Will my Swiss health insurance cover treatment in another canton?
While health insurance falls under a Swiss federal law, each canton is responsible for administering the system on its own territory. What happens if you need to consult a doctor or be hospitalised in another area?
While in some countries you may be restricted from visiting certain doctors, generally speaking, Switzerland’s health insurance system is based on the principle on free choice.
What does this mean?
According to the Federal Office of Public Health (FOPH), “a patient is basically entitled to a free choice of healthcare professional or public care facility".
As The Local reported last week, this means that in its standard form, the basic compulsory insurance — KVG in German and LaMal in French and Italian — allows policyholders to choose their own GPs and consult specialists of their choice without a referral.
These rights are limited only if you buy a cheaper but more restrictive plan like the Health Maintainance Organisation (HMO), Telmed, or Family Doctor model, all of which require you to get prior approval of doctors for non-emergency care.
What about getting treatment in another canton?
It all depends on what kind of medical help you are seeking.
For instance, if, for whatever reason you want to consult a doctor or get an elective surgery in another canton, your health insurance will not totally cover the costs.
KVG / LaMal will only pay for treatment (both outpatient and in-hospital) in the canton where the patient lives, according to the FOPH.
However, this rule applies only to non-urgent situations; emergency cases are treated differently.
If you injure yourself skiing or require urgent surgery while visiting another canton and can’t be easily transferred to a hospital close to your home, then your insurance will cover all the the costs of medical treatment.
“In an emergency, you can go to any hospital in Switzerland", FOPH said, adding that it must be an authorised public health facility, rather than a private clinic, which in principle is not covered by the basic insurance.
It defines “emergency” as a situation when “your state of health does not permit you to be taken to a hospital in the canton where you live. You will be transferred to a hospital in the canton where you live as soon as this is possible and sensible".
FOPH also allows out-of-canton treatment for "particular medical reasons" — that is, if the required care can’t be provided at a public healthcare facility in your canton of residence.
Will the insurance cover any medical costs if you decide to opt for a non-emergency treatment in another canton?
If you are treated in an approved public health facility, your basic insurance will pay the difference between the tariff charged by that hospital and the tariff charged for the same treatment in a hospital in your canton of residence.
If the treatment in the other canton is more expensive than in your home canton, you will have to play the difference yourself, according to the FOPH.
If, however, you have a private or other supplemental coverage in addition to KVG / LaMal, these additional plans might cover the non-refunded difference, but check with your carrier first.
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