The complete LAMal guide

Anyone taking up residence in Switzerland must subscribe to mandatory health insurance. They have three months to register with a recognised insurer, with retroactive effect to the start of the insurance obligation. Late registration means premiums remain owed retroactively and surcharges may apply.

The obligation also applies to newborns: parents have three months from birth to enrol them with a health fund.

If someone subject to the insurance obligation fails to enrol within the deadline, the cantonal authority can proceed with automatic enrolment. This should be avoided: medical costs incurred before enrolment remain the insured person’s responsibility.

OHI only covers benefits that are effective, appropriate, and economical (EAE criteria). Covered benefits are defined by law and are identical across all insurers: no insurer can reimburse a benefit not provided for by law, nor refuse a legal benefit.

OHI provides coverage for illness, maternity, and accidents (if not covered by mandatory accident insurance). This includes:

• Medical consultations and treatments (doctors, hospitals, specialists)

• Hospitalisation (general ward in an approved hospital in the canton of residence)

• Medications on the FOPH list of specialities

• Analyses and laboratory tests (per the list of analyses)

• Physiotherapy, nursing care, certain non-medical services

• Approved preventive measures (certain vaccines, screenings)

• Maternity care

Maternity benefits are fully covered with no deductible or co-payment. They include check-up examinations, delivery (at home, in hospital, or in a birthing centre), midwife care, and childbirth preparation courses. From the 13th week of pregnancy until 8 weeks after delivery, women pay no cost contribution.

Dental care is generally not covered by OHI. Limited exceptions exist if care is caused by a serious and unavoidable disease of the masticatory system, by another serious illness, or by an accident not covered by other insurance. Regular cavities, orthodontics, and implants are excluded.

OHI applies the territoriality principle: it generally reimburses only care provided in Switzerland. Exceptions:

• EU/EFTA: with the European Health Insurance Card (EHIC), medically necessary care is reimbursed at local rates.

• Outside EU/EFTA: reimbursement capped at twice the Swiss rate, for emergencies only.

Third-party guarantor: the insured person pays the provider first, then gets reimbursed by the fund (common for outpatient consultations). Third-party payer: the insurer pays the provider directly (mandatory for inpatient hospitalisation).

OHI premiums are set by each insurer, approved and published by the FOPH. In 2026, the average monthly premium is CHF 393.30, up 4.4% from 2025. Premiums vary by:

• Canton or region of residence

• Age of the insured (children, young adults 19–25, adults)

• Insurance model chosen

• Deductible chosen

The deductible is the annual cost share the insured pays before the insurer steps in.

A higher deductible means a lower premium but greater financial exposure in case of illness. Switching to a higher deductible is only possible on 1 January; switching to a lower deductible must be requested in writing before 30 November.

The co-payment is 10% of costs exceeding the deductible, capped annually at:

• CHF 700 for adults

• CHF 350 for children

An adult with the standard CHF 300 deductible will therefore pay at most CHF 1,000 per year (300 + 700) in cost-sharing, excluding hospital contribution.

In addition to the deductible and co-payment, a CHF 15 per day contribution applies during inpatient stays. Exempt: children up to 18, young adults in education up to 25, and women for maternity benefits.

In addition to the standard model (free choice of doctor), LAMal allows alternative models that offer premium discounts in exchange for restricted choice.

The maximum discount is legally capped: it cannot exceed 50% of the standard premium with the base deductible. These models can be combined with an optional deductible, within the statutory minimum premium limits.

Since all health funds offer identical basic benefits, the main selection criterion is the premium amount. The FOPH provides the official and neutral Priminfo calculator, which lets you compare premiums by canton, age, model, and deductible — anonymously and without sales solicitation.

Termination must be sent by registered mail, and all premiums must be paid up for the change to take effect. The new fund cannot refuse an insured person for basic insurance.

1. Compare premiums on priminfo.ch based on your personal situation.
2. Choose the appropriate insurance model and deductible.
3. Register with the new insurer (which will usually inform the previous one).
4. Send the termination letter to the old fund by registered mail.
5. If you have supplementary insurance, never terminate before being accepted by the new supplementary insurer.

LAMal requires cantons to reduce premiums for insured persons of modest economic means. This mechanism, called a subsidy, ensures that everyone can access health insurance regardless of financial situation. The Confederation pays cantons annual subsidies equal to 7.5% of gross OHI costs, supplemented by cantonal resources.

From 1 January 2026, the indirect counter-proposal to the premium-relief initiative requires cantons to pay a minimum contribution calculated on their gross OHI costs.

Eligibility criteria vary by canton. The law imposes minimums for low- and middle-income families:

• Children’s premiums must be reduced by at least 80%.

• Premiums for young adults in education must be reduced by at least 50%.

Some cantons grant the reduction automatically; others require an application to the competent cantonal authority.

Subsidies are paid directly to health funds, which then reduce the premium invoiced to the insured person.

Supplementary insurance is optional and governed by the Federal Act on Insurance Contracts (LCA), not by LAMal. It extends coverage beyond basic benefits: private hospital room, alternative medicine, routine dental care, etc.

Supervision of supplementary insurance (FINMA) is separate from that of basic insurers (FOPH).

EU/EFTA/UK cross-border workers (G permit) must generally insure in Switzerland from the start of their employment contract. They have 3 months to enrol. Unjustified late enrolment may trigger a premium surcharge, and prior medical costs remain their responsibility.

• EU/EFTA/UK: exempt from the Swiss insurance obligation if they remain covered in their home country and don’t work in Switzerland.

• Outside EU/EFTA/UK: may request exemption if their private insurance is equivalent. Application must be submitted to the competent cantonal authority within 3 months of taking up residence.

Students who keep their legal residence in Switzerland generally remain subject to mandatory insurance. Those studying in EU/EFTA/UK can avoid double enrolment if their host country’s coverage is equivalent.

• EU/EFTA/UK: must insure in Switzerland.

• Outside EU/EFTA/UK: no longer subject to Swiss mandatory insurance; must insure in their country of residence.

Mandatory insurance ends upon departure. Exceptions exist for certain categories (civil servants, posted workers, etc.) under international social-security agreements.

If you cannot obtain reimbursement of medical bills within a reasonable timeframe, you can contact the health insurance ombudsman (om-kv.ch), a free and independent mediation service.