- Accident Insurance (UVG/LAA)
- Mandatory insurance covering workplace and non-workplace accidents. Employees are covered through their employer. Self-employed individuals and non-working residents must include accident cover in their basic health insurance policy.
- Alternative Insurance Model
- A cost-saving variation of basic insurance where you agree to restrictions on how you access care — such as calling a hotline first (Telmed), always visiting your GP first (Hausarzt), or using a specific health centre (HMO). In return, you receive a premium discount of 10–25%.
- BAG / FOPH (Bundesamt für Gesundheit / Federal Office of Public Health)
- The Swiss federal authority responsible for health policy, approving insurers, and publishing the official list of approved premiums each year. The BAG ensures that all insurers comply with KVG/LAMal regulations.
- Basic Insurance (Grundversicherung / OKP / AOS)
- The mandatory health insurance that every resident of Switzerland must hold. It covers a standardised catalogue of medical services defined by law. All insurers must accept every applicant for basic insurance regardless of age or health status. Also known as OKP (Obligatorische Krankenpflegeversicherung) in German or AOS (Assurance obligatoire des soins) in French.
- Cantonal Premium Region (Prämienregion)
- Switzerland divides each canton into one to three premium regions based on healthcare costs in that area. Urban areas typically fall into more expensive regions, while rural areas may be cheaper. Your premium depends on which region your commune belongs to.
- Co-payment (Selbstbehalt)
- After you have paid your annual deductible, you contribute 10% of any further medical costs up to a maximum of CHF 700 per year for adults and CHF 350 for children. This 10% share is the co-payment.
- Complementary Insurance (Komplementärmedizin-Zusatz)
- A type of supplementary insurance that covers alternative and complementary therapies such as acupuncture, osteopathy, homeopathy, and traditional Chinese medicine — treatments not fully included in basic insurance.
- Deductible (Franchise)
- The annual amount you pay out of pocket before your insurer begins covering costs. Adults can choose from CHF 300, 500, 1,000, 1,500, 2,000, or 2,500. Children's options range from CHF 0 to CHF 600. A higher deductible means a lower monthly premium.
- DRG (Diagnosis-Related Groups / SwissDRG)
- The flat-rate payment system used for hospital inpatient stays. Each diagnosis and treatment is assigned to a group with a fixed reimbursement amount. This system standardises hospital billing across Switzerland.
- Emergency Treatment (Notfallbehandlung)
- Urgent medical care provided in an emergency department. Basic insurance covers emergency treatment at any hospital in Switzerland, regardless of your insurance model. There is no requirement to contact your GP or hotline first in a genuine emergency.
- Ergänzungsleistungen (EL) / Supplementary Benefits
- Additional financial support for AHV/IV recipients whose pension does not cover basic living costs. EL can include full coverage of health insurance premiums and medical expenses not covered by basic insurance.
- GP Model (Hausarztmodell)
- An alternative insurance model where you must first consult your designated general practitioner (GP/Hausarzt) before seeing a specialist. The GP acts as a gatekeeper. This model typically reduces premiums by 10–20%.
- Health Insurance Card (Versichertenkarte)
- A personal card issued by your insurer containing your name, insurance number, and AHV number. You present this card at every medical appointment and pharmacy visit. It serves as proof of insurance coverage.
- HMO (Health Maintenance Organisation)
- An alternative insurance model where you receive all primary care at a specific HMO health centre. The centre coordinates referrals to specialists. HMO models offer the largest premium discounts (up to 25%) but limit your choice of primary care provider.
- Hospital List (Spitalliste)
- Each canton publishes a list of approved hospitals. Basic insurance covers inpatient treatment at hospitals on the list of your canton of residence (general ward). Treatment at an out-of-canton hospital is covered only in emergencies or if the treatment is not available locally.
- IPV (Individuelle Prämienverbilligung) / Premium Subsidy
- A government subsidy that reduces health insurance premiums for individuals and families with low to moderate incomes. Administered by each canton with different eligibility criteria and amounts. See our subsidy guide for details.
- KVG / LAMal (Krankenversicherungsgesetz / Loi sur l'assurance-maladie)
- The Federal Health Insurance Act — the primary Swiss law governing mandatory health insurance. It defines the benefits catalogue, insurer obligations, and residents' duty to insure. All basic insurance is regulated under KVG/LAMal.
- LCA / VVG (Loi sur le contrat d'assurance / Versicherungsvertragsgesetz)
- The Federal Insurance Contract Act governing supplementary (voluntary) insurance. Unlike KVG, insurers under VVG can reject applicants, set individual premiums based on health risk, and define their own benefit catalogues.
- Maternity Benefits (Mutterschaftsleistungen)
- Under basic insurance, maternity care is exempt from the deductible and co-payment from the 13th week of pregnancy. Covered services include prenatal check-ups, delivery, postnatal care, and breastfeeding counselling.
- Pharmacy (Apotheke)
- Pharmacies dispense prescribed medications covered by basic insurance. The cost is subject to your deductible and co-payment. Some medications have a higher co-payment rate (20%) if a cheaper generic equivalent exists.
- Premium (Prämie)
- The monthly amount you pay to your health insurer for basic coverage. Premiums vary by canton, insurer, age category, deductible level, and insurance model. They are not based on your income or health status.
- Premium Reduction — see IPV
- Another term for the Individuelle Prämienverbilligung. The government subsidy that lowers your monthly premium based on income. Also called "Prämienverbilligung" in German.
- Referral (Überweisung)
- A written recommendation from your GP to see a specialist. In alternative insurance models (GP, HMO), a referral is typically required before specialist visits are covered. In the standard model, you can visit specialists directly without a referral.
- Supplementary Insurance (Zusatzversicherung)
- Voluntary insurance that covers services beyond basic insurance, such as private hospital rooms, dental care, glasses, alternative medicine, and worldwide emergency coverage. Governed by VVG/LCA, not KVG/LAMal. Insurers can reject applicants.
- Suspension of Coverage (Sistierung)
- In certain cases (e.g., extended stay abroad, military service), you can temporarily suspend your basic insurance. Strict conditions apply, and you must re-activate coverage upon return to Switzerland.
- Switching Period (Wechselfrist)
- The annual window during which you can change your basic insurer. You must cancel your current policy by 30 November for a change effective 1 January. A second switching window exists on 30 June for those with the highest deductible (CHF 2,500) in some cantons.
- Tarmed / TARDOC
- The tariff system used to calculate fees for outpatient medical services in Switzerland. Each procedure is assigned a point value, multiplied by a cantonal rate. TARDOC is the successor system currently being introduced to replace Tarmed.
- Telemedicine Model (Telmed)
- An alternative insurance model where you must call a medical hotline before visiting a doctor. The hotline triages your condition and directs you to the appropriate care. Premium discounts typically range from 10–20%.
- Third-Party Liability (Haftpflicht)
- Not part of health insurance, but often confused with it. Third-party liability insurance covers damage you cause to others. It is separate from KVG and is strongly recommended but not legally mandatory for individuals.
- Waiting Period (Wartefrist)
- A period after enrolling in supplementary insurance during which certain benefits are not yet covered. Common for maternity benefits (typically 12 months) and dental treatments. Basic insurance has no waiting periods — coverage begins immediately.
- Young Adult Rate (Junge Erwachsene)
- A reduced premium category for insured persons aged 19 to 25. Available in most cantons, these rates are significantly lower than adult premiums. The reduction applies automatically based on age.
