Domicile in Switzerland
EU/EFTA nationals and family members of EU/EFTA-nationals, who are insured with an official health insurer of the EU/EFTA*, have a claim to medical treatment in case of illness, recreational accident or maternity if they are resident in Switzerland. The Gemeinsame Einrichtung KVG is responsible for the whole of Switzerland for the examination of a claim and then coordinates the billing of the treatment costs as well as the subsequent invoicing to the relevant health insurance abroad.
On behalf of your health insurance, we cover the costs of medical treatment in Switzerland and pass them on to your health insurance (international benefits assistance). The costs will therefore continue to be borne by your health insurance. Without insurance cover from your health insurance, it is therefore no longer possible for us to provide assistance and to cover the costs. Our assistance as well as the coverage of health care costs are based on the Agreement on the Free Movement of Persons between Switzerland and the EU (annex II of the Agreement on the Free Movement of Persons, art. 17, 24, 26 Regulation (EC) No 883/2004, art. 24 Regulation (EC) No 987/2009) and is only possible as long as the conditions of the EU coordination law are fulfilled. We verify this in close cooperation with your health insurance and exchange information for this purpose (art. 76-78 Regulation (EC) No 883/2004).
Persons, who take up residence in Switzerland and continue to be insured in their home country, can be registered at the Gemeinsame Einrichtung KVG by means of the valid certificate S1 issued by their health insurance. Alternatively, your health insurance company can send us the entitlement certificate electronically.
The treatment costs can only be processed by the Gemeinsame Einrichtung KVG if the certificate S1 is valid and updated.
Please send us, as a first step, your valid claim certificate. You will subsequently receive a questionnaire from us. Your statements on the questionnaire are instrumental in clarifying whether a registration is basically possible or whether you are subject to compulsory health insurance in Switzerland.
The insurance obligation of employed persons depends on the place of their employment or self-employment (place of employment principle). The insurance obligation of pensioners depends on the origin of their pensions. Children are subject to compulsory insurance in the country of residence if one parent is gainfully employed in the country of residence or receives a pension from it.
The duration of the entitlement to international benefits assistance depends on the period of validity of the claim form. If you are subject to compulsory insurance in Switzerland, you will no longer be entitled to have your benefits paid for by your health insurance through international benefits assistance.
Should, for any of the afore-mentioned reasons, the registration for benefits assistance be denied, the relevant Cantonal authorities will be notified. Basically, it is their responsibility to control the adherence to the health insurance obligation in Switzerland (Art. 6 KVG).
Claim to benefits
Persons who can be registered for benefits assistance, will receive an insurance card. This serves as proof of a right to benefits for service providers in Switzerland e.g. hospitals, doctors, physiotherapists etc.
With these forms there is a claim to all benefits provided for by the Swiss health insurance system if they prove to be medically necessary – with the exception of cash benefits (daily allowance). The same rule applies to the non-earning, dependent members of the family.