Health insurance for the self-employed and SMEs: an overview

Self-employed and SMEs: which insurance covers what

As an employee, you are protected in three ways without doing much yourself: basic health insurance pays for your treatment, your employer insures you against accidents under the UVG, and in the event of illness it continues to pay your salary or has daily allowance insurance for this. If you become self-employed, only the first remains. You arrange the other two yourself, or not at all.

If you then hire staff, you change sides: as the employer of an SME, you must insure your employees against accidents and continue to pay their salary in the event of illness. The table shows what is covered where.

Risk	Employees	Self-employed	Legal basis	More detail
Treatment for illness	basic health insurance	basic health insurance, same rules	Art. 3 and 61 KVG	Becoming self-employed
Treatment after an accident	UVG through the employer, without deductible	basic health insurance with deductible, or voluntary UVG	Art. 1a, 4 UVG, Art. 8 KVG	Accident insurance for the self-employed
Loss of earnings after an accident	UVG daily allowance 80 % from the third day	only with voluntary UVG insurance	Art. 16–17 UVG	Accident insurance for the self-employed
Loss of earnings due to illness	continued payment of salary or the employer’s daily allowance insurance	only with your own daily sickness allowance insurance	Art. 324a CO, Art. 67–72 KVG	Daily sickness allowance for the self-employed

The following sections answer the six questions that the self-employed and SMEs ask most often. Each section gives the answer in the first paragraph and refers to the article that covers the topic in depth with steps, a sample calculation and special cases. We cover retirement provision (OASI, occupational pension provision) only insofar as it affects health insurance.

What changes with your health insurer when you become self-employed?

Nothing changes in basic health insurance: it depends on your place of residence, not on your employment, and costs the self-employed the same as employees. What falls away is the accident cover through your employer and the continued payment of salary during illness. You must arrange both yourself, from the first day of self-employment.

Your previous employer’s UVG cover ends on the 31st day after the day on which your entitlement to at least half your salary ends (Art. 3 para. 2 UVG). After that, your health insurer covers accidents again by law (Art. 8 para. 2 KVG). If you had suspended accident cover as an employee, you notify your health insurer of the end of your UVG cover within one month (Art. 11 para. 2 KVV); the premium then rises by the accident share, which is at most 7 % (Art. 91a para. 4 KVV).

You do not have to change health insurer. As a self-employed person, you lower your basic health insurance premium with the same tools as everyone else: deductible, insurance model, switching health insurer at the end of the year. If your income fluctuates a lot, also look into your canton’s premium subsidy; it depends on income, not on the type of employment (Art. 65 KVG).

How to sort out your insurance step by step when you start, what is different with your own GmbH or AG and which OASI and pension contributions come on top is explained in the article Becoming self-employed: getting health, accident and daily allowance insurance right.

Accidents: health insurer or voluntary UVG insurance?

Both cover treatment, but only voluntary UVG insurance also replaces income. Through your health insurer, you pay the deductible and retention fee after an accident as for an illness, and you receive no daily allowance. Voluntary UVG insurance pays for treatment without co-payment and, from the third day after the day of the accident, a daily allowance of 80 % of insured earnings (Art. 16 and 17 UVG).

Self-employed persons resident in Switzerland and their family members who work with them and are not compulsorily insured can take out voluntary insurance (Art. 4 para. 1 UVG). You agree the insured earnings when concluding the contract; for the self-employed, they are at least CHF 66,690 and at most CHF 148,200 a year (Art. 138 and Art. 22 para. 1 UVV). If you work without employees in a sector for which Suva is responsible, for example in construction, you insure yourself with Suva; everyone else with a private UVG insurer (Art. 135 UVV).

Only persons who are compulsorily insured under the UVG are entitled to suspend accident cover with their health insurer (Art. 8 para. 1 KVG). How to decide between the two routes, what determines the premium for voluntary UVG insurance and what six weeks off work after an accident look like in both variants is worked out in the article Accident insurance for the self-employed. The accident share of your premium is shown by the suspension calculator:

Daily sickness allowance: how do the self-employed cover loss of earnings during illness?

With their own daily sickness allowance insurance, under the KVG or under the ICA. It is not compulsory, but without this insurance you have no replacement income if you are ill. Basic health insurance only pays for treatment, never salary.

The two forms differ mainly in acceptance and minimum benefits:

The most important lever is the waiting period: the later the daily allowance starts, the lower the premium; with the KVG form, the insurer must reduce the premium for a waiting period (Art. 76 para. 2 KVG). You bridge the days until the first daily allowance with your own reserves. How the waiting period, the amount and the health questions interact, with a sample calculation for waiting periods of 30 and 60 days, is covered in depth in the article Daily sickness allowance for the self-employed. For ICA contracts, what counts are the general terms and conditions and the information from the insurer.

First employees: what must an SME insure?

Accident insurance under the UVG is compulsory; daily sickness allowance insurance is voluntary. All employees working in Switzerland are compulsorily insured against work-related accidents and occupational diseases (Art. 1a UVG), and you as the employer make sure they are insured with an insurer (Art. 69 UVG). If someone works at least 8 hours a week for you, they are also insured against non-work-related accidents (Art. 13 para. 1 UVV).

You pay the premium for work-related accidents; the premium for non-work-related accidents is borne by the employees: you owe the full amount and deduct their share from their salary (Art. 91 UVG). Art. 66 UVG sets out the sectors for which Suva is responsible; all other businesses choose a private UVG insurer. If you do not insure an employee, the substitute fund pays the statutory benefits and collects substitute premiums from you (Art. 73 UVG).

Federal law does not require daily sickness allowance insurance, but some collective labour agreements do. If you take it out, it is usually as collective insurance for the whole business; under the KVG, an employer can take it out for itself and its employees (Art. 67 para. 3 KVG). If someone leaves, under the KVG form they have a right to transfer to individual insurance, which they must exercise within 3 months of being notified (Art. 71 KVG).

As an employer, you have no role in your employees’ basic health insurance: each person chooses their own health insurer, and there are no collective discounts there, because every health insurer in principle charges its insured persons the same premiums (Art. 61 para. 1 KVG). Besides accident and illness insurance, the first employee also brings OASI contribution accounting and, from a certain annual salary, occupational pension provision. What to clarify with the first employment contract, from registering with the insurer to the threshold for the pension fund and the rule in the event of illness, is explained in the article First employees: UVG, daily sickness allowance and continued payment of salary.

Continued payment of salary during illness: what do employers owe?

Without a special arrangement, as the employer of a person who is ill you pay 3 weeks’ salary in the first year of service, and an appropriately longer period after that (Art. 324a para. 1 and 2 CO). This continued payment of salary requires that the employment relationship has lasted more than three months or was entered into for more than three months, and that the person is prevented from working through no fault of their own.

How long “appropriate” is, the courts determine depending on the region with the Basel, Bern or Zurich scale; in the 2nd year of service it is 1 month, 2 months or 8 weeks depending on the scale. A different arrangement is permitted if it is agreed in writing, at least equivalent and laid down in an employment contract, standard employment contract or collective labour agreement (Art. 324a para. 4 CO). According to SECO, daily sickness allowance insurance paying 80 % of salary for 720 days counts as equivalent if the employer pays at least half the premium.

For an SME with few employees, this is a financial risk: without insurance, the business bears the salary of the person who is ill itself and often also needs a replacement. During illness, after the probation period, there is also a protection period against dismissal: 30 days in the first year of service, 90 days in the 2nd to 5th year and 180 days from the 6th year of service (Art. 336c CO). The scales in detail, a sample calculation with and without daily allowance insurance and a checklist for employers are in the article Continued payment of salary during illness: what employers owe. In the event of an accident, accident insurance applies instead of continued payment of salary.

Common mistakes

• Leaving accident cover suspended. After your employment ends, your health insurer does cover accidents again by law, but it charges the accident share of the premium. Report the end of your UVG cover within one month.
• Starting without a daily allowance. If you are self-employed without daily sickness allowance insurance, you have no replacement income during a longer illness. The question belongs at the start, not on the day you fall ill.
• Not matching the waiting period to your reserves. A long waiting period saves premiums, but you pay for the days until the first daily allowance yourself.
• Answering health questions inaccurately. With ICA contracts, you must answer the questions asked truthfully (Art. 4 ICA); otherwise you risk the contract being terminated.
• Not insuring your first employee. The UVG obligation starts with the employment relationship. If insurance is missing, the substitute fund steps in and claims substitute premiums.

Where to start?

1. Review your basic health insurance: Compare premium, deductible and model in the premium calculator; the health insurers’ key figures are in the overview of health insurers.
2. Arrange accident cover: Decide between accident cover with your health insurer and voluntary UVG insurance; the calculator under Suspending accident cover shows the accident share of your premium.
3. Clarify daily sickness allowance: Decide which part of your income you want to insure and how long you can manage without a daily allowance; then get quotes for KVG and ICA daily allowance.
4. As an employer: Choose a UVG insurer before the first working day and set out in the employment contract what applies in the event of illness.
5. Observe deadlines: Notice of cancellation of basic health insurance must reach your health insurer by 30 November; details under Deadlines.

If you would like to discuss a daily allowance or accident solution personally, you can make a request; it is not necessary for any of the steps. More topics are in the Guides.