Insurance policy

What is an insurance policy?

The insurance policy, or policy for short, is the written proof of your insurance contract. In connection with health insurance, it summarises on one or a few pages which insurance you have with this insurer, for which persons, from when and at what premium. For families, all family members are often listed on one joint policy. In German it is called the Police or Versicherungspolice.

In Switzerland the law makes a clear distinction between two worlds of insurance, and this is also reflected in the policy:

• Basic health insurance under the KVG: it is compulsory, the benefits are set by law, and the insurer must accept you. The KVG does not require a document called a “policy”. Insurers nevertheless issue a policy or a certificate of insurance, because they have to inform you of your premium, deductible, model and accident cover.
• Supplementary insurance under the ICA: these are voluntary contracts. Here the Insurance Contract Act expressly requires the insurer to issue a policy setting out the rights and obligations of the parties. The policy includes the general terms and conditions (GTC) and any additional terms.

The policy should not be confused with other documents. The health insurance card is your proof of insurance for the doctor, pharmacy and hospital. The confirmation of insurance confirms to a body such as your municipality or an employer that you are insured. The quote is an offer before the contract is concluded and not yet a policy.

How it works

A health insurance policy usually contains the following information:

A new policy every year. In basic health insurance the premium usually changes on 1 January. The insurer must notify you of the new premium approved by the FOPH at least two months in advance and point out your right to switch. The FOPH gives 31 October as the latest date for this. Many insurers send the new policy at the same time. Your deadline runs from this notification: if you want to switch basic health insurance with effect from 1 January, your notice of cancellation must reach the insurer by 30 November.

Changes during the year. If you change your deductible or model, or have your accident cover excluded, the insurer issues a new policy. Check it immediately. If you move to a different premium region, your premium also changes and you receive a new policy.

Taking out supplementary insurance. Before the contract is concluded, the insurer must inform you about the insured risks, the scope, the premium, the term and termination, in a form that allows proof by text. You must have the GTC at the latest when you apply for or accept the contract. After applying, you have 14 days to revoke your application. You receive the policy once the insurer has accepted you, often only after your health information has been checked.

Legal basis

Supplementary insurance is governed by the Insurance Contract Act (ICA):

• Art. 11 para. 1 ICA: the insurance company issues the policyholder with a policy setting out the rights and obligations of the parties. Under para. 2, you receive on request a copy of the statements you made in the application, such as your answers to the health questions.
• Art. 3 ICA: before the contract is concluded, the insurer must inform you clearly and in text form about its identity, the insured risks, the scope of cover, the premiums, the term, termination and the processing of personal data. You must already have the GTC when you apply or accept (para. 2). If the insurer breaches this duty, you can terminate the contract under Art. 3a ICA, within four weeks of becoming aware of the breach and at the latest two years after it.
• Art. 2a ICA: you can revoke your application or declaration of acceptance in writing or in text form within 14 days.
• Art. 35a para. 4 ICA: in supplementary insurance to social health insurance, only you as the policyholder have the ordinary right of termination, not the insurer. Under para. 1, you can terminate at the end of the third or any subsequent year with three months’ notice, unless the contract provides for a shorter period.

Basic health insurance is governed by the KVG. It does not require a policy within the meaning of the ICA. Art. 7 para. 2 KVG obliges the insurer to notify every insured person of the new premiums approved by the FOPH at least two months in advance and to point out the right to switch. Art. 89 KVV requires the insurer to clearly separate, for each insured person, the premiums for basic health insurance, the premium share for the accident risk, daily allowance insurance and supplementary insurance.

The ICA used to provide, in Art. 12, a four-week right of correction for discrepancies between the policy and the agreement. This provision was repealed with effect from 01.01.2022. Report errors immediately and in writing.

Example: reading a policy

Anna is 34 (born in 1992) and lives in the city of Zurich (premium region 1). She is insured under the standard “basic insurance” tariff of Sanitas with a CHF 2,500 deductible and works full time as an employee. The premiums come from the FOPH data for 2026 (opendata.swiss); the supplementary insurance is a fictitious example.

Anna can find the premiums of all insurers for her situation in the premium calculator. How the exclusion of accident cover works is explained in the entry suspension.

What this means for you

1. Read your policy every autumn. Check the deductible, model, accident cover, premium region and all supplementary insurance. Compare the premium with the previous year.
2. Use the policy for comparison. With the deductible, model and accident cover from your policy, you can compare the same benefits at other premiums in the premium calculator.
3. Mind the deadline. After the premium notification, you can cancel basic health insurance by 30 November with effect from 1 January. The dates are listed under deadlines, and you will find a sample letter under cancellation letter.
4. Keep basic and supplementary insurance apart. You can switch basic health insurance and keep your supplementary insurance. Only cancel a supplementary insurance once a new one has been confirmed in writing, because the new insurer may ask health questions and turn you down.
5. Keep the policy and the GTC. In a dispute about a benefit, the version of the GTC that applies to you is what counts. You can save your calculations and deadlines in your account.

The health insurer profiles show which products an insurer offers.

Common mistakes

• Filing the policy away unread. Otherwise errors such as a wrong deductible or an exclusion of accident cover that was not applied continue for the whole year.
• Mistaking the health insurance card for the policy. The card shows neither the premium nor the deductible nor any supplementary insurance.
• Relying on the old four-week period. The former right of correction under Art. 12 ICA has no longer applied since 01.01.2022. Report discrepancies immediately.
• Confusing a quote with a policy. A quote is an offer. Only the policy issued after the insurer has accepted you proves the contract, often with reservations in supplementary insurance.
• Cancelling supplementary insurance together with basic health insurance. The two contracts are independent. If you cancel both, you often lose the supplementary insurance for good.

How we calculate premium examples is explained under How we calculate.