By an actuary who also once felt lost in translation between “Franchise” and “Selbstbehalt.”
When I first arrived in Switzerland, I thought I had plenty of time to figure things out once I settled in — turns out, health insurance is one of those things you have to sort out right away. Within ten minutes I had a spreadsheet open, comparing premiums like I was comparing rental apartments — checking the view, space, and monthly rent — except instead of signing a lease, I was committing to health insurance plan. The deeper I went, the more it felt like a uniquely Swiss initiation rite: patience, precision, and a lot of fine print. If that sounds familiar, this post is for you. Let’s unpack the ten questions almost every expat asks — the ones your Swiss neighbour somehow just knows the answers to.
1. Do I really need Swiss health insurance?
Yes — 100%.
In Switzerland, everyone must have basic health insurance (Grundversicherung, or LAMal/KVG) within three months of registering. Even newborns get their own policy.
There’s no employer plan to fall back on — you choose your insurer, your deductible, and your model. Think of it like renting an apartment: everyone needs a place to live, but you choose the size, view, and rent level that fits your budget and comfort.
Want to learn how to pick your plan? Read my next post: How to Choose Your Swiss Health Insurance
Source: Health insurance: Requirement to obtain insurance for persons resident in Switzerland
2. Can I keep my foreign insurance instead?
Occasionally — but rarely.
If you’re an EU/EFTA cross-border worker (Grenzgänger), you might be allowed to keep foreign coverage, but you must file a formal exemption. Everyone else needs a Swiss policy.
It’s one of those rules you can’t charm your way out of — like Swiss recycling or Sunday quiet hours.
Source: Health insurance: Cross-border commuters working in Switzerland
3. What’s the difference between basic and supplementary insurance?
The basic plan is mandatory and identical across all insurers by law. It covers general doctor visits, hospitals, maternity, and emergencies. Supplementary insurance is optional and adds comfort: private hospital rooms, free doctor choice, alternative medicine, dental, or vision. Supplementary is the “want” layer — nice to have, but not required to stay healthy or solvent.
Supplementary insurance can actually be cost‑efficient if you know you’ll use it — for example, regular massages, alternative therapies, a gym memebership, or maternity. In my next post, I’ll show you how to decide whether it’s worth it and how to tailor it to your needs.
Source: BAG_Ratgeber_Obligatorische_KV_e.pdf – DMA Share
Source: Health insurance: Supplementary insurance
4. Why is it so expensive — and what affects my premium?
Premiums depend on your age, canton, and commune. The same person might pay CHF 350 in Zug but CHF 480 in Zurich. It’s not only about your health record — it’s about where you live and which model you choose. The good news: once you understand the levers (franchise, model, accident cover), you can lower your monthly cost substantially.
I guide you through the process of choosing best health insurance for you in my next post: How to Choose Your Swiss Health Insurance
5. How do I choose my deductible (Franchise)?
This is the Swiss version of a poker bet. You choose between CHF 300 and CHF 2 500 — the higher the deductible, the lower your monthly premium. If you rarely visit doctors, the CHF 2 500 option often wins in the long run. But if you have kids, chronic conditions, or simply prefer predictability, stick with CHF 300. It’s a classic risk-management trade-off — one actuaries quietly love. I wrote a post on it, you can go here: How to Choose Your Franchise deductible
6. Can I change my insurer later?
Yes annually — and you should review it every year. The deadline is usually end of November, and switching is straightforward: your new provider prepares a cancellation letter you are responsible for sending before the 30 November deadline. Sign up with the new one, and the handover happens automatically on January 1. No need for awkward phone calls or loyalty guilt trips.
Source: Changing and cancelling health insurance – ch.ch (Swiss Confederation)
7. What happens if I get sick abroad?
Your Swiss policy covers emergency treatment in the EU/EFTA via the European Health Insurance Card (EHIC). Beyond Europe, you’re only covered for emergencies — and only up to double the Swiss price. If you travel to US, consider a travel add-on or supplementary global cover. It costs less than one Swiss emergency X-ray.
Source: Treatment abroad for policyholders resident in Switzerland
8. How does family coverage work?
Each person — even your baby — has their own policy and deductible.
You can mix insurers and models to optimise costs.
For example, your partner might pick a cheaper Telmed plan while you choose a flexible Hausarzt model.
Families with young children often go for lower deductibles because kids visit doctors more frequently (and occasionally stick something in their nose).
9. How do I actually save money on this system?
Buffett once said: “You can’t control the market, but you can control your costs.”
The same applies here.
Practical ways to save:
- Pick an HMO or Telmed model – cheaper, though you’ll need a referral or call first.
- Choose a higher franchise if you’re healthy.
- Exclude accident cover if your employer already provides it.
- Compare annually on trusted platforms like comparis.ch.
A few smart tweaks can easily save CHF 1 000–2 000 per year.
10. Why does everyone complain about the system — but no one changes it?
Because it works — just expensively.
The Swiss model guarantees universal coverage and world-class care. But it’s decentralised and market-driven, which means competition doesn’t always lead to simplicity.
Once you learn the structure, though, it’s less of a mystery and more like a tax you can optimise.
In short
The Swiss health insurance system isn’t out to get you — it’s just unapologetically Swiss: rule-based, efficient, and slightly expensive. But with my simple guide, you can make it work in your favour.