6 beds).
    • The benefits of certain specialized practitioners (usually professors, department heads, etc.) are not covered.
    • Dental expenses are only covered if they result from an accident, or a serious non-preventable illness (i.e. dental care expenses are generally not covered).
    • Alternative medicine is hardly covered at all. However, supplementary insurances allow filling these gaps.

Good to know

Good to know

EPFL employees with an employment rate of 50% or more are automatically insured against occupational and non-occupational accidents. The LAA accident insurance does not impose any deductible or co-payment on the insured.

Complementary insurance

Complementary insurance

Supplementary insurances are subject to the private insurance contract law (VVG), which means that the insurance conditions depend on the risks. As there is no legally defined catalog of benefits, each health insurance company offers its own combinations.

Some special features of supplementary insurance :

  • The insurer may require you to undergo a medical examination by the insurance doctor.
  • The insurer may have reservations.
  • The insurer can refuse you.
  • Premiums are based on risk, which generally means that women and older people will pay more.