Swiss health insurance comes with its own vocabulary, much of it in German, French, or Italian. This glossary translates the most important terms into clear English and explains what they mean for you as a policyholder.
- AHV (Alters- und Hinterlassenenversicherung)
- The Swiss old-age and survivors' insurance scheme. Your AHV number is a unique personal identifier used across all social insurance systems, including health insurance. You need it to register with an insurer and to apply for premium subsidies.
- Accident Insurance (Unfallversicherung / UVG)
- Mandatory insurance covering workplace and non-workplace accidents. If you work 8+ hours per week for one employer, your employer covers non-occupational accidents too. You can then exclude accident coverage from your health insurance to lower premiums.
- Alternative Insurance Model
- Any plan that restricts your choice of doctor in exchange for lower premiums. Includes HMO, telmed (phone-first), and family doctor models. Savings range from 10% to 25% compared to the standard free-choice model.
- BAG (Bundesamt für Gesundheit)
- The Federal Office of Public Health. This federal authority approves premium rates, oversees insurers, and publishes the official premium comparison tool at priminfo.admin.ch. It is the ultimate regulatory body for Swiss health insurance.
- Basic Insurance (Grundversicherung)
- The compulsory health insurance that every Swiss resident must carry. It covers a legally defined catalogue of treatments, medications, and services. Every approved insurer must accept every applicant for basic insurance, regardless of age or health status.
- Co-payment (Selbstbehalt)
- After you have met your annual deductible, you pay 10% of remaining costs up to a yearly cap of CHF 700 for adults and CHF 350 for children. This is in addition to your premium and deductible.
- Compulsory Insurance Obligation (Versicherungspflicht)
- The legal requirement for every person residing in Switzerland to hold basic health insurance. You have 3 months after establishing residence to enrol. Failure to do so results in being assigned to an insurer by the canton, often at a penalty surcharge.
- Deductible (Franchise)
- The annual amount you pay out of pocket before insurance begins covering costs. Adults can choose between CHF 300 and CHF 2,500. Children's deductible ranges from CHF 0 to CHF 600. Higher deductibles mean lower monthly premiums.
- DRG (Diagnosis Related Groups)
- The classification system Swiss hospitals use to bill for inpatient treatments. Each diagnosis is assigned a standardised cost weight. As a patient, you rarely encounter DRG directly, but it determines what your insurer pays the hospital.
- Emergency Treatment
- Basic insurance covers emergency care anywhere in Switzerland, regardless of your insurance model. Even if you have an HMO plan that requires a specific doctor, emergencies are always covered directly without prior authorisation.
- Family Doctor Model (Hausarztmodell)
- An alternative insurance model where you designate a general practitioner as your first point of contact. All specialist referrals must go through your family doctor. In return, you receive a premium discount, typically 10% to 15%.
- Franchise
- The German/French term for deductible. You will encounter this on your insurance documents. See "Deductible" for the full explanation.
- Free Choice of Doctor (Freie Arztwahl)
- The standard insurance model where you can visit any doctor or specialist without a referral. This is the most flexible option but also carries the highest premiums. You pay for convenience.
- Grundversicherung
- German term for basic insurance. See "Basic Insurance." Every approved insurer offers identical basic coverage, so the only difference between providers is the premium price and customer service quality.
- HMO (Health Maintenance Organisation)
- A managed-care model where you must visit a specific HMO centre for all non-emergency treatment. Doctors at the centre coordinate your care and refer you to specialists when needed. Offers the deepest premium discounts, often 20% to 25%.
- Insurance Card (Versichertenkarte)
- A physical card issued by your insurer that you present at medical appointments. It contains your name, AHV number, insurer details, and insurance model. Always carry it, as hospitals and pharmacies need it to bill correctly.
- IPV (Individuelle Prämienverbilligung)
- Individual premium reduction. A cantonal subsidy that lowers your health insurance premiums if your income falls below a certain threshold. Eligibility and amounts vary by canton. See our dedicated subsidy guide for details.
- Krankenkasse
- The German word for health insurer, literally "sickness fund." In everyday Swiss-German, people use this term interchangeably with health insurance itself. When someone says "Krankenkasse wechseln," they mean switching health insurers.
- KVG (Krankenversicherungsgesetz)
- The Federal Health Insurance Act, enacted in 1996. This is the legal foundation for Switzerland's compulsory health insurance system. It defines what must be covered, who must be insured, and how premiums and subsidies work.
- KVV (Krankenversicherungsverordnung)
- The ordinance that implements the KVG in detail. It specifies practical rules such as deadlines for switching insurers, the exact deductible levels, and administrative procedures. Think of KVG as the law and KVV as the rulebook.
- Maternity Coverage (Mutterschaftsleistungen)
- Under basic insurance, prenatal checkups, delivery, and postnatal care (56 days) are fully covered without deductible or co-payment from week 13 of pregnancy. This includes hospital birth, birth centre, or midwife-assisted home birth.
- Obligatorium
- Refers to the compulsory nature of Swiss health insurance. Every resident must have it. Unlike in many countries, there is no opt-out for the wealthy or the healthy. The system is designed to pool risk across the entire population.
- Out-of-Pocket Maximum
- Your total annual exposure under basic insurance is capped: deductible (max CHF 2,500) plus co-payment (max CHF 700) equals CHF 3,200 for adults. After reaching this amount, your insurer pays 100% of covered costs for the rest of the year.
- Prämie (Premium)
- The monthly amount you pay to your health insurer for coverage. Premiums are set annually by each insurer and approved by the BAG. They vary by canton, age group, and insurance model but not by individual health status.
- Premium Region
- Switzerland divides each canton into 1 to 3 premium regions based on healthcare costs. Urban areas typically fall in higher-cost regions with higher premiums. Moving to a different region, even within the same canton, can change your premium.
- Referral (Zuweisung)
- A written recommendation from your primary doctor to see a specialist. Required in family doctor and HMO models. In the free-choice model, you can see any specialist directly without a referral, though some specialists prefer one.
- Risk Equalisation (Risikoausgleich)
- A mechanism that transfers money between insurers to compensate for differences in the health risk of their members. This prevents insurers from profiting by cherry-picking healthy customers and ensures fair competition.
- Supplementary Insurance (Zusatzversicherung)
- Optional coverage beyond basic insurance. Common types include semi-private or private hospital rooms, dental care, alternative medicine, and international coverage. Unlike basic insurance, insurers can reject applicants or charge higher premiums based on health.
- Switching Deadline (Kündigungsfrist)
- The deadline to cancel your current insurance and switch to a new provider. For the standard model, you must notify your insurer by 30 November for the following year. For alternative models, an additional deadline of 31 March applies in some cases.
- Tarmed
- The nationwide tariff system that determines how much doctors can charge for outpatient services. Each medical procedure has a defined point value multiplied by a cantonal base rate. Tarmed ensures standardised pricing across all insurers.
- Telmed Model (Telemedizin-Modell)
- An alternative insurance model requiring you to call a medical hotline before visiting a doctor. A medical professional assesses your symptoms by phone and directs you to the appropriate care. Typical premium discount: 12% to 18%.
- VVG (Versicherungsvertragsgesetz)
- The Insurance Contract Act governing supplementary insurance. Unlike KVG basic insurance, supplementary policies fall under private contract law. This means insurers can set their own conditions, reject applicants, and adjust premiums based on individual risk.
- Waiting Period (Wartefrist)
- A period after purchasing supplementary insurance during which certain benefits are not yet available. Common for maternity-related claims (12 to 24 months) and dental coverage (6 to 12 months). Basic insurance has no waiting periods.
- Wohnkanton
- Your canton of residence, which determines your premium region and the cantonal regulations that apply to you. If you move cantons, your premiums change, and you may need to reapply for premium subsidies in the new canton.