Insurance
Your Insurance, Explained Simply
Swiss health insurance can feel complicated. Here is what you need to know about seeing your family doctor at Clinius: what is covered, what you will pay, and how to make your first visit easy.
The basics
Basic insurance in Switzerland
In Switzerland, basic health insurance (KVG / LaMal) is mandatory. Everyone who lives here must have it, usually within three months of arriving. It is the foundation that covers your medically necessary care.
Basic insurance covers your visits to a family doctor at Clinius, medically necessary treatment, most prescribed medications, and many preventive services. By law, every insurer must cover the same basic benefits, so the care you receive is the same whichever insurer you choose. What changes between insurers is your premium, your insurance model, and your deductible.
Models
Choosing an insurance model
When you take out basic insurance, you choose a model. It decides who you contact first for a health concern. All models cover the same benefits; the right one can simply lower your premium.
Standard
Free choice of doctor: go to any doctor directly. Usually the highest premium.
Family-doctor model
You choose a family doctor as your first point of contact, who coordinates your care. Often a lower premium.
HMO
Your first point of contact is a group practice. Coordinated care, often a lower premium.
Telmed
You call a medical advice line first, which guides your next steps.
Clinius welcomes patients on family-doctor and HMO models. Simply make us your first point of contact—that’s exactly what we’re here for. Always check your policy to confirm which practices your model includes.
Costs
What you will pay
With basic insurance you share part of your yearly healthcare costs. There are two parts.
Franchise (annual deductible)
The amount you pay yourself before your insurer contributes. Adults choose between CHF 300 and CHF 2,500 per year. A higher franchise means a lower premium. Children under 18 have no compulsory franchise.
Selbstbehalt (retention fee)
Once your franchise is used up, you pay 10% of further costs, capped at CHF 700 per year for adults and CHF 350 for children. After the cap, basic insurance covers the rest that year.
These are standard figures and they can change. Always check your own policy for your exact franchise and what you have already paid this year. If anything is unclear, just ask us.
Coverage
What is covered, and what may be self-pay
Covered by basic insurance
Medically necessary consultations and examinations
Diagnosis and treatment of illness
Prescribed medications on the approved list
Referrals to specialists (your cost-sharing still applies)
Many recommended preventive measures and check-ups
May be self-pay
Travel vaccinations and travel-medicine advice
Certain certificates and check-ups for an employer or authority
Purely elective or cosmetic services without a medical indication
Some preventive services beyond basic insurance
We will always tell you in advance if something is likely to be self-pay, so there are no surprises on your bill.
Optional
Supplementary insurance
Beyond mandatory basic insurance, you can take out supplementary insurance (VVG / Zusatzversicherung). This is optional and offered by private insurers, and can cover things basic insurance does not, such as travel vaccinations, certain preventive or alternative treatments, glasses or dental care, and free choice of hospital.
Whether a specific Clinius service is covered by your supplementary insurance depends entirely on your individual plan. If you are not sure, check with your insurer or ask us.
Good to know
Your first visit: practical tips
No practice fee
There is no practice fee to see us. You pay nothing just to walk through the door.
Bring your insurance card
Please bring your health insurance card to every appointment so we can bill correctly.
How billing works
Depending on your insurer, we bill them directly (tiers payant) or send the bill to you to reclaim (tiers garant).
Referrals
On the family-doctor or HMO model, come to us first. If you need a specialist, we arrange the referral so your care stays covered.
Ask early
Worried about a cost? Ask us before treatment and we will explain what to expect.
FAQ
Frequently asked questions
Will my insurance cover a visit to Clinius?
If your visit is medically necessary, your basic insurance covers it, subject to your franchise and retention fee. On the family-doctor or HMO model, just come to us first.
Do I pay anything just to make an appointment?
No. There is no practice fee at Clinius. Your costs depend on the care you receive and your insurance, not on booking a visit.
What will I pay out of pocket?
Until you reach your annual franchise, you pay your bills yourself. After that you pay 10% of further costs, capped at CHF 700 a year for adults (CHF 350 for children). Check your policy for your exact franchise.
Do I need a referral to see a specialist?
On the family-doctor or HMO model, yes. Come to us first and we will arrange the referral so your treatment stays covered.
How do I find out if something is self-pay?
Just ask us before your appointment. We will tell you in advance if a service is likely not covered, and you can also check with your insurer.
This page provides general information only and is not individual advice. What your insurance covers, and what you will pay, depends on your own policy, model, and franchise. Figures are standard amounts and can change. Always check with your health insurer, or ask us.