Health insurance in Switzerland: All you need to know

Transcription

1 Health insurance in Switzerland: All you need to know 25 February 2016 International Master and Exchange Students Annina Wanner / Sandra Zweifel

2 Today s Programme Presented by Health insurance in Switzerland important basics Exemption from the Swiss health insurance obligation - Who can get an exemption? - How to proceed? Annina Wanner Annina Wanner Questions / Answers (regarding exemptions) You need a new insurance in Switzerland? - 3 options - How to proceed? What to do in case of illness? - Where to go / how to find a doctor? - Payment / refunding Sandra Zweifel Sandra Zweifel Questions / Answers (all topics) Annina Wanner / Sandra Zweifel

3 Download this presentation and sample letters from authorities at: Annina Wanner / Sandra Zweifel

4 Important basics: health insurance is mandatory! Health insurance is mandatory for everybody who is staying in Switzerland for more than 90 days! After arrival, you have 3 months to - apply for an exemption OR - get a Swiss health insurance plan Full coverage from the day you entered Switzerland! Do not miss the 3 months deadline! Otherwise, you will be assigned a health insurance plan by the authorities -> this can become very expensive! Annina Wanner / Sandra Zweifel

5 Important basics: basic insurance KVG vs. VVG KVG VVG: What s the difference? KVG = Abbreviation for Krankenversicherungsgesetz, the law that determines the basic health insurance benefits. Its formulation ensures that all health insurance companies offer identical basic health coverage. -> mandatory to have this or equivalent coverage! VVG = Abbreviation for Versicherungsvertragsgesetz, the legal basis for insurance policies under private law. In the health insurance area, supplemental insurances fall into this category. -> not mandatory Annina Wanner / Sandra Zweifel

6 Important basics: What is covered? The coverage provided by the mandatory basic insurance (KVG) is usually sufficient for young and healthy people. Important: Dental treatment is NOT covered! Accident coverage is needed if you do not work at all do not work more than 8 hours/week Annina Wanner / Sandra Zweifel

7 Exemption for students holding an insurance from an EU or Non-EU country EU/EFTA citizens legally insured by their state who own a «European Health Insurance Card» Citizens of any country (EU/EFTA or other) with a private insurance that meets the Swiss requirements (i.e.: covers exactly the same as a Swiss basic insurance according to the KVG law -> this is extemely rare! -> rather choose a Swiss insurance right from the beginning!) You can get an exemption for max. 6 years in total. Afterwards, you will have to get a Swiss health insurance. Annina Wanner / Sandra Zweifel

8 Exemption: Step-by-step guidelines: Annina Wanner / Sandra Zweifel

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11 Exemption procedure: letters from authorities For those living in the city of Zurich: Once your application for an exemption has been received by the «Städtische Gesundheitsdienste», they will send you a letter saying that you obviously have no KVG insurance and that your application is forwarded to the «Gesundheitsdirektion des Kantons Zürich» -> this is the normal procedure since the «Gesundheitsdirektion des Kantons Zürich» makes the final decisions you can thus ignore this letter! If you have any doubts, please come and ask us! Download example letters from authorities: Annina Wanner / Sandra Zweifel

12 Exemption procedure Communication flow for an exemption request in the City of Zurich Student Städtische Gesundheitsdienste Stadt Zürich (SG) Responsible to ensure that every person living longer than 90 days in Switzerland is legally insured. It is this office which will e.g. forcefully insure you Gesundheitsdirektion Kanton Zürich (GD) Responsible for KVG exemption confirmation Legend: SG sends you a letter and asks you to take out a Swiss health insurance OR apply for an exemption. You send your application for an exemption to SG (according to our instructions). SG informs you that your insurance is not a KVG insurance and that they forward your application for an exemption to GD for decision. 4 SG forwards your exemption request to GD for decision. 5 GD informs you about the decision. A copy goes to SG. Annina Wanner / Sandra Zweifel

13 Important!!! In case your application for an exemption has been refused by the Health Department of the Canton of Zurich («Gesundheitsdirektion»), you MUST come and see us IMMEDIATELY! Once you have received the refusal letter, your immediate reaction will be extremely important in order to avoid that you will be forcefully insured! Annina Wanner / Sandra Zweifel

14 Any Questions regarding the exemption procedure? Annina Wanner / Sandra Zweifel

15 Get a Swiss health insurance: 3 options 1) Academic Care 2) Swisscare 3) Any insurance plan Monthly premiums: CHF 80 (CHF 500 deductible) CHF 90 (CHF 100 deductible) CHF 95 (CHF 0 deductible) No cost contribution! Payment mode: monthly, every 3 months, every 6 months, annually 2 offices in Zurich in case you need advice/support Not accepted in the cantons: Aargau, Neuchâtel VVG insurance! -> exemption from KVG obligation required Monthly premiums: CHF 65 (CHF 1000 deductible) CHF 83 (CHF 500 deductible) CHF 99 (CHF 300 deductible) 10% cost contribution Payment mode: every 3 months, every 6 months, annually communication by /phone only Not accepted in the cantons: Aargau, Neuchâtel, Ticino VVG insurance! -> exemption from KVG obligation required Monthly premius: approx. CHF (CHF deductible) it s expensive, but you can get a premium reduction! application for a premium reduction is rather complicated -> you should be fluent in German to be able to handle all this yourself! KVG insurance («normal» Swiss basic insurance) Annina Wanner / Sandra Zweifel

16 Deductible («Franchise») & «cost contribution» Doctor s bill treatment & medication CHF 2000 You have to pay: To be paid once per calendar year. You choose your personal deductible when you sign up for your health insurance. The higher the deductible, the lower the premiums! Deductible CHF 300 Cost contribution: 10% of the rest (CHF 1700) CHF 170 In addition to the deductible: You pay 10% of the remaining costs yourself (max. CHF 700/year) CHF 470 Your insurance company has to pay: CHF 1530 Annina Wanner / Sandra Zweifel

17 Academic Care / Swisscare how to apply? Visit Scroll down to the step-by-step instructions and follow them very carefully! Annina Wanner / Sandra Zweifel

18 Academic Care/Swisscare: Communication flow Student Städtische Gesundheitsdienste Stadt Zürich (SG) Gesundheitsdirektion Kanton Zürich (GD) 3 Your insurance company 5 Legend: SG sends you a letter and asks you to take out a Swiss health insurance OR apply for an exemption. You decide on which insurance you are going to choose (Academic Care or Swisscare) and return the letter from SG to them with the name of your insurance company. You apply for an insurance according to the instructions. Part of this application is «form A», a confirmation of matriculation and a copy of your residence permit. Annina Wanner / Sandra Zweifel SG informs you that your insurance is not a KVG insurance and that they forward your application for an exemption to GD for decision. The insurance company forwards «form A», your confirmation of matriculation and the copy of your residence permit directly to GD. GD informs you about the decision. A copy goes to SG.

19 Academic Care / Swisscare how to cancel it before you leave? To cancel your insurance you will need the «Abmeldebestätigung/deregistration confirmation» of the city hall (outside the city of Zurich: the municipal administration office). -> Deregistration is possible 30 days before departure at the earliest. Inform your insurance company around one month prior to your departure about the exact departure date as well as the actual bank/post account and hand in the above mentioned deregistration confirmation. Both Swisscare and Academic Care will refund unused (full) insurance months. The refund can be made to your Swiss bank/post account (agree with your bank/post to only close the account once refunds are made). If the refund has to be made to your foreign account you will bear the transaction costs this can become expensive. Annina Wanner / Sandra Zweifel

20 What to do in case of illness Minor medical problems (e.g. common cold, cough): -> go to pharmacy and ask for the appropriate medication Medical problems that require a doctor: -> check for «General med. practitioner» -> choose a doctor near your home -> call for an appointment -> bring your Swiss or European health insurance card with you. «Permanence» medical clinic in the main station and in Oerlikon, open 365 days, 7 am 10 pm -> no appointment needed, but you may have to wait up to 2 hours Important: the emergency ward of a hospital is reserved for severe illnesses / severe accidents / life-threatening conditions If you are unsure whether a treatment is covered by your health insurance: double check with your insurance company! Annina Wanner / Sandra Zweifel

21 Usual billing procedure when seeing a general practitioner (doctor) 1. Wait for the doctor s bill (usually comes a few weeks after the treatment) which includes: bill (including a payment slip; payable within 30 days) reimbursement certificate («Rückforderungsbeleg») Annina Wanner / Sandra Zweifel

22 Reimbursement certificate Doctor s name and address Law (KVG or VVG) Duration of treatment Detailed list of treatment & medicine (for each day of treatment) Annina Wanner / Sandra Zweifel

23 Usual billing procedure when seeing a general practitioner (doctor) 2. Pay the bill to the doctor within 30 days. 3. Send the reimbursement certificate («Rückforderungsbeleg») to your insurance company. -> Swisscare: online procedure under «claims» on the Swisscare website 4. Wait for the money to be paid to your account. Important: If your insurance company is too slow with the reimbursement and you are unable to pay the doctor s bill -> call the doctor s practice and ask them to stop any legal proceeding! Annina Wanner / Sandra Zweifel

24 Special billing procedure for students with Swisscare Annina Wanner / Sandra Zweifel

25 Billing procedure for hospital treatments (practiced by all insurance companies) Hospitals (and sometimes even doctors!) send their bills directly to your health insurance company -> In this case you will receive the bill for the deductible/cost contribution directly from your health insurance company. If the bill comes directly from your health insurance company: you have to pay that bill and cannot claim anything back! Annina Wanner / Sandra Zweifel

26 Billing procedure for EU/EFTA students with an exemption Important: Do not deal with your insurance company at home if you are insured by the law in an EU/EFTA country and have an exemption in Switzerland! «Gemeinsame Einrichtung KVG» coordinates the billing of the treatment costs with your health insurance abroad! Have a look a their website: All important information can be found there There is no fixed deductible and 10% contribution, but: cost contribution: CHF 92 within a treatment period of 30 days Hospital stays: CHF 15 per day (for people over 25 years) Annina Wanner / Sandra Zweifel

27 Billing procedure for EU/EFTA students with an exemption 1. Wait for the doctor s bill 2. Pay the bill within 30 days 3. Send the following to the «Gemeinsame Einrichtung KVG» original doctor s bill (without payment slip) incl. «Rückforderungsbeleg» copy of your «European Health Insurance Card» (backside) exemption confirmation - Final letter (Verfügung) from the «Gesundheitsdirektion des Kantons Zürich» «confirmation of matriculation» from ETH Zurich your bank information (IBAN, BIC, bank s name/address, your name/address) 4. Wait for the money to be paid to your account Annina Wanner / Sandra Zweifel

28 Billing procedure for EU/EFTA students with an exemption If the bill comes from the «Gemeinsame Einrichtung KVG», this means: the doctor/hospital sent the bill directly to «Gemeinsame Einrichtung KVG» that now bills you for the cost contribution. You have to pay this, you cannot claim anything back! Annina Wanner / Sandra Zweifel

29 Thank you! Download this presentation and sample letters from authorities at: Further, very useful information can be found on the website of the Federal Office of Public Health (2 pdf s). Annina Wanner / Sandra Zweifel

30 Annina Wanner / Sandra Zweifel