LAMal PLANS – IMPROVED LCA PLANS – MATERNITY & NEWBORNS – ACCIDENT INSURANCE
The Swiss healthcare system is structured around a compulsory public State plan whose legal base is the LAMal (Loi sur l’Assurance Maladie) and multiple private improved plans whose legal base is the LCA (Loi sur le Contrat d’Assurance). These are commonly respectively referred to as LAMal and LCA plans. For those that are employed more than eight hours per week by the same employer their accident protection will be transferred from the LAMal plan to a plan whose legal base is the LAA (Loi sur l’Assurance Accident), this plan is included in the work contract and partially financed by the employer. The LAMal and LCA plans are financed by the tax payer.
1. LAMal PLANS
All Swiss residents must subscribe to the LAMal health plan from their official day of entry into the country. If this is not done within a three-month period, the resident will be automatically affiliated to one of the 60 approved companies that provide health care plans.
Each insurer offers an average of 4 different insurance models to their clients. The standard model is known as the “basis” model and is always the most expensive option. The three other options impose certain restrictions which enable the insurance company to sell them at reduced prices.
It should be noted that the yearly LAMal premiums the entire population pay are adapted each year to cover the cost of healthcare in Switzerland. This is achieved by primarily covering acute and chronic medical conditions in the public healthcare system. An improved medical plan must be subscribed to for more comfort and extended coverage in the private medical system.
The public State LAMal plan includes:
- Inpatient treatment in the public hospital of the canton of residence without free choice of surgeon
- Outpatient treatment in the canton of residence
- Accident insurance for Swiss residents that are not employed more than eight hours per week
- Prescribed medication
- Medical transport (very limited protection)
- Home care to avoid hospitalization
LAMal deductible
An annual deductible or excess ranging from CHF 300.- to CHF 2’500.-* must be subscribed to for all LAMal plans. The higher the deductible chosen the lower the monthly premium. On top of this deductible an obligatory LAMal participation of 10% of all medical bills is also applied up to a CHF 700.- (10% of 7’000.-) limit for adults and 350.-(10% of 3’500.-) for children.
*0 – 600 for children
2. IMPROVED PRIVATE LCA PLANS
The improved private LCA plans are required to complete and to cover the multiple areas that remain unprotected under the public LAMal Swiss health and accident insurance plan.
The improved LCA plans have modules that will cover the following (meaning that the LAMal plan does not cover these risks well or at all…):
- eyes
- dental
- vaccinations
- osteopathy, massage, acupuncture and other « alternative » therapies
- psychologist
- gym participation
- contraception
They also provide:
- the free choice of hospital, private clinic and operating surgeon in the event of hospitalization or maternity
- full coverage abroad
- medically required transport (ambulance, helicopter…)
- allowances in case of death and invalidity
- daily sickness allowance benefits
- loss of income benefits
- reduced waiting times for medical interventions and surgery
- improved comfort (single or double room facilities)
- improved accident coverage
To avoid financial strain and unexpected bills that could extend into tens of thousands of francs the three following improved coverages should ALWAYS be subscribed to:
- Full medical coverage abroad
- Full medical transport
- Full coverage outside your canton of residence
We also highly recommend:
Deductible protection in the event of hospitalization: a night in the hospital can cost between 2.5k and 10k. To cover these significant medical expenses, it is less expensive to take out deductible protection in the event of hospitalization than taking out a low annual deductible.
3. MATERNITY & NEWBORN COVERAGE IN SWITZERLAND
Maternity is fully covered in the Swiss system and the future mother benefits from a zero deductible and LAMal participation policy from week thirteen of pregnancy until eight weeks after birth.
Important
On the LAMal plan women must give birth in the local public hospital in the common ward. For all women who wish to give birth with their own gynecologist in the hospital or clinic of their choice they must subscribe to an improved private or semi-private LCA insurance plan. A nine or twelve month waiting period always applies to this option, so for those who arrive in Switzerland who are already pregnant the birth will automatically take place in the public hospital (or the mother will bear the cost of the private clinic).
As far as giving birth itself is concerned, the Swiss are open to alternative options. These include home births, birth houses, water birth, etc.
Newborn health insurance coverage
Newborn insurance coverage is referred to as “prénatale” in French and it should always be subscribed to BEFORE THE BABY IS BORN. The LAMal health insurance plan is public, so no medical questionnaire is required prior to subscription. On the other hand, the LCA improved plans are private, and a medical questionnaire is obligatory. The only exception is for policies that are subscribed to before the birth of a child. This means that even if the baby is born with a serious medical condition it will be fully covered if the policy is subscribed to “pre-birth”. Please contact us to benefit from this advantage.
4. LAA & LAMal ACCIDENT INSURANCE
For Swiss residents that are employed more than eight hours per week by the same employer, accidents and illness are treated separately in the Swiss system. Employees are covered by the LAA plan provided by their employer, the benefits are:
- Full medical care
- Loss of income benefits if work is interrupted following the accident
- The common or public ward of the Cantonal or recognized hospital without the free choice of doctor, operating surgeon, specialist and clinic or hospital if this option has not been subscribed to by the employer.
In the event of an accident children and those not employed or self-employed are covered by the LAMal, the benefits are:
- Full medical care, less the LAMal deductible and the 10% LAMal participation
- The common or public ward of the Cantonal or recognized hospital without the free choice of doctor, operating surgeon, specialist and clinic or hospital if an LCA plan has not been subscribed to.
In the event of an accident employees will pay less than those that do not work or who are self-employed as they will have no participation to pay. An improved accident insurance plan should always be added to the LAA and LAMal basic plans.
An improved accident insurance plan includes:
- Free choice of specialist
- Private or semi-private accommodation
- Free choice of clinic or hospital
- Disability and death coverage following an accident
