Mandatory Health Insurance Switzerland (OKP, Basic Insurance)
Mandatory health care insurance (OKP) is Switzerland's basic health insurance under the KVG: every resident must take out cover (Art. 3 KVG), every licensed insurer must accept applicants without medical underwriting, and the benefits catalogue (Art. 25 et seq. KVG) is identical for all insurers.
Concept and Legal Basis
Mandatory health care insurance (obligatorische Krankenpflegeversicherung, OKP) is Switzerland’s basic health insurance governed by the Federal Health Insurance Act (KVG). Under Art. 3 KVG every person resident in Switzerland must take out cover within three months of taking up residence or of birth; the cantons enforce the obligation and assign defaulters to an insurer. Carriers are private health funds that need a licence from the Federal Office of Public Health (BAG) under the KVAG and must run basic insurance on a non-profit basis. The insured person chooses the insurer freely (Art. 4 KVG); the insurer must accept every person subject to the obligation within its geographical area of activity without medical underwriting, exclusion or waiting period.
Benefits Catalogue and Switching
The scope of benefits is uniform by law: Art. 25 et seq. KVG cover general benefits in case of illness (medical treatment, hospital stay in the general ward, medicines on the specialities list, nursing care), maternity benefits, and accident benefits where no accident insurer is liable. The catalogue is detailed in the KVV ordinance and the Health Care Benefits Ordinance (KLV) and must meet the WZW criteria of effectiveness, appropriateness and cost-effectiveness. Because benefits and the duty to accept are identical across insurers, funds compete on premium, service and alternative insurance models. Under Art. 7 KVG members may switch with three months’ notice to the end of a calendar half-year; when a premium increase is announced, notice by the end of November suffices to switch on 1 January.
Country Comparison
Unlike German statutory health insurance (GKV), the OKP is not financed by income-related contributions but by per-capita premiums combined with state premium subsidies. Switzerland also has no benefits-in-kind principle in the German sense; the default is the tiers garant system with cost sharing by the insured. In Austria, compulsory insurance with the ÖGK arises from employment (ASVG), not from residence. Supplementary benefits such as free choice of hospital or semi-private wards are covered in Switzerland by private supplementary insurance under the Insurance Contract Act (VVG).
Legal basis
- CH: Art. 3 (insurance obligation), Art. 4 (choice of insurer, duty to accept), Art. 7 (change of insurer), Art. 24–31 (benefits)
- CH: Art. 4 et seq. (licence to operate social health insurance)
- DE: § 2 (benefits in kind principle) and § 5 (compulsory membership) SGB V as the German benchmark