Cost reduction: Health insurance (Swiss)

I did most of my career in the insurance business and used to consult private costumers on health insurances (among others) in Switzerland. All the knowledge in this post is based on a profound experience of many years. To make the content easily actionable I had to simplify or generalise some elements. This is why I have to underline that it might not suit your individual situation.

Disclaimer: The content of this post ist for general information purposes only. You should not construe any such information or other material form this post as legal, tax, investment, financial or other advice. Do your own research.

The Swiss health insurance

The Swiss health insurance system consists of 2 parts:

The base insurance which is mandatory for everyone living in Switzerland.
The complementary insurance which is optional

Even though they are mostly sold together and grouped in 1 policy, you have to treat them separate to optimise them since there are big differences:

The base insurance (mandatory)
1. Can be cancelled every year latest by end of november (30.11.)
2. Every insurance is obliged to accept you (doesn’t require a good health)
3. Every insurance has exactly the same coverage (by law)
4. Is here to cover every basic health need
5. The price changes every year
The complementary insurance (optional)
1. Can have longer duration periods than one year and can mostly be cancelled latest by end of September (30.09.)
2. No insurance is obligated to accept you (requires a good health)
3. Every insurance has slightly different coverage
4. Is here to cover what the base insurance doesn’t
5. The price changes irregularly

The problem of the health insurance system in Switzerland

So the thing to understand here is that the base insurance offers you full flexibility to chase the cheapest option every year while the complementary requires you to opt-in while healthy (early in life) and therefore giving you almost 0 flexibility once you generate high health costs.

Furthermore the price of the base insurance varies insanely from year to year and/or from canton / area where you are located. Here’s a real example for an adult in Zurich City (year 2023, plz 8001, Franchise CHF 300.-, all alternative models):

The most expensive option is Vivacare (standard model): CHF 592.30 per month
The cheapest option is KPT (alternate model telcare & family doctor): 401.30 per month

It’s a difference of CHF 191 per month or 2’292 per year (!) and that for the same coverage, the only difference is the model of the cheapest one which requires you to call a hotline or visit the family doctor first (and not going to a specialist directly)

If thats not enough, there are some rare cases where the complementary health insurance punish you by imposing a higher deductible on the complementary health insurance if you don’t combine the base and complementary insurance with them.

How to navigate this madness?

I treat the base and complementary insurance separate and switch the base insurance every year if there is an option available which is at least CHF 100.- cheaper per year than the current base insurance I have.

I selected one of the biggest health insurances for the complementary insrance and plan to keep it until I die.

Doing so I got the benefits of not overpaying on the base insurance while having a stable longterm solution for the complementary insurance.

The downsides are that I have to check which one will cover a bill before sending it in (95% of the cases its the base insurance covering it) and I have sometimes to deal with a slightly worse service if I pick a small base insurance (for example paying back after 25 days instead of 7 days)

But the downsides are in my opinion absolutely worth the effort since the cost reduction can be very significant as the example above shows.

The ultimate tutorial for optimising your base health insurance

Define the configuration you need:
1. Are you working more than 8hours per week?
  1. If yes -> You can exclude the accident coverage (since its covered by your employer)
  2. If no -> You have to include the accident coverage
2. Do you have health costs below approx. CHF 1’000 per year?
  1. If yes -> pick a franchise (deductible) of CHF 2’500
  2. If no -> pick a franchise (deductible) of CHF 300
    No other deductible makes sense, you can check it with simple math or trust me 😉
3. Would you be comfortable to visit a family doctor or call a hotline first before consulting a specialist?
  1. If yes -> Pre select one or more alternative model which you could deal with:
    1. Family doctor: Always go first to your family doctor, unless its an emergency
    2. HMO: Always go first to a health maintenance organisation (Gruppenpraxis), unless its an emergency
    3. Telcare: Always call first a hotline where a doctor will check with you on the phone how to proceed. They can send you to specialists directly
    4. Other models: There are some other models which consists of a combination of one above + other special rules like pharmacies you need to get the medication from etc.
  2. If no -> pick the standard model
Now that you have defined the configuration you need, go to (and only there) the official site with all the insurances and prices listed – link: Priminfo
1. Add your postal code
2. Add your year of birth
3. Select the franchise (deductible) based on the ruleset above
4. Include or exclude the accident coverage based on the ruleset above
5. select your current health insurance and the current model
6. Keep all the checkboxes active of the models you could accept
7. Click on Calculate (Berechnen)
8. Here’s a screenshot – click to expand:
Check the comparison
1. Select the comparison to be by year instead of month
2. Check what the potential of savings would be for you by sorting the column Sparpotenzial / Mehrkosten (it is calculated automatically and displayed in green)
  1. Is the difference to your base insurance substantial?
    1. If no -> Stop here and keep your current base insurance + check next year again
    2. If yes -> Check the insurances and the required models from top down until you find one which suits you. That requires a bit of research on the insurers website and maybe a call to clarify what you would have to pay attention selecting that model
    3. Here’s a screenshot – click to expand:
3. Select the best option for you
  1. Go to the website of the selected health insurance and buy it starting the next year (can be done almost everywhere online, sometimes they require you to send in the signed papers.
    1. Pay attention to only buy the base insurance, they might try to sell you complementary insurances in the same process.
    2. Pro-tips:
      1. Pay it yearly and you will get from 0.5% to 2% discount
      2. Don’t worry to take a base insurance you don’t know. The coverage is the same by law for all of them and you can switch back every year if you are not happy with your choice.
4. Cancel your current base health insurance before the end of November with a registered mail (Eingeschriebener Brief) and keep the receipt until the current health insurer has confirmed it to you.
  1. Be very carful to just cancel the base insurance! You might not be able to get the complementary insurance back if you cancel it by accident.
  2. Here’s a template you can use: Download template
5. Done, repeat next year 😉

The ultimate tutorial for optimising your complementary health insurance

Be aware that you need to be in good health to get one. So if you don’t have one, do it now if you are in good health. It might be too late soon.
1. If you are not in good health, try to get one. You might be rejected though.
2. If you already have a complementary health insurance, check if the suggestions below are covered. If not, try to adapt or change it.
Pick a big health insurance which has a good reputation. Options based on my opinion:
1. Helsana
2. SWICA
3. CSS
4. VISANA
5. Sanitas
Based on my experience the must haves are coverages for risks who could break your neck (financially):
1. Outpatient insurance who covers:
  1. Unlimited coverage for emergencies worldwide (Nottransporte und Notfallbehandlungen weltweit)
  2. Medication not covered by the base insurance
  3. Orthodontic treatments (for children)
1. Base flexible hospitalisation insurance
  1. Gives you the option to upgrade (for a fee) the hospital level which might give you access to a specialist or a faster treatment
2. Please note that these coverage mostly come in packages with other more or less relevant coverages.
Based on my experience everything else is nice-to-have and might cover partially or fully cost which are very unlikely to break your neck (financially).
1. Most of these coverages are limited to CHF 1’000 – 3’000 per year.
2. Therefore I really urge you to understand what is really included and wherever you actually might need it.
3. Most common coverages are:
  1. Alternative medicine
  2. Check-ups
  3. Fitness center contribution
  4. Dental costs
  5. etc.
You can get offers and sometime even apply online. The insurance will ask you to answer questions about your health in order to decide wether they will accept or decline you.
1. Once you are accepted, they are not allowed to cancel your policy as long as you pay the premiums (by law).
2. Pro-tips:
  1. Pay it yearly and you will get from 0.5% to 2% discount
  2. Some have health apps and give you cash reward or discounts up to CHF 600.- for using them (Helsana, SWICA, CSS)
  3. Once you have the unlimited coverage for emergencies worldwide you can cancel the broadly used “Rega-Gönnerschaft” since the insurance covers the costs of Rega and every other emergency service around the world if needed.
Done!

Any questions?

Leave a reply below and I will try to answer it!

Giles.Money

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