Compulsory health insurance (OKP)

What is the OKP?

OKP is the abbreviation for obligatorische Krankenpflegeversicherung, compulsory health insurance. This is the name used in the Federal Health Insurance Act (KVG) for the insurance you know in everyday life as basic health insurance. You will find the abbreviation on policies and in official letters, so it is worth knowing. The OKP is part of social health insurance, which the KVG divides into two branches: the OKP, which is compulsory for everyone, and voluntary daily allowance insurance for loss of earnings (Art. 1a para. 1 KVG).

The OKP pays in case of illness, maternity and accident, as long as no accident insurance covers the costs (Art. 1a para. 2 KVG). Anyone who works at least eight hours a week for one employer is insured against accidents through the employer under the Accident Insurance Act (UVG); the accident cover in the OKP can then be suspended (Art. 8 KVG).

It is important to distinguish it from supplementary insurance. The OKP is subject to the KVG and the Health Insurance Supervision Act (KVAG) and is supervised by the Federal Office of Public Health (FOPH). Supplementary insurance such as a semi-private hospital ward, dental or complementary medicine cover consists of private-law contracts under the Insurance Contract Act (ICA, VVG in German) (Art. 2 para. 2 KVAG). Different rules apply to them: the insurer may ask health questions, add reservations or turn you down. In the OKP, all of this is prohibited.

The OKP applies to everyone resident in Switzerland, from newborns to pensioners. It also covers some people who are not resident here, such as cross-border commuters working in Switzerland or pensioners receiving a Swiss pension who live in an EU or EFTA state; the Federal Council can extend the requirement to take out insurance to them (Art. 3 para. 3 KVG).

How it works

Joining: Anyone who moves to Switzerland or is born here must take out insurance within three months (Art. 3 para. 1 KVG). If you join on time, cover applies retroactively from birth or from the date you took up residence. If you join late, you are only insured from the date you join and may have to pay a premium surcharge of 30 to 50% for a maximum of five years (Art. 5 para. 2 KVG, Art. 8 KVV). The details are explained under requirement to take out insurance.

Choice of insurer: You may choose freely among all insurers that have FOPH approval to offer social health insurance (Art. 4 KVG). As of 01.01.2026 there were 34 such insurers. Every insurer must accept you within its area of operation, without health questions (Art. 5 let. i KVAG). You will find an overview with key figures under health insurers.

Benefits: The OKP covers the costs of services used to diagnose or treat an illness and its consequences (Art. 25 KVG). These include outpatient and inpatient treatment by doctors, chiropractors and nurses, laboratory tests prescribed by a doctor, medicines as well as aids and appliances, medical rehabilitation, a stay in the general ward of a listed hospital and a contribution towards transport and rescue costs. Further articles cover nursing care (Art. 25a), prevention (Art. 26), congenital disorders (Art. 27), accidents (Art. 28), maternity (Art. 29) and dental treatment in narrowly defined cases (Art. 31). The details are set out in ordinances and lists, summarised in the catalogue of benefits.

The WZW condition: Every service must be effective, appropriate and cost-effective (Art. 32 para. 1 KVG), known in German as WZW. Effectiveness must be scientifically proven. Services that may no longer meet these criteria are reviewed in an evidence-based procedure and, if the result is negative, are no longer reimbursed (Art. 32 paras. 3 and 4 KVG, in force since 01.01.2026).

The same benefits everywhere: In the OKP, insurers may not cover any costs other than those laid down in law (Art. 34 para. 1 KVG). That is why the scope of benefits is identical with every insurer. The differences lie in the premium, the insurance models on offer and the service.

Costs for you: You pay a monthly premium in advance (Art. 90 KVV). When you receive treatment, the co-payment is added: the deductible (Franchise) as a fixed annual amount and a 10% retention fee (Selbstbehalt) on costs above it (Art. 64 para. 2 KVG). The standard deductible for adults is CHF 300, and the retention fee is capped at CHF 700 a year, for children at CHF 350 (Art. 103 KVV). Adults can choose deductibles of CHF 500, 1,000, 1,500, 2,000 and 2,500 (Art. 93 KVV). For a hospital stay there is also a contribution of CHF 15 per day; children, young adults in education and women receiving maternity benefits are exempt (Art. 104 KVV).

Legal basis

The OKP is governed by Title 2 of the KVG. The most important articles are:

• Art. 1a KVG: Social health insurance comprises the OKP and voluntary daily allowance insurance. It provides benefits in case of illness, accident (where no accident insurance pays) and maternity.
• Art. 3 KVG: Requirement to take out insurance within three months of taking up residence or of birth.
• Art. 4 and 7 KVG: Free choice of insurer and switching with three months’ notice to the end of a calendar half-year, or with one month’s notice after the new premium has been announced.
• Art. 24–34 KVG: Benefits, the WZW criteria (Art. 32) and the prohibition on covering benefits other than those laid down in law (Art. 34 para. 1).
• Art. 61 KVG: The insurer sets the premiums, grades them by canton and region and must set lower premiums for children and young adults.
• Art. 64 KVG: Co-payment consisting of the deductible and a 10% retention fee.
• Art. 2 and 5 KVAG: Only approved insurers may offer the OKP; supplementary insurance is subject to the ICA. The insurer must accept anyone required to take out insurance within its area of operation.

The Health Insurance Ordinance (KVV) sets out the amounts and procedures, for example the deductibles (Art. 93 and 103 KVV). The Health Care Benefits Ordinance (KLV) and its annexes specify in detail which services are paid for.

Example: same benefits, different premiums

Lea is 34, lives in the city of Zurich and takes out insurance with accident cover. The OKP benefits are the same with every insurer. Even so, the premiums for 2026 differ considerably (premiums 2026, municipality of Zurich, region 1, adults, with accident cover, all 128 offers across insurers and models; source FOPH):

How much Lea pays in total also depends on her healthcare costs. With a CHF 2,500 deductible, her own share in an expensive year can reach CHF 3,200 (deductible plus CHF 700 retention fee); with a CHF 300 deductible it is at most CHF 1,000. The premium calculator shows the current premiums for where you live, using the official FOPH data.

What this means for you

Because the OKP benefits are the same with every insurer, it is mainly worth comparing premium, model and deductible. These questions will help you:

1. Are you insured correctly? If you are new to Switzerland or the parent of a newborn: the deadline for joining is three months. If you miss it, you risk a premium surcharge.
2. Do you need the accident cover? If you work at least eight hours a week for one employer, you are insured against accidents under the UVG and can have the accident cover in the OKP suspended. This lowers the premium.
3. Does your deductible match your costs? If you hardly have any medical costs, a high deductible often works out cheaper; if you need regular treatment, CHF 300 usually does.
4. Is a model an option for you? GP, HMO and Telmed models cost less, but restrict your free choice of the first point of contact.
5. When can you switch? After the new premium has been announced, your notice must reach the insurer by 30 November for the switch to take effect on 1 January. All dates are listed under deadlines, and switching health insurer explains the procedure.

You do not have to cancel supplementary insurance when you switch your OKP insurer. Your current insurer may neither force you to do so nor cancel it simply because you have switched (Art. 7 paras. 7 and 8 KVG).

Common mistakes

• Assuming that a more expensive insurer pays more. In the OKP, the benefits are laid down by law. A higher premium does not give you a wider range of benefits.
• Confusing the OKP with supplementary insurance. The OKP does not pay for a single room, dental cleaning or alternative medicine of your choice. Before treatment, check which insurance it comes under.
• Paying for accident cover twice. If you are insured through your employer under the UVG and keep accident cover in the OKP, you pay a share of the premium you do not need.
• Missing the deadline after moving here or after a birth. After three months, cover only applies from the date you join; the insurer does not pay bills from the time before.
• Comparing only the premium. The cheapest premium may come with a restricted model or a high deductible. Always compare the same deductible and the same model.

We explain how we calculate premiums and examples under How we calculate.