Claim to benefits
Persons who are insured with an official health insurance of one of the EU states or Iceland, Norway or Liechtenstein (EFTA) have a claim to necessary medical treatment in case of illness, recreational accident or maternity during a temporary stay in Switzerland, providing the treatment cannot wait until they return to their home country. They are entitled to benefits according to the regulations of Swiss Federal Law in respect of health insurance (KVG) providing a valid insurance certificate (European Health Insurance Card or Provisional Replacement Certificate) is available. If the responsible health insurance agrees to pay for the costs of planned treatment in Switzerland, it will issue a claim form E 112 or S2 for this specific treatment before the person travels to Switzerland.
Costs resulting from accidents at work will be dealt with by the accident insurance SUVA, Team Ausland, Fluhmattstrasse 1, 6004 Luzern as assisting institution.
The medical service providers are bound to grant the same legally applicable benefits to a person from an EU/EFTA state as a person insured in Switzerland has a right to. Therefore, claims to benefits, applicable tariffs as well as cost sharing arrangements are subject to Swiss regulations in respect of health insurance.
According to Swiss health insurance law KVG, insured persons have the right to choose any medical service provider who has been approved by the Swiss health insurance and who is appropriate for the treatment in question.
Auditing of accounts
The Gemeinsame Einrichtung KVG coordinates the assessment of claims, examines invoices in respect of conformance to the legal regulations as well as the contractual and negotiated conventions for the whole of Switzerland. It settles treatment costs and subsequently invoices the competent health insurance abroad.
Cash benefits are not paid by the Gemeinsame Einrichtung KVG but have to be claimed direct from the competent health insurance abroad.