Ah, Swiss health insurance…

One of those things you know you need when you move here, so you sign some papers, choose a franchise, nod politely when someone explains LAMal and complémentaire… and hope Future You will understand what you just bought.

Future Me did not.

After a few years in Geneva, two kids, pregnancies, specialists, ORL / speech therapists follow ups, dental conversations and more insurance paperwork than I care to remember, there are definitely a few things I wish someone had explained to me before I actually needed them.

So this isn’t an insurance expert’s guide. We’re not brokers, and please don’t make any major financial decisions because two women on the internet told you to. 😅

This is simply a list of things I personally wish I’d known earlier, plus a quick refresher on how the system works for anyone who, like us, moved here from somewhere with a completely different insurance setup.

1. A quick Swiss health insurance refresher
2. If you’re thinking about having a baby, look into supplementary insurance BEFORE you’re pregnant
3. Kids’ dental insurance: look at it EARLY
4. Your franchise is NOT your monthly premium
5. January = we start again 🥲
6. Your kids don’t necessarily need the same insurance setup as you
7. If you work, check whether you’re paying for accident coverage unnecessarily
8. More expensive basic insurance doesn’t mean better medical coverage
9. Compare your health insurance
10. Supplementary insurance is where you REALLY need to read the tiny print
11. Don’t cancel supplementary insurance before you’ve been accepted by the new one
12. Understand how you’re actually going to be billed
13. Autumn is insurance admin season
14. Check whether you’re eligible for a health insurance subsidy
15. Ask questions BEFORE you need the insurance
16. A Very Short summary (TLDR)

First, a quick Swiss health insurance refresher

In Switzerland, health insurance is individual and mandatory. It’s not automatically provided through your employer: each person (including children) needs their own policy.

When you move to Switzerland, you generally have three months to arrange your basic health insurance.

Basic vs. supplementary insurance

There are essentially two layers:

Basic insurance (assurance de base / LAMal)	Supplementary insurance (assurance complémentaire)
– This is mandatory. – The benefits are defined by Swiss law, so the basic medical coverage is the same regardless of which authorised insurer you choose. – Insurers also cannot refuse you for basic insurance because of your age or medical history.	– This is optional and can cover additional things depending on your policy (i.e: dental care, alternative medicine, additional hospital options or private/semi-private hospital accommodation.) – Unlike basic insurance, supplementary insurers can ask about your health and can refuse your application or place restrictions on your coverage. That distinction becomes VERY important later. 👀

Three words you’ll hear constantly

Premium (prime)	Franchise	Quote-part / co-payment
The amount you pay every month for your insurance, whether you use it or not.	– The amount you pay yourself each calendar year before your basic insurance starts contributing. – For adults, you can choose a franchise ranging from CHF 300 to CHF 2,500.	Once you’ve reached your franchise, basic insurance generally pays 90% of eligible costs and you pay the remaining 10%, up to an annual maximum of CHF 700 for adults. Generally, – Higher franchise = lower monthly premium, – Lower franchise = higher monthly premium.

Sounds simple enough… until you actually need to use it. 😅

What’s a Telmed / family doctor / HMO model? + PRAXIS FYI

When choosing basic insurance, you’ll also choose how you access healthcare.

Standard	Family doctor	Telmed	HMO (Health Maintenance Organization)
gives you the most freedom to choose doctors.	generally agree to contact your designated GP first, who can then refer you to a specialist if needed.	usually need to contact a medical hotline or app first before booking an appointment	generally agree to visit a designated medical centre or group practice first. They coordinate your care and refer you to specialists when necessary.

The more restrictive models usually come with cheaper premiums, but make sure you understand the rules of your particular policy, especially before booking specialists directly. Requirements and exceptions can vary by insurer and model.

A little FYI for 2027: You may also start seeing the term PRAXIS when comparing health insurance. This is a new official classification that groups the traditional Family Doctor and HMO models together, since both essentially work around having a designated medical practice as your first point of contact.

So don’t panic when yet another Swiss insurance word appears on your screen. 😅 It’s mainly a new way of categorising models you may already know.

Yes, you can change basic insurers

Your basic insurance premium can change every year. New premiums are announced in autumn, which is a good reminder to compare your options for the following year.

For a standard change effective 1st January, your current insurer generally needs to receive your cancellation by 30th November.

And that’s basically Insurance 101.

Now onto the stuff I actually wish someone had told me before I needed it…

2. If you’re thinking about having a baby, look into supplementary insurance BEFORE you’re pregnant

This is probably one of my biggest “I wish someone had told me this” moments.

If having private or semi-private hospital coverage for a future pregnancy is important to you, do not wait until you’re pregnant or “planning to get pregnant soon” to look into it.

Depending on the insurer and policy, supplementary maternity benefits can have waiting periods and eligibility conditions.

In my own experience, I learned that I needed to have the relevant supplementary coverage well in advance, essentially planning around a year before pregnancy, to benefit from the private hospital and doctor options I wanted.

And because supplementary insurers are allowed to assess your health when you apply, “thinking about in the next 6 months” or getting pregnant first and figuring out the insurance afterwards may be too late for certain benefits.

So if babies are even vaguely part of your future plans, this is one of those incredibly unromantic conversations worth having with your insurer early.

Welcome to Switzerland.

Important: that one year timeframe isn’t a universal Swiss rule. Waiting periods and conditions vary between supplementary policies, so ask your insurer specifically what applies to maternity and private/semi-private hospital coverage.

Good news: basic insurance already covers a lot during pregnancy

You absolutely do not need private insurance to receive maternity care in Switzerland.

Basic insurance covers defined maternity services, including pregnancy check-ups, childbirth and certain postnatal care.

But here’s another little detail I wish I’d known:

While specific maternity services are covered without the usual franchise or co-payment from the beginning of pregnancy, the broader exemption for general medical treatment only kicks in from the 13th week of pregnancy and continues until eight weeks after childbirth.

This means that certain medical tests or treatments during your first trimester may still be subject to your usual franchise and co-payment if they aren’t classified as maternity-related services. It’s also worth checking that maternity-related care is correctly identified as such on your invoices, so your insurer knows how to process it (first hand experience over here).

I’ve heard from other mamas who had blood work done early in pregnancy and later found a lovely little CHF 500–600 bill waiting for them… 🥲

My tips:

• Before having blood work done, especially during early pregnancy, ask your doctor and insurer whether the tests are considered maternity-related and covered without cost-sharing.
• If a non-urgent test can safely be scheduled later, ask whether the timing could affect your coverage.
• Of course, never delay medically necessary blood work or prenatal screening just to save money. Some tests need to be performed during specific weeks of pregnancy.

Private or semi-private supplementary insurance is therefore more about the additional benefits, choice and comfort included in your particular policy, rather than whether you can receive proper maternity care in the first place.

And one tip for after the baby arrives:

Don’t forget about that eight week postpartum window either. If you’re planning to see a physiotherapist or start perineal/pelvic-floor rehabilitation, it’s worth looking into appointments as early as possible.

Depending on where you book, waiting times can easily be a few weeks, sometimes close to a month, which suddenly eats up a big chunk of those eight weeks.

So while you’re probably not thinking about your pelvic floor when you’re three days postpartum and surviving on very little sleep 😅, it’s worth getting those appointments in the diary early.

Just keep in mind that not every physio or perineal rehabilitation session is automatically covered simply because it takes place within those eight weeks. Coverage can depend on whether the treatment is medically prescribed and how it’s billed, so check with your doctor, therapist and insurer beforehand.

3. Kids’ dental insurance: look at it EARLY

Parents, this is another one.

Don’t wait until your child actually needs dental work or orthodontics before thinking about dental insurance.

Basic Swiss health insurance generally doesn’t cover routine dental treatment or orthodontics, except in certain specific medical situations.

We were advised to arrange supplementary dental coverage while the kids were young, ideally before around age four, depending on the insurer because once they’re older, insurers may require dental examinations or assess existing problems before accepting them.

This isn’t a universal “age four” Swiss rule, so check the exact age and conditions with your chosen insurer.

But my personal advice? Put “kids’ dental insurance” on your admin list when they’re still tiny, not when the orthodontist starts talking about braces.

Future You may be extremely grateful.

4. Your franchise is NOT your monthly premium

This took some getting used to. Your:

Premium (prime)

Franchise

what you pay every month just to have the insurance.

the amount of eligible healthcare costs you pay yourself each calendar year before your basic insurance starts contributing. – And even after reaching your franchise, you generally still pay 10% of further eligible costs, up to the annual legal maximum. – For adults, the lowest franchise is CHF300 and the highest optional franchise is CHF2,500. – If you suddenly need specialists, tests, medication, physio and multiple appointments? You will become intimately acquainted with the number 2,500.

Choose your franchise based on your actual situation and how much financial risk you’re comfortable carrying, not just the prettiest monthly premium.

5. January = we start again 🥲

Another fun discovery.

Your franchise works on a calendar year basis.

So reaching your franchise in November does not mean you’re now living your best insurance covered life for the next twelve months.

January comes.

The counter resets.

Happy New Year. 🎉

If you know you’ll have several non-urgent appointments, treatments or follow-ups, it’s worth at least being aware of where you are in your franchise for that year.

Obviously, don’t delay necessary medical treatment just to optimise insurance costs.

6. Your kids don’t necessarily need the same insurance setup as you

Every family member has their own health insurance policy, including children.

And their needs aren’t necessarily yours.

Maybe you want alternative medicine. Maybe your child needs dental coverage. Maybe one family member regularly sees specialists while another basically sees a doctor once every three years (this is personally my case).

You also don’t necessarily all need to be insured by the same company.

So don’t automatically assume everyone in your family needs exactly the same supplementary packages, franchise, model or even insurer.

Comparing your family’s needs person by person can actually make a lot of sense.

7. If you work, check whether you’re paying for accident coverage unnecessarily

This is a small one that can easily get overlooked.

If you work at least eight hours per week for the same employer in Switzerland, you’re generally covered by your employer’s accident insurance for occupational and non-occupational accidents.

In that case, you can usually ask your health insurer to suspend the accident component of your basic health insurance, which reduces your premium.

If you’re not employed or don’t meet the required number of hours you’ll generally need accident coverage through your health insurance instead.

It’s not going to finance your next holiday, but hey, we’ll take every franc.

8. More expensive basic insurance doesn’t mean better medical coverage

This one is important when comparing insurers.

The benefits included in compulsory basic insurance are defined by law and are the same regardless of which authorised insurer you choose.

So paying a higher premium for basic insurance doesn’t automatically mean you’re getting “better healthcare.”

What can differ is the monthly premium, customer service, administration and the insurance model you choose.

So when comparing insurers, look beyond the logo and price.

And remember that choosing the cheapest Telmed/HMO/family doctor model won’t necessarily be the best deal for you if the restrictions drive you crazy.

Cheap is only useful if the model actually fits the way you use healthcare.

9. Compare your health insurance

Here’s a little tip recommended by other local expats that we think is worth sharing.

Don’t automatically renew your health insurance every year without comparing what’s available.

In Switzerland, basic health insurance premiums can change annually, and you might find that another provider offers the same legally required basic coverage for a lower monthly premium.

And considering Geneva has some of the highest health insurance premiums in Switzerland, it’s definitely worth checking!

Two websites worth bookmarking

Comparis — recommended by local expats	Priminfo — the official Swiss government comparison tool
– This is one of Switzerland’s best-known comparison platforms and a handy starting point if you’re looking to compare health insurance. – You can explore different providers, premiums, franchises and insurance models to see which options might suit your situation. – It’s also useful for comparing other things, such as household insurance, car insurance and telecommunications.	– If you’d prefer an official source, Priminfo is the Swiss government’s health insurance premium comparison platform. – It’s free and lets you compare approved basic insurance premiums based on your location, age, franchise and insurance model.

Our tip

• Use both websites to get a clearer picture of your options.
• Remember that cheaper doesn’t always mean more convenient.
• Check the insurance model, restrictions and customer service before making a decision.
• And if you’re comparing supplementary insurance, pay particular attention to the benefits, exclusions and waiting periods. Unlike basic insurance, supplementary coverage isn’t standardised.
• One last thing: Autumn is the perfect time to compare, as the following year’s premiums are announced around September.
• For a standard basic insurance switch effective 1 January, your cancellation generally needs to reach your current insurer by 30 November. **Add an annual reminder to your calendar.

10. Supplementary insurance is where you REALLY need to read the tiny print

Basic insurance is heavily regulated.

Supplementary insurance is where things get much more individual.

One person’s policy might cover something yours doesn’t. Your friend’s insurer might reimburse a treatment that yours won’t.

There may be annual limits, approved-provider lists, reimbursement percentages, exclusions, waiting periods and all sorts of other conditions.

Basically: Never assume “I have supplementary insurance” = “I’m covered.”

Before booking an expensive treatment, therapy or specialist because you think your complémentaire covers it, ask.

And ideally ask in writing.

Screenshots and PDFs are your friends.

11. Don’t cancel supplementary insurance before you’ve been accepted by the new one

This deserves its own giant warning sign.

Because basic insurance providers must accept you, changing your basic insurance is relatively straightforward.

Supplementary insurance is completely different.

A new provider can assess your health and potentially refuse your application, exclude certain conditions or place restrictions on your coverage.

So if you’re planning to switch supplementary insurance:

Do not cancel your existing policy first and assume another company will accept you.

Apply, wait for confirmation, understand exactly what the new policy covers, and only then deal with cancelling the old one.

And how often can you actually change your supplementary insurance?

Unlike basic insurance, supplementary insurance doesn’t necessarily follow the same annual switching rules.

Depending on your contract, you may be able to cancel at the end of each insurance year, provided you respect the notice period. For longer contracts, you generally have the right to cancel after three years with three months’ notice, although some policies allow you to leave earlier.

So before switching, check your contract’s cancellation conditions and deadlines.

And most importantly, make sure your new insurer has accepted you before cancelling your existing coverage.

Because saving CHF 20 a month isn’t worth discovering you’ve lost coverage you can no longer get back.

12. Understand how you’re actually going to be billed

Another little Swiss insurance vocabulary lesson you’ll eventually encounter:

Tiers payant	Tiers garant
the healthcare provider sends the bill directly to your insurer. Your insurer then charges you whatever portion you’re responsible for.	the bill comes to you first. You pay it and it is then submitted to your insurer for reimbursement, depending on your coverage and franchise.

You’ll encounter both systems depending on the provider, pharmacy and insurer.

And yes, be mindful that your inbox will contain a lot of medical invoices… I now suddenly understand why everyone here keeps paperwork for approximately 700 years.

13. Autumn is insurance admin season

Every year, premiums for the following year are announced in autumn.

Don’t just see the letter/email, sigh at the increase and carry on.

Use it as your annual reminder to check:

• Has my premium increased significantly?
• Is my franchise still appropriate?
• Would another basic insurer be cheaper?
• Would a different model work for me?
• Do my kids still have the right coverage?
• Have our family’s healthcare needs changed?

Just remember that basic and supplementary insurance have different rules and cancellation deadlines, so don’t assume changing one automatically changes the other.

And again: be particularly careful before touching supplementary insurance.

14. Check whether you’re eligible for a health insurance subsidy

Depending on your income and household situation, you may qualify for financial assistance towards your basic health insurance premiums in Geneva. These are called subsides d’assurance-maladie.

It’s worth checking your eligibility with the Canton of Geneva, particularly if your household or financial situation has recently changed.

Because Swiss health insurance isn’t exactly known for being cheap… so if you’re entitled to a little help with those monthly premiums, take it.

15. Ask questions BEFORE you need the insurance

Probably my biggest lesson from navigating the Swiss system is that insurance is incredibly boring…

…until suddenly it isn’t.

Pregnancy. Dental treatment. Speech therapy. Physio. Dermatology. Hospitalisation. Children’s specialists.

That’s usually when you discover the sentence: “Unfortunately, your policy doesn’t cover…”

So once a year, it’s worth doing a little insurance admin check.

• What is my franchise?
• What supplementary coverage do I actually have?
• What do my kids have?
• Has anything changed in our health or family situation?
• Are we thinking about another baby?
• Do we need dental or orthodontic coverage?
• Are there reimbursement limits we don’t know about?

Twenty boring minutes now can potentially save a lot of confusion and money later.

The very short version

If I could go back and give Newly-Arrived-in-Switzerland Me a little insurance checklist, it would be:

• Understand the difference between basic (LAMal) and supplementary (complémentaire) insurance.
• If you’re considering pregnancy and want private/semi-private hospital benefits, look into supplementary coverage well before you’re pregnant.
• Look into dental/orthodontic insurance for your children while they’re still very young.
• Understand what your franchise actually means before choosing CHF 2,500 just because the monthly premium is cheaper.
• Remember that your franchise resets every calendar year.
• Make sure you understand the rules of your Telmed, family doctor or HMO model before seeing specialists directly.
• Check whether your employer already provides accident insurance.
• Don’t assume every family member needs identical coverage or even the same insurer.
• Compare your basic insurance again when the new premiums are announced in autumn.
• Never cancel supplementary insurance until you know you’ve been accepted elsewhere.
• And when in doubt: ask your insurer before booking or paying for something expensive.

One final disclaimer

This is based partly on our personal experience living in Geneva and is meant as a friendly starting point not financial, legal, medical or insurance advice.

Insurance policies, supplementary benefits, eligibility requirements, cancellation deadlines and reimbursement rules can vary between providers and policies and can change over time.

Always confirm the current conditions directly with your insurer or an independent insurance adviser.

Because if there’s one thing we’ve learned about Swiss insurance, it’s this:

Assume nothing. Ask everything. And keep the paperwork. 😅