Social assistance and health insurance

What does social assistance mean for health insurance?

Social assistance is the last tier of social security in Switzerland. It covers the living costs of people who cannot meet them from their own income, assets or social insurance benefits that take precedence. The cantons and municipalities are responsible for it; federal law only sets the framework.

For health insurance, receiving social assistance does not change the insurance relationship. You remain with your insurer in basic health insurance and have the same benefits and the same free choice of doctor as everyone else. What changes is who bears the costs. The premium is paid through the premium subsidy and the remaining amount through the public authorities. Social assistance covers the deductible and retention fee if you are in need.

Social assistance must be distinguished from supplementary benefits to old-age and survivors’ insurance (AHV) and invalidity insurance (IV). With supplementary benefits, a flat-rate amount for basic health insurance is included in the calculation and paid directly to the insurer (Art. 10 para. 3 let. d and Art. 21a ELG). Supplementary insurance under the Insurance Contract Act (ICA) is not part of basic care; whether social assistance takes its premiums into account is decided by cantonal law.

How it works

Premium

1. Premium subsidy first. The cantons must relieve insured persons of modest means and pay the amount directly to the insurer. In the canton of Zurich, the person concerned or the social services office arranges the subsidy if it is still missing. It is not permitted there to waive the subsidy and have the whole premium settled through the canton.
2. Remaining premium through the public authorities. Depending on the canton, social assistance or the municipality covers the part of the premium that the subsidy does not cover. Each canton decides which premium is considered appropriate; to set the amount of the subsidy, many cantons work with a reference premium. In the canton of Zurich, the municipality of residence under civil law transfers the uncovered part to the insurer.
3. Obligation to choose a cheap option. In the canton of Zurich, people receiving social assistance must switch to a cheaper insurer as far as possible and reasonable, and social assistance must support them in doing so. In addition, since 1 January 2025 it has been possible to switch from the standard model to a GP, HMO or telemedicine model at any time, not only at the end of the year.

Co-payment

In the canton of Zurich, the deductible and retention fee are part of basic medical care and are covered if you are in need. This also applies to the higher retention fee of 40% for overly expensive original medicines. Medicines bought yourself without a doctor’s prescription, on the other hand, are included in the basic living allowance.

Legal basis

The Federal Health Insurance Act (KVG) has no specific rule for people receiving social assistance; the general provisions apply. Art. 65 para. 1 KVG requires the cantons to grant premium subsidies to insured persons of modest means and to pay them directly to the insurers. Art. 64a KVG governs unpaid premiums: reminder, debt enforcement and the canton covering 85% of the claims for which a certificate of unpaid debt has been issued (para. 4). Art. 84a KVG allows insurers to disclose the necessary data to the social assistance authorities if premiums remain unpaid after an unsuccessful reminder.

The Health Insurance Ordinance (KVV) contains two explicit references to social assistance. Under Art. 8 para. 2 KVV, no premium surcharge for joining late is charged if a social assistance authority pays the premiums. Under Art. 9 para. 1 KVV, an insurer may only terminate the insurance because of late payment for people to whom Swiss social assistance law does not apply. Since 1 January 2025, Art. 100 para. 2 KVV has allowed a switch at any time to a model with a restricted choice of service provider.

The organisation of social assistance is a matter of cantonal law. In the canton of Zurich, the rules are set out in the social assistance act (§ 15a SHG, obligation to switch) and in the cantonal implementing act for the KVG (§ 15 EG KVG, covering the remaining premium). According to the Zurich social assistance handbook, the premiums covered do not count as social assistance in the sense of support because of Art. 3 para. 2 let. b of the federal act on responsibility for supporting people in need.

Example: an expensive insurer in Zurich

Daniel is 38 (born in 1988), lives in the city of Zurich and has been receiving social assistance since 2026. He is insured in the standard model with a CHF 300 deductible with an insurer whose premium is at the top end. The table shows the range in the municipality of Zurich (region 1), adults with accident cover (2026 premiums, source FOPH):

What this means for you

1. Check the premium subsidy. Clarify with the social services office whether the subsidy has been applied for. You can find the cantonal rules under premium subsidy.
2. Look for a cheap option. Compare the premiums for your municipality in the premium calculator, also with the GP, HMO or telemedicine model. You can find the profiles under health insurers.
3. Meet the deadlines. Plan the switch of insurer using the deadlines. You can create the cancellation letter with the cancellation letter tool.
4. Pass on bills. Forward bills for the deductible and retention fee to the social services office so that they can be covered.
5. Report unpaid premiums. If you owe money to your insurer, talk to the social services office early. More on this under payment arrears.

Common mistakes

• Cancelling your insurance yourself to save premiums. Basic health insurance is compulsory. Without a new insurer, your old insurer remains responsible.
• Not applying for the premium subsidy. It takes precedence over social assistance; if it is missing, money is missing from the budget.
• Keeping an expensive insurer. Where there is an obligation to switch, refusing can lead to a reduction in social assistance.
• Bearing co-payments yourself. In the canton of Zurich, the deductible and retention fee are part of basic care. Submit the bills.

We explain how we compare premiums under How we calculate.