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Frequently asked questions

THE INSURANCE SYSTEM IN SWITZERLAND AND EXEMPTION FROM COMPULSORY HEALTH INSURANCE

What is Swiss health insurance?
Since 1996, all persons staying in Switzerland for more than three months must have health insurance. This health insurance must cover certain benefits, all of which are insured by Swiss health insurance companies under what is known as basic insurance. These include examinations, treatments and medication costs in the event of illness, accident, childbirth and abortions. Dental treatments are only covered in exceptional cases.

In general, insured persons must first pay for the benefits claimed themselves and then apply for a refund from the insurance company. Hospitals can arrange direct settlement with the insurance company. For all basic insurance policies, the insured persons must contribute to the costs incurred. This contribution includes excesses and a deductible.

• The excess is a sum of money that you can usually choose yourself. All health costs incurred during the course of a year are borne by the insured person until this amount is reached. Once the amount is reached, any additional invoice amounts are covered by the health insurance.

• If the excess has been exhausted and new invoices are added, 90% of these will be covered by the insurance policy. The remaining 10% must be paid by the insured person. Here, too, there is an annual upper limit (CHF 700). Once this cap is reached, the invoices will be covered in full by the insurance.

This is regulated by the Health Insurance Act (HIA). Certain persons such as
foreign students, interns or trainees, can apply to be exempted from statutory health insurance. If an exemption is granted by the local authorities, you can opt for private insurance as long as you meet the requirements of the HIA. Private insurance may be less costly. coverio offers the necessary benefits in accordance with the HIA.
What is an exemption from compulsory health insurance?
According to the Swiss Health Insurance Act (HIA), all residents of Switzerland are obliged to take out basic insurance. However, certain groups of people (including students, interns) may apply for an exemption from compulsory Swiss health insurance. This exemption must be approved by the cantonal authorities. This exemption means that these groups of people can instead take out private insurance as long as it meets the requirements of the HIA. coverio offers the necessary benefits in accordance with the HIA.
Can the exemption application be refused?
Yes, if the local authorities determine that you are not eligible, they may refuse your exemption request. Reasons for the refusal and a deadline for contesting the decision would be communicated in this case. In the event of a refusal, you must take out insurance with a Swiss health insurance company and contact coverio to initiate the premium refund process.
What is an exemption confirmation?
An exemption certificate is a document that is usually issued by the local authorities of your canton of residence and confirms your exemption from statutory health insurance based on your cover through coverio. Upon receipt of this document, send a copy to coverio, quoting the policy number.

Keep the document in a safe place, as you will need a copy or scan of the document if you submit a refund request.
Does an exemption mean that I don't have to pay contributions for health insurance?
No, regardless of the exemption outcome, you will still have to pay contributions. The exemption does not release you from the obligations of the Swiss Health Insurance Act (HIA), which stipulates that every resident of Switzerland must have health insurance. The exemption means that, subject to official approval, you are permitted to choose a private health insurance such as coverio.
HOW DO I APPLY FOR AN EXEMPTION FROM COMPULSORY HEALTH INSURANCE?
After you become a coverio customer, you will receive detailed instructions by e-mail, as the procedures may vary depending on the local authorities in your canton of residence. As a rule, you must fill out an exemption form and submit the completed form, together with the required documents, to the competent cantonal authority. If this authority requires further confirmation from coverio, you can request this from coverio. If possible, the documents should be submitted by e-mail and in PDF format. The coverio team will confirm the insurance cover and return the documents to you. You can then submit these to the competent authorities. This review process may take a few weeks to several months.

Please note that coverio will not be able to provide you with updates on the status of the procedure in the meantime. Your insurance cover is valid during the exemption process if the authorities give you a positive decision. As soon as you receive the notification from the local authorities, you are obliged to submit the exemption confirmation to coverio without being asked.

How long is the exemption valid?
If you have received written confirmation of exemption from compulsory health insurance in Switzerland, it is usually valid for 3 years. Thereafter, it may be extended for up to three more years by a written request. The insurance term with coverio with a valid exemption is therefore a maximum of 6 years.
Do I have to pay contributions for my health insurance during the exemption process?
Yes, cover is mandatory while your exemption request is being processed. Non-payment will lead to the cover being suspended. coverio is then obliged to inform the authorities. This suspension interrupts the exemption process and you may be registered with a Swiss health insurance company by the authorities. The Swiss Health Insurance Act (HIA) requires you to have insurance cover from the day you arrive in the country. The payment deadline must be adhered to in order to prevent cover being suspended and the authorities being notified as a result. The law specifies that the exemption confirmation must be obtained and submitted to the insurance company within three months.
Which cantonal office do I need to contact in order to be exempted?
If you have received written confirmation of exemption from compulsory health insurance in Switzerland, it is usually valid for 3 years. Thereafter, it may be extended for up to three more years by a written request . The relevant forms and the addresses to which they must be submitted can be found on this page under "Useful Information".

insurance policy

What is an insurance policy?
In the insurance world, the contract that a customer enters into with an insurance company is called a "policy". This also includes the General Conditions of Insurance (GCI). This document describes in detail which cases are covered by the insurance and which are not. coverio recommends that you read this document carefully.
How long does it take for me to get my insurance policy?
If you take out insurance with coverio online and pay by credit card, you will receive your insurance policy immediately by e-mail together with the confirmation of insurance and payment.

If you pay for your insurance policy by having an invoice sent, this process can take up to two weeks. Once your payment is credited, we will send you your insurance and payment confirmation by e-mail.
How do I get proof of insurance?
When you take out your insurance, you will receive an insurance policy. This also serves as confirmation of insurance.

termination of the insurance

How do I terminate an insurance policy with coverio if I leave Switzerland?
If you leave Switzerland permanently, you can terminate the insurance on the day after your deregistration in your municipality of residence. To terminate your insurance, please follow the instructions on the online form, which can be found on this page under "Service". Please have the official confirmation of deregistration from the responsible municipality of residence to hand.

The amount you have paid in excess in this case (for the period after your official departure) will be refunded once all the necessary documents have been checked by coverio. Please note that coverio requires the following information for the refund: Name of the bank, address of the bank, IBAN, BIC/SWIFT, name and address of the account holder. In most cases, the refund will be made within 30 days. The processing time may take a little longer in certain cases. If you have not received a refund from coverio within 45 days, please contact us immediately by phone, e-mail or via the contact form.
How do I terminate an insurance policy with coverio if I want to switch to another insurer?
Please note that you can terminate your coverio policy at the end of a calendar year (31 December) subject to a three-month notice period (notice received by 30 September of the current year).

In order for the termination to be effected quickly and easily, we kindly ask you to fill out the termination form, which you can find on this page under "Service". coverio is legally obliged to check the proof of the new insurance in the event of a change of health insurance. Therefore, please have the corresponding proof to hand for the termination from 1 January. Please note that an offer does not constitute proof. A valid insurance policy must be submitted.
How do I terminate an insurance policy with coverio if I'm not leaving Switzerland?
Your coverio policy can be terminated with three months' notice to the end of a calendar year. If you miss this deadline, ordinary termination of your policy is not possible until the following year. Extraordinary termination is only possible if you leave Switzerland or receive a premium increase (this does not include premium increases for entering a higher age bracket). The policy will become invalid if the canton's exemption from the HIA obligation expires. In this case, you are obliged to notify coverio of the change of exemption status.

In order for the termination to be effected quickly and easily, we kindly ask you to fill out the termination form, which you can find on this page under "Service". coverio is legally obliged to check the proof of the new insurance in the event of a change of health insurer. Therefore, please have the corresponding proof to hand for the termination. Please note that an offer does not constitute proof. A valid insurance policy must be submitted.
How do I terminate an insurance policy with coverio if I have married a Swiss national?
Congratulations! Here at coverio, we are delighted for you and congratulate you on your marriage. With regard to insurance, this change in marital status has the following consequences: once you marry a Swiss citizen, the exemption from compulsory health insurance expires. As a result, you must take out insurance with a Swiss health insurance fund in accordance with the Swiss Health Insurance Act (HIA). Insurance with a private provider such as coverio is no longer possible. You are obliged to inform coverio and the competent authorities immediately of any such changes.

In order for the termination to be effected quickly and easily, we kindly ask you to fill out the termination form, which you can find on this page under "Service". coverio is legally obliged to check the proof of the new insurance in the event of a change of health insurer. Therefore, please have the corresponding proof to hand for the termination. Please note that an offer does not constitute proof. A valid insurance policy must be submitted.

PROCEDURE IN THE EVENT OF EMERGENCY, ACCIDENT OR ILLNESS

What should I do in an emergency?
In an emergency situation, you can go directly to an emergency practice or hospital if you are able to do so. If you cannot make your own way to a hospital or emergency practice, call the official medical emergency number for Switzerland (112). Please note that medical transport in Switzerland is not fully covered by basic insurance. Further information can be found in the General Conditions of Insurance (GCI).

Outpatient treatments (without an overnight stay at a medical facility) are usually paid for by the patient in Switzerland. This means that you will receive an invoice for this treatment at the medical facility. You must pay this invoice yourself and can then submit a refund request to coverio via an online form in order to claim back the costs. Please note the various exclusions and any deductibles.
What do I do if I need to go to a hospital or doctor's practice for foreseeable treatment?
For inpatient treatment (including overnight stay at a medical facility), a confirmation of cover must be requested from coverio. Prior to a stay in hospital, you can thus obtain a declaration of consent from coverio stating that the planned treatment will be paid for. coverio will then issue the cost credit to the clinic providing the treatment. coverio will cover the costs of a stay in a general hospital ward in Switzerland. Present your insurance policy upon entering the medical facility. Following confirmation of cover, the treatment costs will be billed directly to coverio.

In the case of treatment without confirmation of cover, you will receive an invoice for the treatment at the medical facility. You must pay this and can then send a refund request to coverio via an online form to claim back the costs. Please note the various exclusions and any cost contributions.
HOW DO I FIND A DOCTOR OR HOSPITAL WHERE I CAN RECEIVE TREATMENT?
The health system in Switzerland offers various points of contact for health problems. In addition to specialist doctors, there are pharmacies with extensive healthcare knowledge and accident & emergency departments for health emergencies. The differences between the points of contact and the specialist areas that are most often needed can be found on this page under "Useful Information" and "Healthcare System".

You are free to choose your own doctor in Switzerland. Within your own canton of residence, you can decide for yourself which doctor or specialist you would like to be treated by. It is important that the medical practitioner you choose is recognized in the respective canton. Depending on the scope of the insurance cover, various exclusions apply. Consequently, coverio recommends that you consult the General Conditions of Insurance (GCI) in advance. An overview of which hospitals and specialist doctors are available can be found here: https://welches-spital.ch/ and https://doctorfmh.ch/.)

TREATMENT AND REIMBURSEMENT COSTS

Which treatments are insured and paid for by the insurance?
In accordance with the Swiss Health Insurance Act (HIA), health insurance provides benefits in the event of illness, accident – if not covered by accident insurance – and maternity.These benefits include, among other things, medically necessary examinations and treatments by doctors, hospital stays as well as nursing care and certain non-medical services. It also participates in medically necessary transportation to the nearest hospital or repatriation to Switzerland, rescue and recovery operations as well as costs for certain medical prevention measures.
How can I submit a refund request for an illness/accident?
Please use the online form under "Service" to report any illnesses or accidents for which you would like to claim benefits from coverio. Please note that coverio only covers illnesses or accidents that correspond to the insurance benefits of your policy in accordance with the General Conditions of Insurance (GCI). Exclusions may apply, depending on the insurance product. coverio recommends that you check exactly which benefits are covered by your insurance policy before you decide on treatment.
How long does the refund take?
As soon as coverio has all the necessary documents, the review of the refund request will begin. In most cases, the refund will be made within 30 days. The processing time may take a little longer at certain times. If you have not received a refund from coverio within 45 days, please contact us immediately by phone, e-mail or via the contact form.

Other frequently asked questions

What is the cost contribution (deductible & excess)?
In accordance with the provisions of the Swiss Health Insurance Act (HIA), you are obliged to participate in your health insurance by means of two types of cost contribution. These two contributions are the deductible and the excess.

The excess is a sum of money that you can usually choose yourself. All health costs incurred during the course of a year are borne by you until this amount is reached. Once the amount is reached, any additional invoice amounts are covered by the health insurance.

The deductible represents the amount you meet yourself each year after reaching the excess for healthcare services. From that point on, you will pay ten percent of your treatment costs, but no more than CHF 700 per calendar year. The deductible is independent of the amount of the chosen excess.

Important information: Changes to the excess are only possible as of 1 January and must be reported by 30 September. The excesses are valid for at least one year.

Please note that the respective treatment date and not the invoice date is decisive for the calculation of the cost contribution (excess & deductible). So, if you were treated in December and received the corresponding invoice in January, this treatment will be charged to the previous year.
How can I change my address if I relocate within Switzerland?
A change of address must be reported to coverio immediately. To do this, use the online form on the website under "Service". In the event of a change of address, please always specify the date from which the new address is valid.