Swiss health system: LAMal, choice of fund, deductible and reimbursements (cross-border guide)

Context

In a nutshell

• The Swiss healthcare system is based on LAMal, a mandatory health insurance. Frontier workers can choose their own health insurance fund. The deductible is € 10,000 for new frontier workers. * Refunds are possible for healthcare treatments in Switzerland and abroad.

Key facts

• What: Swiss health system
• When: From 1 January 2024
• Where: Switzerland, with a focus on the canton of Ticino
• Who: Frontier workers and Swiss citizens
• Amount: € 10,000 (deductible for new frontier workers)

The Swiss health system is based on LAMal, a mandatory health insurance. Frontier workers can choose their own health insurance fund, with a deductible of € 10,000 for new frontier workers. Reimbursements are possible for healthcare treatments in Switzerland and abroad.

How the Swiss healthcare system works

The Swiss health system is managed by the Health Insurance Act (LAMal), which requires all Swiss citizens to be insured against illness. Border workers, i.e. third-country nationals living in Switzerland, can choose to join one of the 62 health insurance funds in Switzerland. These coffers offer a range of health services, including medical treatments, consultation visits, tests and medications.

Deductibles and refunds

The deductible of € 10,000 for new frontier workers is a measure aimed at

Operational details

Compulsory health insurance (LAMal) is an obligation for all Swiss citizens and border workers. LAMal covers healthcare treatments in Switzerland and abroad, with a few exceptions. Border workers can choose their own health insurance fund, with a deductible of 10,000 Swiss francs for new border workers.

Choice of health insurance fund

Border workers can choose between different health insurance funds, such as the Sickness-Invalidity (MI), the Sickness Fund (CM), the Caisse centrale d 'assurance maladie (CCAM) or the Fondation suisse d 'assurance maladie (FSAM). Each case has its own conditions and coverage limits. For example, the MI covers health treatments in Switzerland and abroad, with a deductible of 10,000 Swiss francs for new frontier workers. CM, on the other hand, covers health treatments in Switzerland and abroad, with a deductible of 10,000 Swiss francs for new border workers and a ceiling of 100,000 Swiss francs.

Deductible and ceiling

The deductible is the amount the patient must pay before they can qualify for LAMal coverage. The ceiling, on the other hand, is the maximum amount that LAMal covers for a health treatment. For example, if a patient has a deductible of 10,000 Swiss francs and a ceiling of 100,000 Swiss francs, the LAMal will cover up to 90,000 Swiss francs of medical treatment.

Refunds

Patients can request reimbursement of

Recommended tools

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Key points

To benefit from the Health Act (LAMal), you must enroll in a health insurance fund. The most common health insurance funds in Switzerland are LAMal and KVG. Frontier workers can choose their own health insurance fund, with a deductible of € 10,000 for new frontier workers.

LAMal is a federal law that regulates health insurance in Switzerland. It was introduced in 1911 and has been modified several times over the years. According to the law, every Swiss citizen must be enrolled in a health insurance fund. The most common health insurance funds in Switzerland are LAMal and KVG.

The choice of health insurance fund depends on individual needs. Some Swiss citizens may choose to join LAMal, while others may prefer KVG. LAMal is one of the largest health insurance funds in Switzerland, with over 1.5 million policyholders. The KVG, on the other hand, is one of the smallest health insurance funds, with about 300,000 insured.

The deductible is the maximum amount an insured must pay for medical treatment. The deductible varies depending on the health insurance fund chosen. LAMal has a € 700 deductible, while KVG has a € 300 deductible. Border workers, on the other hand, have a deductible of € 10,000 for the first 10 years of registration.

Swiss citizens can apply for a

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