Reimbursement of outpatient care

Finance Health

Have you just subscribed to Swiss health insurance and are wondering which benefits are covered? Funded in the form of a premium, Swiss health insurance is individual. While the basic insurance offers the same services to all insureds, the supplementary insurance covers optional benefits. We explain all of your rights!

The same basic health coverage for everyone

The LAMal law provides for strictly regulated competition for basic health insurance . Indeed, insurers have the free choice of setting the amount of the health premium , but cannot under any circumstances select the risks . Thus, the health insurance benefit base is the same for everyone, regardless of the sickness fund chosen by the affiliate .

And even federal law provides for the subscription of a standardized health contract for all. Once contracted, the insured and the insurer are subject to the general insurance obligations (GIC) provided for in this contract.  

General outpatient basic insurance services

The LAMal law provides the same coverage for all members , on a principle of federal solidarity. Thus, regardless of the health fund chosen, the insured benefit from the same health insurance benefit in terms of outpatient treatment , such as:

  • The consultation with a general practitioner or specialist is covered by basic insurance. The basic principle is the free choice of doctor, but certain special health systems, such as the HMO or family doctor model , are more and more widespread. By this affiliation , the insured renounce the free choice of doctor, thus benefiting from reduced premiums .
  • The 7 basic maternity examinations are covered by basic insurance ( ultrasounds and other necessary examinations), as well as childbirth and part of the training in preparation for childbirth.  
  • Consultation with a chiropractor .
  • Consultation with a physiotherapist : on medical prescription , 9 renewable sessions are reimbursed by the LAMal.
  • Consultation with an occupational therapist : on medical prescription, 9 renewable sessions are reimbursed by the LAMal.
  • The nursing on prescription.
  • Dietetic consultations: on medical prescription, 6 renewable sessions are reimbursed.
  • Consultations concerning diabetics : on medical prescription, 10 renewable sessions are reimbursed.
  • Speech therapy : on medical prescription, 12 renewable sessions are reimbursed.
  • Medical psychology consultations: up to 40 sessions per year can be reimbursed, but only concerns scientifically proven treatments.
  • The rehabilitation medical prescription.
  • Certain strictly prescribed alternative medicines , such as homeopathy , phytotherapy , anthroposophic medicine and Chinese medicine , are exceptionally reimbursed.
  • Laboratory analyzes and drugs covered by basic insurance are strictly provided for in the ordinance on benefits in compulsory insurance.
  • The dental care are covered only in case of serious illness.
  • The glasses and lenses are covered only for children, or in case of serious illness.

Optional supplementary insurance benefits

Some outpatient services are unfortunately not sufficiently covered by the basic insurance, depending on the needs of the insured. This is why 80% of them subscribe to a complementary mutual . The latter can thus cover the following services:

  • Alternative medicine: medicines such as osteopathy , naturopathy , or acupuncture are not covered by basic insurance.
  • Dental care: dental follow-up is not covered for adults, except for serious illness.
  • Long-term psychotherapy follow-up: if a follow-up exceeding 40 sessions is deemed necessary, then it is better to contract an adequate mutual for full support.
  • Glasses and lenses: for adults requiring glasses, additional insurance must be taken out.

The basic basket covered by LAMal insurance

The compulsory health insurance LAMal makes it possible to cover the basic services of the insured: medical appointments, nursing care, maternity, rehabilitation and pharmacy are for example essential needs reimbursed by the basic insurance. To obtain reimbursement for broader health care , it is important to consider taking out additional health care specific to your needs.

 36 total views

Leave a Reply

Your email address will not be published. Required fields are marked *