Swiss health insurance: the mandatory basic plan

Switzerland has an individual mandate with teeth: everyone who lives here buys basic health insurance from a private insurer, and you have three months to do it.

The short version

It's mandatory. Anyone who takes up residence in Switzerland must take out health insurance within three months, and each family member needs their own policy [1].
Sign up on time and cover is retroactive to the day your Swiss residence started. You also owe premiums back to that date [1].
Deductibles run from CHF 300 to CHF 2,500 a year for adults. After the deductible you pay 10% of costs, capped at CHF 700 a year for adults [2][3].
The basic plan is the same everywhere. Benefits are set by law, so you're shopping on price, insurer service and plan model. Compare premiums on the federal site priminfo.admin.ch [4].
Supplementary insurance is optional and is where the private rooms, dental work and extras live.

USD conversions use the Federal Reserve H.10 rate of October 30, 2026 (USD 1 = CHF 0.8230).

How the Swiss system works (and how it's not like back home)

If you're used to getting coverage through your employer stateside, here's the big shift: in Switzerland, your employer doesn't buy your health insurance. You do, personally, from one of the licensed private insurers (the Krankenkassen). The mandatory part is called basic insurance, or Grundversicherung (OKP or KVG in official German).

Think of it as a heavily regulated ACA marketplace where everyone has to buy in:

Insurers must accept you for basic insurance, whatever your age or health.
The benefits are identical at every insurer, because they're set by federal law.
Premiums vary by insurer, canton, region within the canton, age band, deductible and plan model.
Each person has a separate policy, including kids. There's no "family plan" in the US sense.

Your Swiss employer still deducts accident insurance and social security from your paycheck, but the health premium bill comes to you every month. Budget for it like rent.

A heads-up on US coverage: Medicare generally doesn't pay for care outside the US, so Swiss basic insurance is your real coverage here even if you're 65 or older.

The three-month deadline

The Federal Office of Public Health (FOPH, or BAG in German) puts it plainly: "Anyone settling in Switzerland must take out health insurance within three months after taking up residence" [1]. The same three-month window applies to a newborn [1].

What happens depends on when you sign up:

When you sign up	When cover starts	What you pay
Within 3 months of taking up residence	Back-dated to the start of your residence, and costs you already had are reimbursed	Premiums back to the start of your residence
After 3 months	Only from the day you enroll	A late-enrollment surcharge, unless the delay is justified

Source: FOPH [1].

Miss the deadline altogether and the canton steps in: the designated cantonal office assigns you to an insurer on your behalf [1]. You won't get to shop around for that year.

Some people can be exempted, mainly certain EU, EFTA and UK nationals, some students and diplomatic staff, and only on request with equivalent coverage [1]. A typical American moving to Zurich on a work permit isn't in those groups, so plan to buy Swiss basic insurance. Ask the canton's exemption office if you think you might qualify.

A step-by-step for new arrivals

Register your residence at your Kreisbüro (Zurich's district office) after you arrive.
Pick a deductible and a plan model (see below).
Compare premiums on priminfo.admin.ch for your ZIP code, birth year and deductible [4].
Apply online with the insurer well within three months, giving your arrival date as the start date.
Keep your US travel or expat policy until the Swiss policy confirms, then cancel it.
Watch the mailbox. The canton checks that every new resident is insured and will send a reminder if it doesn't have proof.

Deductibles and the 10% co-pay

Swiss cost-sharing has three layers, and they work much like a US plan with a deductible and coinsurance.

The deductible (Franchise). The standard deductible for adults is CHF 300 (about USD 365) a year, and children under 18 have none [2]. You can choose a higher optional deductible in exchange for a lower premium. The optional levels go up to CHF 2,500 (about USD 3,040) [3]. Children's optional deductibles are much smaller, in steps up to CHF 600 [3].

The retention fee (Selbstbehalt). Once you've met the deductible, you pay 10% of costs, up to CHF 700 (about USD 850) a year for adults and CHF 350 (about USD 425) for under-18s [2].

The hospital contribution. Adults pay CHF 15 (about USD 18) per day in the hospital, with exemptions for under-18s, young adults up to 25 in education, and maternity care [2].

Maternity is treated generously: routine pregnancy checkups, childbirth and related care carry no co-pay, and from the 13th week of pregnancy to 8 weeks after birth you pay no co-pay on general medical care either [2].

Here's how the adult deductible options and the maximum premium discount the law allows line up:

Annual deductible	Maximum yearly premium discount vs. CHF 300
CHF 300 (standard)	none
CHF 500	CHF 140
CHF 1,000	CHF 490
CHF 1,500	CHF 840
CHF 2,000	CHF 1,190
CHF 2,500	CHF 1,540 (about USD 1,870)

Source: FOPH [3]. Not every insurer offers every level.

The rule of thumb Swiss residents use: if you're healthy and have savings, CHF 2,500 usually wins on total cost. If you have a chronic condition, regular prescriptions or a baby on the way, the CHF 300 deductible often comes out ahead. Do the math with your own expected costs.

Timing matters too. A change of deductible can only take effect at the start of a calendar year [3], so pick carefully when you first sign up.

Choosing an insurer and a plan model

Because the benefits are the same everywhere, you're choosing on price and service. The federal premium calculator on priminfo.admin.ch is run by the FOPH and lets you compare every licensed insurer for your location, birth year, deductible and plan model [4]. It's already showing 2027 premiums, which the FOPH announced would rise by 5% on average [4].

The plan models change how you get care, much like an HMO versus a PPO:

Standard: see any doctor you like. The most expensive option.
Family doctor (Hausarzt) models: you go to your chosen GP first for referrals.
Telemedicine models: you call a medical hotline before seeing a doctor.
HMO and pharmacy models: you use a health center or pharmacy as your first stop.

The cheaper models can save a lot, but break the rules (say, seeing a specialist without the referral) and the insurer may refuse to pay.

Switching later

Insurers send next year's premiums by the end of October. To change basic insurer for January 1, your cancellation letter has to reach the insurer by November 30. If you're on the standard CHF 300 deductible, you can also switch at the end of June with three months' notice [5]. Basic and supplementary policies are independent, so you can keep them with different insurers [5].

Premium subsidies in Zurich

Premiums are not income-based, which can sting for families. The safety valve is the individual premium reduction (IPV, individuelle Prämienverbilligung), which helps insured people "in modest economic circumstances" [6].

In the canton of Zurich:

SVA Zurich runs it and identifies people who may qualify from their tax data [6].
It's paid by application only, and the money goes straight to your insurer [6].
Application forms go out in early summer for the following year [6].
Children get at least 80% of a reference premium covered, and young adults in education at least 50%, if the household qualifies [6].

The canton doesn't publish a simple income cutoff on that page, so we're not quoting one. If your household income is modest or you have several kids, check with SVA Zurich.

Supplementary insurance: the optional extras

Supplementary insurance (Zusatzversicherung) covers what the basic plan doesn't, or covers it more comfortably. Common add-ons:

Hospital upgrades: a semi-private or private room, and your choice of doctor in the hospital.
Dental care, which basic insurance largely doesn't cover. Many Americans are surprised by this one.
Eyeglasses, alternative medicine, gym memberships and travel cover.

Here's the fine print. Supplementary policies are private contracts, so unlike basic insurance, insurers can ask health questions and turn you down or exclude conditions. Apply soon after you arrive, while you're healthy, and answer the health questionnaire truthfully; a wrong answer can void the policy. Supplementary policies usually have their own cancellation dates, often the end of September [5].

Health insurance questions come up constantly in our community group for Americans in Switzerland, and members are good at sharing which plan model worked for them.

Swiss health insurance: the mandatory basic plan, the three-month deadline and how to choose