Swiss Basic Health Insurance (LAMal / KVG): Coverage & Alternative Models

Under Art. 3 KVG, all new residents must take out basic health insurance within 3 months of taking up residence or giving birth in Switzerland.

Coverage applies retroactively to the date of municipal registration (Einwohnerkontrolle). While you will be billed for past monthly premiums, all eligible medical expenses incurred since arrival are fully covered.

If an expat fails to enroll within the 3-month statutory window, the cantonal public health authority will forcibly assign them to an insurer at a non-negotiable rate and may levy a financial surcharge for late enrollment under Art. 5 KVG.

Under Art. 25–34 KVG, the mandatory benefit basket is legally standardized across all Swiss health insurers. It encompasses outpatient medical treatment by certified physicians, prescribed medications on the federal Specialty List (Spezialitätenliste), hospital general ward care in your home canton, maternity care, and emergency transport.

Maternity care (routine check-ups, ultrasound scans, delivery, and breastfeeding advice) is completely exempt from both the annual deductible (Franchise) and the 10% co-payment (Selbstbehalt).

Because basic benefits are identical across all ~40 Swiss health insurance funds, choosing the lowest-cost insurer in your canton provides the exact same medical quality as the most expensive brand.

While the traditional Standard Model allows free choice of any doctor without referral, alternative care models offer significant premium savings:

1. Telmed Model (15% to 25% discount): You must call a 24/7 medical hotline (or log a consultation in a partner app) prior to visiting a doctor or specialist.

2. HMO / Group Practice Model (15% to 20% discount): You designate a specific health center (HMO practice) for all primary consultations.

3. Family Doctor / Hausarzt Model (10% to 17% discount): You commit to consulting your chosen primary care doctor before any specialist referral.