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HEALTH INSURANCE

What isn’t covered by Switzerland’s compulsory health insurance?

Switzerland’s basic health insurance is among the most expensive in the world, but there are certain services it doesn’t pay for. Here are some of the benefits the scheme won’t cover in full.

What isn't covered by Switzerland’s compulsory health insurance?
Basic insurance: You will have to share your hospital room with other patients. Photo: Pixabay

Basic insurance — KVG in German and LaMal in French and Italian —  is compulsory in Switzerland. It doesn’t come cheap, but it is quite comprehensive and includes coverage for illness, medications, tests, maternity, physical therapy, preventive care, and many other treatments.

It also covers accidents for those who do not have accident insurance through their workplace.

Basically, whatever the doctor orders is covered by KVG / LaMal, at least partially.

READ MORE: Everything you need to know about health insurance in Switzerland

However, there are some treatments the basic insurance won’t pay for.

Experimental treatments

Any experimental treatments or drugs — that is, those not approved by the Swissmedic regulatory agency or the Federal Office of Public Health (FOPH) will not be covered.

This exclusion is not specifically Swiss; insurance schemes is most countries won’t cover unauthorised medical treatment either.

Dental care

In most cases, services such as teeth cleaning, dental fillings, root canals, tooth extractions, and orthodontic braces, are not included under basic insurance.

The only exceptions, according to the Federal Office of Public Health (FOPH), are dental interventions “necessitated by a serious disorder of the masticatory system, or if such treatment is required to support and ensure the success of medical treatment for a severe general disorder (e.g. leukaemia, heart-valve replacement)”.

Most dental treatments are not covered. Photo by Pixabay

Eyeglasses and contact lenses

Compulsory health insurance will contribute up to 180 francs per year towards glasses and contact lenses prescribed by an ophthalmologist for children up to the age of 18.

No such benefit exist for adults. However, “in the case of serious visual impairment or certain illnesses (e.g. disease-related refraction abnormalities, postoperative alterations or corneal disease), compulsory health insurance will, regardless of age, make higher contributions towards medically prescribed spectacle and contact lenses”, FOPH says.

READ MORE: Reader question: Can Swiss health insurance exclude me if I have pre-existing conditions?

Ambulance

Emergency vehicles that transport you to a hospital can be quite expensive — depending on the canton, the costs can range from 900 to 2,000 francs per trip. 

Basic health insurance will contribute a certain amount  to the cost of emergency transportation, but only if it is a medical necessity — a serious accident, an illness, or a life-threatening situation. But if the patient could have travelled by private car or public transport, basic health insurance policies will pay nothing.

Insurance will cover some of the cost of ambulance transport only in emergency. Photo by Fabrice COFFRINI / AFP

Private hospital room

While the cost of your hospitalisation will be fully covered, the basic insurance does not pay for a private room.

You will be accommodated in a room with other patients.

Depending on a medical facility — whether it’s a small hospital or a large, university medical centre, you could end up with just one other person or possibly four or five, the latter being common in teaching hospitals.

If you insist on a private accommodation, you will have to pay for it out of your own pocket.

Reader question: Can Swiss health insurance exclude me if I have pre-existing conditions?

Vaccines

Immunisations outlined by FOPH  will be paid for by insurance, as will the Covid vaccine.

Not covered, however, are travel-related vaccinations or preventive measures, such as against yellow fever or malaria.

Treatment abroad

Outside Switzerland, only emergency care is covered  — double the amount that the same treatment would cost in Switzerland.

Usually, basic health insurance will not cover transportation costs back to Switzerland, except in case of emergency, when it will cover 50 percent of the total cost of transportation to the nearest hospital abroad — but no more than 500 francs per year. 

If you only have a basic insurance policy and travel abroad often, especially to the United States, you should take out a travel insurance that will cover you for illness and accidents in foreign countries above and beyond what your Swiss carrier will pay.

And if you want to upgrade your treatment options, consider taking out a supplemental insurance or, if you can afford it, private one.

READ MORE: Should you buy supplemental health insurance in Switzerland?

You can find out more about what KVG / LaMal will and will not cover here.

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OPINION & ANALYSIS

OPINION: Anti-abortion activists in Switzerland are just posturing with latest hollow move

As women’s reproductive rights are on the verge of being drastically eroded in the United States, Switzerland is witnessing the launch of two parallel popular initiatives seeking to restrict access to abortion here, writes Clare O'Dea.

OPINION: Anti-abortion activists in Switzerland are just posturing with latest hollow move

This is pure posturing by anti-abortion activists. It is obvious they can’t win the popular vote – the last time there was a vote on abortion in 2014, 80 per cent voted to leave the current regime unchanged – but Swiss campaigners still want to remind the public of their dissent. 

If they hurt women along the way, perhaps that’s acceptable collateral damage for them. Or perhaps that’s the whole point. The initiatives were launched together in December 2021 and the signature gathering deadline is in June 2023.   

All these campaigners achieve by dragging abortion onto the public agenda is piling additional stress and guilt on women who are going through a personal, in some cases heartbreaking, healthcare dilemma. Perhaps the rationale is that this extra pressure would have a deterrent effect. 

Switzerland was one of the first European countries to legislate for abortion in 1937, allowing abortion when the woman’s health was in danger. The cantons were free to decide how strictly to interpret the law and this led to a patchwork of abortion services across the country. 

Women ended up needing to travel inside the country to access abortion right up to 2002 when voters accepted the new abortion law allowing unrestricted access to abortion in the first 12 weeks of pregnancy. The law set conditions for abortions after this point. 

Reader question: Is abortion legal in Switzerland?

The first of the two initiatives is the ‘Save viable babies’ campaign to stop late-term abortions unless the mother’s life is in danger. This would apply to pregnancies from 22 weeks gestation where the foetus could potentially survive outside the womb with medical support. 

The second one is the blandly named ‘Sleep on it’ initiative, seeking to impose a one-day waiting period before allowing women and girls to access abortion treatment. Both sets of signatures are being collected together “for synergy reasons”. 

Three Swiss People’s Party (SVP) parliamentarians are behind the campaigns, including two women, Andrea Geissbühler and Yvette Estermann. They got nowhere in parliament with similar proposals which is why they are taking them to the people. No political party supports either initiative. 

Of the total of some 11,000 pregnancy terminations performed in Switzerland each year, approximately 95 per cent are carried out by the 12th week in accordance with the so-called time-limit regulations. 

Only a very small proportion of all terminations take place at an advanced stage of pregnancy. Some 150 terminations per year are performed after the 17th week of pregnancy. The ‘Save viable babies’ campaign is targeting pregnancies terminated from 22 weeks gestation onwards. There are an estimated 40 such cases per year. 

Just to be clear, the campaign wants the whole country to vote on the fate of 40 women per year going through a terrible personal crisis along with their distressed families. 

OPINION: Switzerland’s denial of voting rights to foreigners motivated by fear

The Swiss National Advisory Commission on Biomedical Ethics published an opinion on the practice of late termination of pregnancy in 2018. Here’s what they had to say about these 40 cases annually. 

“The reasons and circumstances underlying advanced pregnancy termination are many and varied. Almost always, the women concerned find themselves in a situation beyond their control, posing a moral dilemma. The need for a decision, and the consequences thereof, can have a lasting impact on the women and their families. Accordingly, the primary ethical principle is that all options need to be jointly considered, with empathetic and careful support being provided for the people concerned.”

Those options include what is called palliative birth for babies with serious conditions who will die at birth or shortly afterwards. 

Guess what, collecting signatures for 18 months for a popular initiative banning late term abortions is the opposite of empathetic support. It exacerbates the suffering involved. But this is a mindset where nothing is more important than the life of the foetus, least of all the parents’ suffering. 

The number of abortions carried out in advanced pregnancy has remained virtually unchanged over the last ten years. Forty out of 11,000 is not very many, but the fact that these situations arise every year represents a sad fact of life. 

EXPLAINED: What happened after Swiss women got the right to vote in 1971?

Meanwhile the ‘Sleep on it’ initiative seeks to introduce a one-day wait between contacting a doctor and receiving the treatment. In three-quarters of cases this means a prescription for abortion pills. 

The one-day wait seems like a spurious and hollow demand. It is normal to think before you go to the doctor for any procedure. I have no doubt that when a woman asks a doctor for an abortion, she has already thought about it – for days if not weeks. She doesn’t need to go through an extra sleepless night to satisfy anyone.   

We know that the best way to reduce the number of abortions is either to reduce the number of unintended pregnancies – through information and services – or to significantly improve the material situation of women, for example income, housing, safety or job security. These factors already contribute to Switzerland’s low abortion rate

But the anti-abortion activists famously concentrate on the least effective tool – banning abortion or making access difficult. 

As an Irish citizen born in the 1970s, I came of age in a country that enshrined the right to life of the unborn in the constitution in 1983, which is what the ‘Save viable babies’ initiative seeks to do. That constitutional ban took a terrible toll on Irish women and girls for 35 years until it was repealed.  

This constitutional ban affected not only abortion services but maternal care in Ireland, with unnecessary suffering and risks imposed on miscarrying women by doctors afraid of breaking the law, as is now being seen in Poland.  

What we know about Swiss abortion is that it is safe, legal and rare. In an imperfect world, this is as good as it gets, no matter what the purists say.

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