What does the mandatory healthcare insurance cover?

It is one thing to know what we will be paying to be insured, but knowing what this cover is for is better. 

The mandatory healthcare insurance allows the provision of quality care to the entire population in case of: 

• Illness. 
• Accident.
• Maternity. 

Illness

The mandatory healthcare insurance will cover, for everyone who does not fall within the exception criteria, any kind of medical issue. 

When should we cover ourselves for accidents? 

This is more of a question for your employer. It is normally not necessary to add the accident option to your insurance. But it is also possible that you do not have an employer… What would happen then? 

Actually, there are three different possible cases: 

1. You are unemployed: (student, housewife, retired, other) it is mandatory to include the accident insurance either directly in your health insurance policy, or to go through a third-party insurance to cover this risk. 
2. You are employed less than eight hours per week: your employer must insure you against professional accidents (accidents that occur at the workplace or while on duty). However, it is your responsibility to cover yourself for nonprofessional accidents. 
3. You are employed more than eight hours a week: your employer must insure you against all kinds of accidents. Make sure to double check whether you removed the accident option from your contract to avoid paying for it twice. 

The accident cover comes at a cost! It is estimated to represent 7.5% of the health insurance premium, which amounts to between 360 CHF and 600 CHF per year. It is very important that you make sure you are not insured twice. 

Maternity 

On top of being covered by the mandatory healthcare insurance, maternity is exceptional in Switzerland as no contribution is requested from you in case of a pregnancy. This means no deductible nor quote-part from the 13^th week of pregnancy onward and up until the 8^th week after giving birth. 

Yes, you read that right, you can give birth at a hospital in Switzerland 100% free of charge. But let’s have a closer look at this shall we? 

The list of things covered by the insurance in the context of maternity are the following: 

1. Every complication related to the pregnancy or illnesses that could happen from the 13^th week of pregnancy onwards. 
2. Check-ups (two echography, trimestral tests). 
3. Advice on breastfeeding and preparation for delivering. 
4. Delivery at a hospital or a birth house. 
5. The hospitalisation of your child upon birth is covered by the insurance of the mother. 

I think we can all agree on the fact that our dear LAMal has more than one trick up its sleeve and works pretty well. Yet, some big gaps do exist in the basic insurance. They can all be covered, without any exception, by adequate supplementary insurances.