The gaps in mandatory healthcare insurance

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An insurance is always here to support you financially when you are facing a problem but, as always, there are some things that are covered and other things that are not. 

This article will allow you to understand the existing gaps in the LAMal and whether you consider necessary or not to take out other private insurances

Hospitalisation gaps 

There is a whole range of services that are not covered by the basic insurance. For example, if you are hospitalised, you will only be covered in a public hospital recognised by your canton (CHUG/CHUV, etc) and in a common room setting. Which means that you will not be allowed to require a private room but that instead, you will most often be three to four roommates. It will also not be an option for you to ask to be treated in private establishments such as the Cécile clinic or in Genolier. 

Outpatient gaps (Ocular / Dental / Osteo)

Most ocular treatments are not included in your basic insurance. Coverage is possible as long as you have not reached the pivotal age of 18. 

  • Glasses: children get 180 CHF per year for prescribed glasses or contact lenses. 

Regarding teeth, the law does not plan for any kind of cover, regardless of whether the individual is a minor or not. The only reimbursement possibility happens when the problem follows an illness. 

And if you are experiencing backpains and decide to go see an osteopath, not a single dime will be reimbursed to you. 

Gaps regarding international travel  

It is so nice to picture yourself for a moment in the sun or the sea, feeling the wind breeze, or laying on a long chair. At the same time, it is a lot less pleasant to imagine what would happen if, after having mojito that day, you ended up at the hospital because of an indigestion… and an insolation on top of it. 

And yet, these things happen and it is important to understand what would follow in this case. 

The LAMal reimburses… brace yourself: twice the amount it would have had to pay for the same care in Switzerland. Put differently, it will bill the same services you got abroad at Swiss prices and will reimburse you double the amount. 

Pretty cool right? I would say so for 90% of cases because Switzerland is an expensive country, including when it comes to healthcare. However, in some countries, the costs are even more expensive than in Switzerland: Japan, USA, Australia, etc… 

In conclusion, the LAMal is a good cover abroad, but it is not fullproof. 

Gaps in transportation and rescue 

There are other important gaps that are often forgotten about but that can have a huge influence on your finances in case you have to face them: 

  • Transportation: the LAMal reimburses 50% of the medical transportation costs or a maximum of 500 CHF per civil year. This amount is insufficient in nearly all cases. To give you an example, in Switzerland, being transported in an ambulance will set you back 700 CHF, minimum. 
  • Rescue: rescue is covered in Switzerland for up to 50% or a maximum of 5,000 CHF per civil year. Helicopter rescues are extremely expensive and the basic insurance’s compensation is far from enough to cover one. 

Gaps in the mandatory healthcare insurance for maternity 

  1. The insurance will not cover, neither for you, nor for your child, the complications that may happen during the first twelve weeks of pregnancy. 
  2. You may not give birth in the hospital of your choice. 
  3. You cannot choose your room, nor the amount of people you will share it with. 
  4. You cannot request to be treated by your gynaecologist. 

In case you require special care or wish to make up for these gaps, it is important that you turn to supplementary healthcare insurances. 

Every case can be covered at varying degrees by supplementary insurance.

The covers of the mandatory insurance are wide and offer guaranteed quality care but just like and other social insurance, it has its limits. At least now, you know about all of them.

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