Covid-19: What does the health insurance cover ?

Qualibroker-Swiss Risk & Care answers frequently asked questions

In these particularly difficult times, many of you have questions about your health insurance cover regarding the coronavirus. You will find first answers here below.

All our advisors are working from home and remain at your service for help, guidance and to answer all your questions. Do not hesitate to contact us by email : fmsi@swissriskcare.ch

[Notice to readers] These are unprecedented times and some of the information given may change as the authorities respond to the economic crisis. Therefore, the information will be updated regularly.

Is the coronavirus test covered by Swiss obligatory health insurance?

Since January 28, 2021

The federal government covers the costs of PCR tests and rapid antigen tests provided that one of the following criteria is met:

• You have symptoms matching Covid-19.
• You receive a notification from the SwissCovid App that you’ve been in contact with an infected person. You’ll find information on this on the SwissCovid App and Contact Tracing site.
• The cantonal office or a doctor orders you to have a test as part of the quarantine or an outbreak investigation.
• You are called for a test to prevent a large-scale outbreak, for example in schools, ski areas, in certain regions, etc. In this case you will be contacted by the cantonal office.
• You have a test to protect vulnerable people, for example before visiting a hospital or retirement or care home. In this case you will be invited for a test directly by the establishment in question.

The federal government will not cover the costs of the test if:

• You want to leave quarantine early and get tested from day 7
• You need a negative test result for travel.
• You are being tested at the request of your employer.
• The test is carried out abroad.
• The test is part of precautionary measures for hotels, fairs, international conventions, concerts and sporting events or at the workplace.

In the last situation the following applies:

• Testing is voluntary. Employers cannot oblige employees to have a test, and employers are not entitled to be notified of the medical findings on their employees.
• All rapid tests must always be done by trained medical personnel.
• A positive result from a rapid test must always be confirmed with a PCR test. The Federal Government will pay the costs of the confirmatory PCR test.
• The use tests is no substitute for the existing hygiene and social distancing rules or precautionary measures.

Source : Federal Office of Public Health FOPH

Between June 25, 2020 and January 27, 2021

The federal government will therefore be assuming the cost of all coronavirus tests (cf. Press release of June 24, 2020).

The persons tested do not participate in the costs through the deductible and the 10% retention fee.

Note that invoicing is always done through insurers.

This assumption of costs is subject to the following two conditions:

• The prescribing doctor specifies directly on her or his lab request form whether the test is carried out because of illness or because prescribed by the cantonal head physician. Please be aware: There is no reimbursement for voluntary tests request solely by the person who wants to get tested.
• The testing laboratory invoices the costs according to the doctor's prescription.

You will find more information on this subject on the leaflet of the FOPH (Federal Office of Public Health).

Between March 4 and June 24, 2020

Coronavirus tests done in Switzerland are covered by the health insurers as a benefit eligible for reimbursement through obligatory health insurance coverage and if the two conditions mentioned above are met.

Legal co-payment amounts (deductible and 10% retention fee) apply.

When infection of exposed healthcare professionals is being suspected, the law on epidemics applies. In such cases, the canton concerned covers the costs without any deduction of co-payment.

Before 4th March, 2020

The coronavirus tests were covered by the Confederation, i.e. the federal government.

Who pays for coronavirus treatments?

The obligatory health insurance reimburses both laboratory and medical costs, regardless of the test result.

Legal co-payment amounts (deductible and 10% retention fee) apply.

Our health insurance specialists are at your service

Health lies more than ever at the heart of our concerns. A comprehensive health insurance coverage protecting you against all health concerns is therefore very important. Do not hesitate to contact us for an assessment of your current coverage and potential for improvement.

Working together with most health insurance companies, our experts will be able to provide you with neutral and independent advice on covered benefits as well as on gaps in your current insurance coverage.