KVG/LAMal: Basic insurance tailored to your needs
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What is basic health insurance?
Basic health insurance, also known as LAMal (health insurance law) or compulsory health care insurance, is defined as compulsory insurance for anyone residing in Switzerland. The aim of this insurance is to guarantee citizens access to care, while offering rates that are adapted to people's health expenses.
These same rates are not set on the basis of a person's financial capacity, the state must still offer a system of subsidies, for policyholders with modest incomes.
Basic health insurance covers health problems, accidents and maternity. The law precisely regulates the list of benefits covered, so this requires all health insurance companies to offer the same services.
What are the different basic insurance models?
HMO
The HMO model, or HMO organization, is a healthcare network bringing together a number of doctors in a group practice, be they generalists, specialists, or therapists. If you choose this model, it is imperative that you consult your doctor first. He or she will refer you to a specialist if necessary.
Family doctor model
The family doctor network is made up of various independent general practitioners, grouped together in a region. As an insured person, you have free choice of this doctor, as a family doctor, and therefore waive your free choice of doctor.
You should consult your family doctor as a matter of priority. He or she remains your first point of contact and will be able to answer all your medical questions. He also has the decision to continue your treatment himself or to refer you to a specialist.
Other models
Medical consultation by telephone beforehand
Other insurers offer models of so-called "telemedicine" insurance or Telmed providing for a medical consultation by telephone before any medical visit. This is also how you can save on your insurance premiums.
Insurance with bonus
Your premium is calculated pro rata for years or no reimbursements of benefits. The starting premium is 10% higher than an ordinary premium, and you don't have the option of increasing your deductible. Nevertheless, over five years, your premium can decrease by up to 55%.
What are the health insurance deductibles?
The franchises of basic health insurance correspond to the amount the insured person will have to pay before the health insurer begins to cover medical expenses. For example, with a deductible of 300, the insured person will have to spend at least this amount before he or she can receive reimbursements from his or her health insurance company for the year.
What are the different deductibles?
Deductibles for an adult or young adult:
- 300 CHF
- 500 CHF
- 1'000 CHF
- 1'500 CHF
- 2'000 CHF
- 2'500 CHF
Deductibles for a child:
- 0 CHF
- 100 CHF
- 200 CHF
- 300 CHF
- 400 CHF
- 500 CHF
- 600 CHF
What does basic health insurance cover? (LAMal)
Basic health insurance covers the costs of illness, accidents (in the absence of accident insurance) or maternity. Coverage is provided in the insured person's canton of residence. In the event of an emergency abroad, the insured is covered if his or her return to Switzerland is not possible thanks to the bilateral agreements linking Switzerland and the countries of the European Union.
How much does KVG/LAMal cost?
Basic insurance premiums depend not only on the insured's canton of residence, but also on his/her age and franchise. For children under 18, premiums are reduced. The age brackets for basic insurance premiums are divided as follows:
- Children - Up to and including 18
- Young adults - 19 to 25
- Adults - 26 and over
Updated on: 22/01/2024Written by Alexis MilonHead of health insurance department at Comparea.To learn more about our team click here.
Frequently Asked Questions
From the moment you start living in Switzerland, you have three months in which to choose your health insurance company. After this period, the government will automatically select a KVG/LAMal insurance company for you.
Generally speaking, you don't need to pay the bill yourself. In fact, your health insurance card is enough to guarantee access to care. Your insurance company will pay the healthcare provider (hospital, doctor). However, some costs are not covered by basic insurance and must be paid by you: 10% of the bill (co-payment)
Cross-border commuters are free to choose between LAMal or CMU (French health insurance) for their health cover.
