Swiss abroad health insurance – what are the options? 

What happens to my health insurance? When emigrating from Switzerland, different rules apply depending on your new country of residence. Keystone / Christian Beutler

Moving abroad requires considerable planning, and one of the hardest things is finding the right health insurance. Should you sign up for coverage in your adopted home, or is it worth keeping your Swiss insurance? Is that even an option? SWI swissinfo.ch unpacks this complex issue. 

When it comes to health insurance abroad, it’s crucial to know where you stand. Are you a pensioner, a posted worker, a Swiss national living abroad, a diplomat, a student, or are you on a military mission? And what about employment status? Are you gainfully employed or not? These distinctions can make all the difference. 

This article deals primarily with long-term emigrants, not posted workers. 

Posted workers

Posted workers are persons employed by a Swiss company and assigned to work abroad for a certain period. They usually remain covered by Swiss social insurance for two years, with a possible extension of a maximum of six years. The Central Compensation Office is usually in charge of approving whether such assignments remain covered by Swiss health insurance, or not.  

Now, let’s focus on the true emigrants. The rules vary depending on the countries of residence which can be divided into two main groups, EU/EFTA countries, including the United Kingdom, and all non-European countries.  

EU/EFTA countries 

Within EU/EFTA countries, those seeking health insurance can be divided into two groups. The first group includes pensioners receiving state pension or disability insurance benefits, while the second group includes all others. 

If you receive a state pension 

Anyone receiving a state pension or disability insurance benefits from Switzerland – and only from Switzerland – is generally required to have health insurance under the Swiss Health Insurance Act. 

However, in the EU things are often not that simple. With certain countries, such as its immediate neighbours and Spain, Switzerland has negotiated something known as “option right”. This allows pensioners to choose whether to take out mandatory basic insurance in Switzerland or in their country of residence.  

It is crucial to act quickly though. The decision on where to take out basic insurance must be made within the first three months of registering in a new country. Only in Spain can this choice be made later. 

Here is an example. A retired couple moves to Portugal relying on their state pension and occupational pension benefits. As they receive a pension from Switzerland, Swiss health insurers are obliged to accept them for compulsory basic health insurance. 

That said, they do not have complete freedom to choose their Swiss insurer. Only health insurers with more than 500,000 basic insurance policyholders are required to cover individuals within the EU. The deductible is always fixed at CHF300, ($330) no matter what. 

Just as premiums in Switzerland vary from canton to canton, they also vary within EU countries. They are calculated based on the costs policyholders incur in the respective country. Health insurers with many policyholders are usually able to offer lower rates because the risk is spread. In Poland, for example, Visana, a Swiss health insurance provider, is five times more expensive than its competitor CSS.  

If you work abroad or do not receive a state pension  

Regulations differ for individuals who do not receive a state pension or disability insurance benefits. For example, if a Swiss citizen moves to London for work, she/he must take out her mandatory basic insurance in the UK because the “place of employment principle” applies. 

If the person is not employed in London and does not receive a Swiss pension, she/he can stay with the Swiss health insurance provider. In this case, the regulation falls under the Insurance Contract Act, not the Swiss Health Insurance Act. As is common with supplementary insurance, it is up to the health insurer to decide whether to accept an applicant, insure them with restrictions or reject them entirely. As mentioned above, the situation changes if the emigrant receives a Swiss state pension or is insured under the Health Insurance Act.  

If you plan to move permanently to an EU or EFTA country – not as a posted worker – and want to stay insured with a Swiss health insurance provider under the Insurance Contract Act, timing is important. You must apply before deregistering in Switzerland and moving your registered address abroad. Simply notifying your insurer of the change after the move won’t work. This rule is enforced by the Financial Market Supervisory Authority (FINMA). 

All the above applies only to Swiss citizens who settle in an EU country, Iceland, Norway or the UK. 

If you move to a country outside the EU or EFTA 

For individuals moving to any other country, the situation is completely different. In such cases, every health insurance provider can decide whether they want to offer insurance coverage abroad.   

With more than 2,500 policyholders, Swiss insurer KPT is the undisputed market leader for voluntary health insurance outside the EU or EFTA. Its dominant position has historic roots. Originally the insurer for federal staff and transport companies, KPT has long been the favourite provider for diplomatic personnel – and this tradition continues today. Swiss foreign ministry employees working at embassies and for organisations across the globe are all covered by KPT.  

«We have discovered that the cost difference between countries is not that significant.»

Markus Rudaz, Head international + partners team at KPT.

An interesting fact is that KPT’s premiums are uniform outside Europe. Swiss citizens living in the US or Japan where hospital rates are well above average, pay the same premiums as those living in Tunisia, Brazil or China. “We have discovered that the cost difference between countries is not that significant,” says Markus Rudaz, who heads the international + partners team at KPT. This is partially because Swiss citizens who live in a country with a poor healthcare system often seek treatment in Switzerland.  

Another reason is that destinations like Thailand or South America have increasingly well-developed healthcare systems which primarily serve tourists or expatriates from industrialised countries. Locals are often unable to afford such sophisticated healthcare systems.   

Swiss Insurance Contract Act vs. Health Insurance Act 

It is important to note that coverage provided by international health insurers is similar to, but not identical to compulsory health insurance. It falls under the Insurance Contract Act rather than the Health Insurance Act, much like supplementary insurance. KPT’s voluntary international health insurance has an upper limit for hospital costs. But this gap can be closed by paying an additional fee or by taking out supplementary hospital insurance. In fact, 90% of KPT policyholders opt to do this. 

Another interesting feature of voluntary international health insurance is that, unlike compulsory basic insurance, the Insurance Contract Act allows providers to increase premiums as policyholders age. In other words, even though premiums are uniform worldwide, they are split into age groups. This means that the older you are, the more expensive your supplementary insurance becomes.  

Here is an example. A 40-year-old man pays a monthly premium of CHF132 for his health insurance with accident coverage. His policy includes a deductible of CHF1,000 and a 10% cost contribution while an additional CHF64.40 per month is charged for semi-private supplementary hospital insurance. 

With age, this man faces higher premiums. Insurance providers increase premiums in increments of five or ten years. Once retirement age is reached, premiums can often be more than double of what a 40-year-old would pay. However, there is a limit on the increase. Some insurers stop raising premiums at age 66, while others cap them at age 71.   

Apart from the KPT, SWICA also provides health insurance to Swiss nationals living outside the EU/EFTA under the Insurance Contract Act. Their sub-unit, called Global Care, also uses a uniform rate for all countries, similar to KPT. 

CSS also offers a similar international health plan. Unlike KPT and SWICA, this plan has two different rates, a higher rate for zones with expensive healthcare systems such as Japan, Hongkong, Singapore, Canada and the US, and a lower rate for the rest of the world. 

In our Guide to Moving Abroad, you will find further tips for emigrating from Switzerland and life abroad.

As with most supplementary insurances under the Insurance Contract Act, health insurers are not obliged to accept applicants. Older people or those with pre-existing medical issues might find it difficult to obtain coverage with a Swiss health insurer. They may have to turn to one of the many international providers.   

Well-known international providers include Allianz Care from Germany, Bupa from the UK, Globality Health from Luxembourg and Cigna Global with headquarters in Glasgow. If someone who is insured abroad with Cigna returns to Switzerland, they can take out supplementary insurance with KPT without undergoing a health check.  

SWICA offers the same for returnees and policyholders of the internationally experienced and Luxembourg-based Globality Health, a subsidiary of Munich Re.  

Edited by Balz Rigendinger, adapted from German by Billi Bierling /ds