Cover abroad

What is cover abroad?

Cover abroad refers to what your health insurance pays if you need medical help outside Switzerland. It mainly concerns temporary stays: holidays, business trips, language stays, studies or a trip around the world, as long as you keep your residence in Switzerland. Different rules apply to people who live abroad permanently (see moving abroad and Swiss abroad).

Cover abroad consists of two parts:

• Basic health insurance under the Federal Health Insurance Act (KVG/LAMal). It follows the territoriality principle: in principle, it only pays for compulsory benefits provided in Switzerland by approved service providers. The law makes an exception for emergencies abroad, with upper limits.
• Supplementary or travel insurance under the Insurance Contract Act (VVG/ICA). It covers what basic health insurance does not pay: the difference on expensive hospital bills, repatriation to Switzerland, search and rescue costs abroad and often cancellation costs as well. The scope and limits are set out in the contract.

Under the ordinance, an emergency exists if you need medical treatment during a temporary stay abroad and returning to Switzerland is not appropriate. If you deliberately travel abroad to get treatment there, it is not an emergency within the meaning of the law. An emergency therefore does not have to be life-threatening: a broken arm on holiday or an acute infection that cannot wait until you return is also an emergency within the meaning of basic health insurance.

How it works

Within the EU, EFTA and the UK. The European Health Insurance Card (EHIC) is on the back of your Swiss basic health insurance card. If you show it to a doctor or hospital in the state healthcare system, you are entitled to all benefits that are medically necessary, taking into account the nature of the benefit and the expected length of your stay. You are treated like a person insured in the host country. This can also mean that co-payments customary in the host country apply. Providers outside the state system may not accept the card; ask before treatment.

Outside the EU, EFTA and the UK. Here, basic health insurance pays for emergencies at most twice the amount that the same treatment would have cost in Switzerland. For a hospital stay, this means at most 90% of the Swiss costs. The reason: in Switzerland, the cantons pay at least 55% of inpatient costs and the health insurer at most 45%. Abroad, the canton pays nothing, so the insurer pays at most twice its Swiss share. In countries with high treatment costs such as the USA, Canada or Japan, a large part of the bill can therefore quickly remain unpaid.

Co-payment. Benefits abroad are also subject to your deductible and the 10% retention fee, as in Switzerland.

Transport and rescue. Basic health insurance pays 50% of the costs of medically necessary patient transport, up to CHF 500 a year, and 50% of rescue costs, up to CHF 5,000 a year. Rescue costs expressly only apply to rescues in Switzerland. Repatriation from abroad to Switzerland is not a benefit of basic health insurance. For that, you need supplementary or travel insurance with assistance services.

Medicines and aids. If you buy medicines abroad, basic health insurance only pays if you need them because of an illness during your temporary stay.

Planned treatment. If you deliberately go abroad for treatment, basic health insurance does not pay in principle. Exception: the service cannot be provided in Switzerland. In that case, your doctor submits a reasoned application to the insurer’s medical adviser, and the insurer decides in advance.

Legal basis

Art. 34 para. 2 let. a KVG allows the Federal Council to provide for the costs of services provided abroad for medical reasons to be covered; under para. 3, it can limit them. This is implemented in Art. 36 of the Health Insurance Ordinance (KVV):

• Para. 1: the Federal Department of Home Affairs (FDHA) specifies the services that cannot be provided in Switzerland.
• Para. 2: basic health insurance covers the costs of treatment provided abroad in emergencies. An emergency exists if insured persons need medical treatment during a temporary stay abroad and returning home is not appropriate. Anyone who travels abroad for the purpose of treatment is not in an emergency.
• Para. 4: at most twice the amount of the costs that would be reimbursed in Switzerland is covered.
• Para. 5: the provisions on international benefits assistance are reserved.

International benefits assistance in EU and EFTA states is based on the Agreement on the Free Movement of Persons (AFMP) with its Annex II on the coordination of social security and on the EFTA Convention, and for the United Kingdom on a separate agreement. The FOPH (Federal Office of Public Health) describes the consequences on its page for tourists and globetrotters.

Art. 26 of the Health Care Benefits Ordinance (KLV) governs the contribution to transport costs (50%, up to CHF 500 per calendar year), Art. 27 KLV the contribution to rescue costs for rescues in Switzerland (50%, up to CHF 5,000 per calendar year).

There are no benefits laid down by law for travel and supplementary insurance; they are subject to the VVG, and the scope follows from the policy and the general terms and conditions.

Example: appendicitis in New York

Eva, 29, spends two weeks on holiday in New York and needs emergency surgery for appendicitis. She stays in hospital for two nights. The amounts of the hospital bill are assumed; the rules come from Art. 36 KVV and the FOPH explanations.

The 10% retention fee on CHF 7,800 would be CHF 780; for adults, however, it is capped at CHF 700 a year (Art. 103 KVV). If Eva already had other costs in the same year, her co-payment is correspondingly lower.

What this means for you

A quick check before every trip is worthwhile:

1. Where are you going? For the EU, EFTA and the UK, the card is often enough for emergencies in the state system. For the USA, Canada, Japan and other countries with high costs, the FOPH recommends travel insurance.
2. Is repatriation covered? Basic health insurance never pays for it. Check your supplementary insurance or take out travel insurance with assistance services.
3. Do you have your health insurance card with you? Without the card, you may have to pay up front and submit the bill later.
4. How long will you be away? For long stays without moving your residence, you remain subject to compulsory insurance in Switzerland. Basic health insurance cannot be suspended, not even for a trip around the world.
5. Are you undergoing treatment? Take enough medicines with you and clarify with your health insurer what is paid for abroad.

We set out which supplementary insurance policies include which cover abroad side by side in the supplementary insurance comparison. You can find the offers of individual insurers in the health insurer profiles. You compare the basic health insurance premium, which continues while you travel, in the premium calculator. For transport within Switzerland, see transport costs.

Common mistakes

• Believing that basic health insurance covers everything worldwide. Outside Europe, it pays at most twice the Swiss amount, and in hospital at most 90% of the Swiss costs.
• Forgetting about repatriation. Basic health insurance does not pay for rescues and repatriation from abroad.
• Deregistering from your municipality (Gemeinde) and cancelling your health insurance. Deregistering alone does not end your residence. As long as you have no new residence abroad, you remain subject to compulsory insurance.
• Planning treatment abroad and hoping basic health insurance will pay. It only pays for planned treatment abroad if it is not possible in Switzerland and the insurer has given its approval in advance.
• Choosing a private clinic in Europe. The European Health Insurance Card is valid in the host country’s state system.

We explain how we build examples and sources under How we calculate.