Reader question: Can I get a reduction on Swiss health insurance if I never use it?
If you never (or rarely) get sick and don’t need medical care in Switzerland, good for you! But does this mean your premiums will be lower?
This question assumes that the premiums for Switzerland’s basic compulsory health insurance (KVG in German and LaMal in French and Italian) are based on the policyholder’s state of health, and how often they claim benefits.
Such a set-up would make sense - but the system does not work this way.
Premiums are not dependent on a person’s health or how often they use medical services, just as they are not income-based either.
As the Federal Office of Public Health points out, insurance carriers can’t “make distinctions on the basis of health status.”
Rather, rates are calculated according to age, gender (they are higher for men than for women, based on overall risks), place of residence, and health insurer.
The actual amount you will have to pay also depends on the deductible you choose — the amount you will have to pay yourself before the insurance starts covering incurred costs. Deductibles range from the lowest, 300 francs, to the highest, which is 2,500 francs. (There are various other amounts in between as well, but these two are the most common).
READ ALSO: Which Swiss health insurance deductible makes most sense?
There is also another specificity of KVG / LaMal, which explains why premiums are not determined by an individual’s health status: the whole scheme is based on the principle of solidarity, the extent of which is rare in other nations’ health insurance systems.
What does this mean ?
Rather than applying an individual approach to healthcare insurance, Switzerland’s system is based on the idea that all insured people form a group.
You can think of this system in terms of a huge pot to which each resident of Switzerland makes a contribution (that is, premium payments), so that in an emergency there are enough resources available to give someone the help they need when they need it.
"This means that even those who are in perfect health and never need to see a doctor, pay their monthly premiums and thus indirectly provide for those who are ill and need more medical support," according to a report by the WIRE research think tank.
In other words, all the people of the same age group living in the same canton pay the same premium, rather than different rates based on their health or other personal circumstances.
This applies only to the obligatory basic insurance; supplemental insurances have a different rate base.
READ ALSO: How the Swiss health insurance system is based on solidarity
Yes, but are there ways for healthy people to get lower rates?
It is understandable, given how expensive Switzerland’s health insurance is, and how premiums have been increasing every year, that you want to save as much money as you can.
Fortunately, there are ways to do that, though these options are available to all, and not just to healthy people.
Significant savings could be made by switching carriers or plans, from the more expensive to cheapest ones — for instance, by choosing a policy with a limited choice of doctors, or one that requires a referral to see a specialist (which ‘regular’ plans don’t).
A good thing about this is the level of your coverage will not change — by law, all insurance providers must offer the same range of services and benefits to all insured people, regardless of whether they have ‘regular’ or ‘cheap’ plans.
Now, if you really can’t afford to pay for health insurance and if premiums eat up at least 8 percent of your income, you qualify for government aid.
Before deciding whether you receive the assistance, however, your canton of residence will look not only at your earnings, but at any other financial assets you hold as well.
Generally speaking, anyone who is a low earner or has a large number of children, could be eligible for subsidised premiums, though criteria, as well as amounts, may vary from one canton to another.
And if you are tempted not to get any insurance to save the costs — bad idea.
You may prefer not to purchase a health policy, and instead pay out of pocket for any medical costs they incur.
You’d rather put aside a bit of money each month just in case you ever need to seek medical help, and pay your bill from that stash.
This, however, is not an option.
The bottom line is that KVG / LaMal is obligatory. Without it, you will not only be refused medical care other than for vital emergencies, but you will also not be able to register at your commune of residence, rent an apartment, get employment, and be denied many other services as well.
There are several exemptions to this rule, none of them the based on a person’s health status:
- You are retired and get a pension exclusively in an EU or EFTA state
- You are a cross-border worker with healthcare policy in a EU or EFTA state
- You are a foreign student and have comparable insurance from your country
- You work for international organisations or are a diplomat
READ ALSO: What happens if I don't buy Swiss health insurance?
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This question assumes that the premiums for Switzerland’s basic compulsory health insurance (KVG in German and LaMal in French and Italian) are based on the policyholder’s state of health, and how often they claim benefits.
Such a set-up would make sense - but the system does not work this way.
Premiums are not dependent on a person’s health or how often they use medical services, just as they are not income-based either.
As the Federal Office of Public Health points out, insurance carriers can’t “make distinctions on the basis of health status.”
Rather, rates are calculated according to age, gender (they are higher for men than for women, based on overall risks), place of residence, and health insurer.
The actual amount you will have to pay also depends on the deductible you choose — the amount you will have to pay yourself before the insurance starts covering incurred costs. Deductibles range from the lowest, 300 francs, to the highest, which is 2,500 francs. (There are various other amounts in between as well, but these two are the most common).
READ ALSO: Which Swiss health insurance deductible makes most sense?
There is also another specificity of KVG / LaMal, which explains why premiums are not determined by an individual’s health status: the whole scheme is based on the principle of solidarity, the extent of which is rare in other nations’ health insurance systems.
What does this mean ?
Rather than applying an individual approach to healthcare insurance, Switzerland’s system is based on the idea that all insured people form a group.
You can think of this system in terms of a huge pot to which each resident of Switzerland makes a contribution (that is, premium payments), so that in an emergency there are enough resources available to give someone the help they need when they need it.
"This means that even those who are in perfect health and never need to see a doctor, pay their monthly premiums and thus indirectly provide for those who are ill and need more medical support," according to a report by the WIRE research think tank.
In other words, all the people of the same age group living in the same canton pay the same premium, rather than different rates based on their health or other personal circumstances.
This applies only to the obligatory basic insurance; supplemental insurances have a different rate base.
READ ALSO: How the Swiss health insurance system is based on solidarity
Yes, but are there ways for healthy people to get lower rates?
It is understandable, given how expensive Switzerland’s health insurance is, and how premiums have been increasing every year, that you want to save as much money as you can.
Fortunately, there are ways to do that, though these options are available to all, and not just to healthy people.
Significant savings could be made by switching carriers or plans, from the more expensive to cheapest ones — for instance, by choosing a policy with a limited choice of doctors, or one that requires a referral to see a specialist (which ‘regular’ plans don’t).
A good thing about this is the level of your coverage will not change — by law, all insurance providers must offer the same range of services and benefits to all insured people, regardless of whether they have ‘regular’ or ‘cheap’ plans.
Now, if you really can’t afford to pay for health insurance and if premiums eat up at least 8 percent of your income, you qualify for government aid.
Before deciding whether you receive the assistance, however, your canton of residence will look not only at your earnings, but at any other financial assets you hold as well.
Generally speaking, anyone who is a low earner or has a large number of children, could be eligible for subsidised premiums, though criteria, as well as amounts, may vary from one canton to another.
And if you are tempted not to get any insurance to save the costs — bad idea.
You may prefer not to purchase a health policy, and instead pay out of pocket for any medical costs they incur.
You’d rather put aside a bit of money each month just in case you ever need to seek medical help, and pay your bill from that stash.
This, however, is not an option.
The bottom line is that KVG / LaMal is obligatory. Without it, you will not only be refused medical care other than for vital emergencies, but you will also not be able to register at your commune of residence, rent an apartment, get employment, and be denied many other services as well.
There are several exemptions to this rule, none of them the based on a person’s health status:
- You are retired and get a pension exclusively in an EU or EFTA state
- You are a cross-border worker with healthcare policy in a EU or EFTA state
- You are a foreign student and have comparable insurance from your country
- You work for international organisations or are a diplomat
READ ALSO: What happens if I don't buy Swiss health insurance?
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