Ill abroad and on holiday: what health insurance covers

What basic health insurance pays abroad

Basic health insurance is insurance for treatment in Switzerland. Abroad, it only pays in exceptional cases, the most important being an emergency. Under Art. 36 para. 2 KVV, an emergency exists if you need treatment during a temporary stay abroad and returning to Switzerland is not reasonable. It is not an emergency if you travel abroad precisely to be treated.

How much the insurer then covers depends on the country:

Why only 90 % in hospital? In Switzerland, the cantons bear at least 55 % of the costs of a hospital stay, the insurer at most 45 %. Abroad, the canton pays nothing; the insurer pays at most twice its share, i.e. 90 % (FOPH). In countries with high hospital costs, that is often far from enough.

The cover abroad of basic health insurance also has no assistance service: nobody arranges a hospital, an interpreter or the flight home for you. Travel and supplementary insurance do that.

Step by step: before the trip and in an emergency

1. Check your health insurance card. The European Health Insurance Card is usually printed on the back of your health insurance card. If it is missing or has expired, order it from your insurer before you travel.
2. Clarify your existing cover. Check your policy to see whether you have supplementary insurance with cover abroad, travel protection or assistance. Some supplementary hospital insurance policies cover emergencies worldwide. Credit cards and travel agencies also sell travel insurance; check whether it covers medical costs or only cancellation.
3. Note the emergency number. Supplementary insurance with cover abroad usually has an emergency call centre. Some only pay if the call centre has approved or arranged the treatment, for example CSS’s myFlex hospital insurance (additional conditions, section 4.5). Save the number in your phone.
4. In an emergency: get treatment, then report. In the EU, you show the card. Outside Europe, you often have to pay upfront. Inform your insurer or the emergency call centre as early as possible, especially for a hospital stay.
5. Keep invoices and reports. You need detailed invoices, proof of payment and medical reports for reimbursement. Without documents, the insurer cannot calculate what the treatment would have cost in Switzerland.
6. Apply for reimbursement. You submit everything to your insurer. It reimburses according to the rules above, less the deductible and retention fee; you submit the rest to your travel or supplementary insurance.

The rules in detail

Emergency: temporary stay, return not reasonable

Art. 36 para. 2 KVV requires two things: a temporary stay and treatment for which returning home is not reasonable. Holidays, business trips, a language stay or a world trip are temporary as long as you keep your residence in Switzerland. Basic health insurance remains compulsory during this time; according to the FOPH, you cannot suspend it for a trip. Whether returning home would have been reasonable is assessed by the insurer case by case on the basis of the medical reports.

EU, EFTA and UK: international benefits assistance with the card

With the European Health Insurance Card, you are entitled to medically necessary benefits during your stay in the 27 EU states, Iceland, Liechtenstein, Norway and the United Kingdom. The basis is the Agreement on the Free Movement of Persons, the agreement with the United Kingdom and Art. 95a KVG. You are treated like a person insured there, with the payment rules and co-payments of the country you are staying in (Gemeinsame Einrichtung KVG). Private clinics that are not part of the state system are not covered.

Other countries: twice the Swiss tariff

In all other countries, the insurer reimburses at most twice the amount that the treatment would have cost in Switzerland (Art. 36 para. 4 KVV). For outpatient treatment, that is enough in many countries. For hospital stays, it is at most 90 % of Swiss hospital costs, and in countries with high prices a large gap remains. The FOPH therefore recommends supplementary travel insurance for stays outside the EU, especially for countries with high treatment and transport costs.

Co-payment and transport

The deductible and retention fee also apply to treatment abroad: 10 % of the costs above the deductible, at most CHF 700 per year for adults (Art. 103 KVV). Basic health insurance pays 50 % towards patient transport, at most CHF 500 per year (Art. 26 KLV), and 50 % towards rescues only in Switzerland, at most CHF 5,000 (Art. 27 KLV). An air ambulance home is therefore not covered.

What travel health insurance covers

Travel insurance or supplementary insurance with cover abroad is voluntary and governed by the Insurance Contract Act (Art. 2 para. 2 KVAG). What it pays is set out in the general terms and conditions. Typical components:

Some supplementary hospital insurance policies include worldwide emergency cover. The “Economy” and “Balance” levels of CSS’s myFlex hospital insurance, for example, cover emergencies worldwide, limited to the acute phase, if returning to Switzerland cannot reasonably be expected (additional conditions, section 2.1). The article Flexible hospital insurance explains how such products work. Your insurer’s general terms and conditions and information are always decisive.

Sample calculation: emergency in Europe and overseas

Example with fictitious people. Nina, 34, has basic health insurance with a CHF 1,500 deductible and no supplementary insurance. She has had no medical costs so far this year. All invoice amounts below are assumed; the rules are the statutory ones.

With travel or supplementary insurance covering medical costs abroad, the difference of CHF 31,000 above the maximum amount would have been covered, depending on the general terms and conditions with a co-payment of its own. As a rule, supplementary insurance does not cover the deductible and retention fee of basic health insurance.

Special cases

Accident instead of illness

If you work at least 8 hours per week for the same employer, you are also insured against non-work-related accidents through compulsory accident insurance (Art. 13 para. 1 UVV). It reimburses medical treatment abroad up to twice the amount of the Swiss costs (Art. 17 UVV). If you have therefore excluded accident cover from your health insurance, that is not a problem; the suspend accident cover calculator explains how it works.

Longer stay, language stay, moving away

As long as your residence remains in Switzerland, you remain insured with your insurer and pay premiums. For a language stay or a year abroad, it is worth reading the article Year abroad and language stay. If you move away completely, the requirement to take out insurance ends; what applies then is explained in the article Moving abroad. There are separate rules for pensioners resident abroad, see Pensioners abroad.

Planned treatment abroad

Treatment for which you travel abroad is not an emergency. Basic health insurance only pays for it if it cannot be provided in Switzerland, and only with your insurer’s prior approval (Art. 34 para. 2 KVG, Art. 36 para. 1 KVV). Details in the article Treatment abroad.

Pre-existing condition and travel insurance

Travel and supplementary insurers may ask health questions and exclude existing illnesses. If you have a chronic illness, check the general terms and conditions to see whether treatment for it is covered while travelling.

Common mistakes

• Believing that basic health insurance covers everything worldwide. Outside Europe, it pays at most 90 % of Swiss costs in hospital, and nothing for transport back.
• Leaving the card at home. Without a European Health Insurance Card, you often have to pay upfront in the EU and organise reimbursement yourself.
• Double insurance without a plan. Credit cards, travel agencies and supplementary insurance often cover similar things. Before signing up, check what you already have.
• Not calling the emergency call centre. Some supplementary insurers only pay if their call centre has approved the treatment.
• Submitting invoices without details. The insurer needs the diagnosis, services and amounts to determine the Swiss comparison value.

The article Which supplementary insurance explains which supplementary insurance suits the way you travel; you will find all topics in the Supplementary insurance section. Basic health insurance itself is the same with every insurer, abroad too. You compare 2026 premiums in the premium calculator, and Switching health insurer explains the switch.