KVG - Basic insurance
What is the purpose of the KVG and how does it work?
The LAMal is commonly referred to as basic insurance. Its aim is to provide health cover for everyone living in Switzerland. KVG/LAMal coverage is identical for all insurance companies. The policyholder is free to choose the health insurer. The latter must accept it, whatever its age or state of health, without reservation or waiting period. Since the LAMal is public in purpose, even if it is managed by private companies, it is subject to the same rules and has exactly the same coverage between each of the LAMal health insurance funds.
Apart from quality of service, speed of reimbursement and a few other subtleties, which we’ll explain in detail below, they’ll be totally identical.
LAMal, what are the health insurance age brackets?
There are only 3 age categories:
- Children (0 to 18 inclusive)
- Young adults (aged 19 to 25)
- Adults (aged 26 and over)
KVG/LAMal, how do optional deductibles work?
First, let’s understand what a franchise is:
The deductible is the unreimbursed amount that the insured must first pay before receiving any reimbursement from his or her KVG/LAMal health insurance.
Once the deductible has been reached, the insurance company will assume all reimbursements provided for under the LAMal, with the exception of the co-payment. In fact, a 10% deductible remains payable by the policyholder, even after the deductible has been exceeded. However, this contribution is capped at CHF 350/year for children and CHF 700/year for adults.
Example: you have a deductible of $300 and receive an initial invoice for $1,000 from your doctor. You will be responsible for the first 300 francs of the year. The insurance company will then pay the 700.00, but you will have to pay the 10% co-payment, i.e. 70.00.
Total at your expense 300.00 + 70.00 = 370.00
total payable by insurance company 630.00
The deductible is an annual amount that can only be changed on January 1 of the following year, and must be notified to your insurance company by November 30 at the latest. Hence the importance of reassessing your needs and rates once a year.
year with his advisor.
What franchises are available, and which one should I choose?
There are several franchises available for different age groups:
0 – 100 – 200 – 300 – 400 – 500 – 600
300 – 500 – 1’000 – 1’500 – 2’000 – 2’500
300 – 500 – 1’000 – 1’500 – 2’000 – 2’500
Which franchise to choose and how?
Children: the price difference between a 0 deductible and a 600 deductible is not significant enough to justify increasing it.
We therefore recommend leaving it at 0 in 90% of cases.
Adults: as we saw above, the following optional deductibles are available: 300 – 500 – 1,000 – 1,500 – 2,000 – 2,500
Our first recommendation is to choose only the extremes: either 300 or 2,500. The in-betweens are not worth the effort, and offer lower premium savings.
Calculating the ideal deductible:
A 300 deductible will cost around 450.00 / month for an adult, and a 2,500.00 deductible around 330.00 / month.
The difference between the two deductibles is therefore : 120 x 12 months = $1,440 / year. You should assume that even with a low deductible of CHF 300, the first CHF 300 will be paid by you. We will therefore add them to the 1,440.00, bringing our reference sum to 1,740.00. This reference amount could be increased by taking into account co-payments, but we’re not going to take them into account to leave a safety margin and simplify the calculation.
Our recommendation is as follows: if you have more than 1,440 medical expenses (drugs, doctor or hospital) per year, then the small deductible of 300 is for you. If, however, your annual expenses are less than 1,440, then the 2,500 is the right amount for you.
Quite apart from the numbers, you also need to choose the franchise you’re most comfortable with.
Shortcomings of the KVG/LAMal
Unfortunately, the LAMal only offers minimum coverage, known as vital coverage. Here are a few examples of major gaps in KVG/LAMal coverage:
- Ambulance: Coverage of 50% of the bill; maximum $500.
- Coverage / rate differences abroad: Double the Swiss rate
- Emergency repatriation from abroad :
- Hospitalization: Public hospitals only, no free choice of surgeon
- Teeth : No refunds
- Glasses / Lenses: No reimbursement for adults
- Off-list drugs : No reimbursements
- Natural Medicine: Limited to
- Sport / Wellness : No refunds
Cover gaps in your KVG/LAMAL health insurance
Unfortunately, KVG/LAMal offers only minimal coverage, which is why we strongly recommend taking out supplementary VVG/LCA insurance to cover the gaps in your KVG/LAMal health insurance while reimbursing the benefits you really need.
