Premiums, changes, savings potential: this is what you need to know about your health insurer

Premiums reflect healthcare costs. The average increase of 6.6 percent last year was mainly due to the corona pandemic. On the one hand, the pandemic itself was very expensive (for example, due to the treatment of hospitalized patients and vaccinations). But it also caused indirect costs because procedures postponed due to Corona were rescheduled from the second half of 2021.

But the expected costs for the coming year also play a role. At the end of July, health insurers determine their premiums for the next calendar year based on the expected costs and submit them to the Federal Public Service of Health (BAG) for approval. The BAC checks

• whether the premiums correspond to the costs;
• whether the premium discounts, for example by opting for a higher deductible or a GP model, are legally compliant and
• whether the insurers have sufficient reserves.

Many health insurers are active as sponsors. Do I use my bonus to finance the princely wages of footballers and ice hockey stars?

Yes. As announced at the end of last year with “K-Tipp”, health insurers such as KPT, Swica and Helsana each pay between 6 and 9 million francs for sponsorship and advertising from the basic insurance funds. This can also include donations to popular sports. And it’s all legal: the Health Insurance Act (KVG) does not prohibit advertising and sponsorship with money from basic insurance.

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What is a bonus again, what is a franchise?

You pay a monthly premium to your health insurer. The deductible indicates the amount up to which the insured person pays his own costs. Bonuses and deductibles have an inverse relationship with each other. If the deductible is low, you pay a higher monthly premium. If the deductible is high, the premium will be lower accordingly. The lowest deductible for adults is 300 francs, the highest 2,500 francs.

Which franchise should I choose?

Until the health insurer pays – so until the deductible has been reached – you have to pay everything out of your own pocket. Healthy people should therefore opt for a high deductible, because they will probably not use it anyway and can thus save money every month with low premiums. The rule of thumb is: If you have healthcare costs of less than 2,000 francs per year, choose the highest deductible of 2,500 francs. If you certainly have an annual cost of more than 2,000 francs, choose the lowest deductible of 300 francs. Experts find the three franchise levels in between to be of little use, because you do not save enough on premiums.

How do you change your health insurance?

If you want to change your basic insurance, you must cancel no later than the end of November. The cancellation must be received by the health insurer no later than November 30, during normal office hours. You can take out new insurance until December 31. Please note: Different conditions apply to supplementary insurance, sometimes even notice periods of six months.

Can a health insurer force me to stay?

Yes. This is the case if you have not canceled in time. Or if you are in arrears with your premium payment.

Could it be that I don’t have insurance?

No. A health insurer may not refuse basic insurance to anyone and may not even ask about complaints. Because basic insurance is mandatory. The situation is different with supplementary insurance. The health insurers make money from it. And here health insurers can reject someone, for example because of previous illnesses. For example, you may not be allowed to take out additional insurance because you have already had a hernia.

What is the cheapest health insurance?

This depends on various factors. Premiums may vary depending on where you live. What also counts is how lean a health insurer is, i.e. how high the administration costs are. Online comparison platforms such as Comparis or the BAG itself offer calculators with which you can personally calculate which cash register is the cheapest for you.

How can I save on basic insurance?

All health insurers offer models that allow you to save on premiums. Telme for example. You first call a hotline that provides initial medical advice. There is also the so-called GP model: you must always first visit your GP, who will then refer you to a specialist if necessary. Another option is the HMO model. The insured person hereby undertakes to always first visit a specific group practice in the event of illness. All these alternative models – the list is not exhaustive – are cheaper than the standard model. In some cases there are also combinations of these, for example Telmed and the GP model.

How can I save on medicines?

From January 1, patients who insist on the original medication from the doctor and the pharmacy will have to pay a deductible of 40 francs (today it is 20). So: explicitly insist on a generic medicine where possible. They are not only cheaper in terms of deductible, but also in terms of price. And if everyone does this, everyone benefits because premiums rise less. If we save just over 300 million francs per year on medicines, the next premium increase will be one percent lower.

How do I get a premium discount?

That is different. In some cantons you get the discount without having to lift a finger, in others you are automatically notified whether you are entitled to a premium discount and you only have to sign the application. Ultimately, you have to realize that you have a right in three cantons. Detailed information about the premium reduction can be found here. (sf)