Does health insurance pay for ambulance transport and rescue?

What basic health insurance pays

Basic health insurance does not pay the full cost of patient transport, but a contribution towards medically necessary transport costs and towards rescue costs (Art. 25 para. 2 let. g of the Federal Health Insurance Act, KVG). The details are set out in the Health Care Benefits Ordinance (KLV). It distinguishes between two cases with different limits; both are explained in the glossary under Rescue and transport costs.

Transport is only covered if it is medically indicated, takes you to an approved service provider suitable for the treatment that you may choose under your insurance model, and your state of health does not allow any other public or private means of transport (Art. 26 para. 1 KLV). The vehicle must meet the medical requirements of the case (Art. 26 para. 2 KLV). A rescue gets you out of an acute emergency, for example an emergency on the road or in the mountains. The higher limit applies here, but only for rescues in Switzerland (Art. 27 KLV).

Both limits apply per calendar year and separately from each other. The health insurer decides how a call-out is classified on the basis of the rescue service’s invoice.

Only transport and rescue companies that are approved under cantonal law, have a contract with the insurers and meet the quality requirements may bill (Art. 56 of the Health Insurance Ordinance, KVV).

What supplementary insurance pays

The gap between the invoice and the contribution from basic health insurance can be closed by voluntary supplementary insurance, usually supplementary outpatient insurance or a separate module for rescue and transport. It is governed by the Insurance Contract Act (ICA); the law does not prescribe any cover there. Each health insurer sets out in its general terms and conditions:

• what share of the remaining costs it pays and up to what limit per year or per event,
• whether it covers rescues and repatriation from abroad,
• whether it also helps pay for journeys without medical care, such as a Red Cross transport service,
• whether search operations and recoveries are included.

Abroad, basic health insurance only pays for emergency treatment and, outside the EU, EFTA and the UK, at most twice the Swiss costs (Art. 36 para. 2, 4 and 5 KVV); it pays nothing towards a rescue abroad. Rescue and repatriation to Switzerland are only covered by supplementary or travel insurance. More on this in the article Ill abroad and on holiday.

Supplementary insurance may not take over the deductible and retention fee of basic health insurance (Art. 64 para. 8 KVG); it only pays towards the part that basic health insurance does not reimburse. We are building a comparison of supplementary products under Supplementary insurance. The general terms and conditions and the information from your health insurer always prevail.

Conditions

• Medical necessity: transport is only covered if your condition does not allow any other means of transport. Basic health insurance does not pay for journeys you could make by train, bus, taxi or in your own car.
• Suitable service provider you may choose: the destination must be an approved service provider suitable for the treatment that you may choose under your insurance model (Art. 26 para. 1 KLV).
• Approved company: ambulance and rescue services can only bill basic health insurance with cantonal approval and a contract with the health insurers (Art. 56 KVV).
• Deductible and retention fee: the health insurer’s contribution first counts towards the deductible; after that, a 10 % retention fee applies up to a maximum of CHF 700 a year for adults and CHF 350 for children (Art. 103 KVV).
• Accident insurance first: after an accident, accident insurance pays the necessary transport and rescue costs, without the KLV limits (Art. 13 of the Accident Insurance Act, UVG). Employees working at least 8 hours a week for the same employer are also insured against non-work-related accidents (Art. 13 of the Ordinance on Accident Insurance, UVV). Anyone insured in this way may suspend the accident cover of their health insurance (Art. 8 KVG); self-employed people and people without an employer remain covered through their health insurer, with the same limits as for illness.
• Supplementary benefits: anyone receiving supplementary benefits is reimbursed by the canton for documented costs of transport to the nearest place of treatment (Art. 14 para. 1 let. e of the Federal Act on Supplementary Benefits, ELG), within the cantonal rules.

Sample calculation

Example with fictitious people and assumed invoice amounts. Marco, 52, is self-employed and is therefore insured against accidents through his health insurer. He has a CHF 300 deductible, which has already been used up this year. In May he collapses at home; the rescue service invoices an assumed CHF 1,800 for the call-out. The contributions follow from Art. 27 KLV and Art. 64 KVG.

How hard a high deductible hits such invoices depends on your costs over the whole year. The deductible calculator works out the break-even point, and you can compare premiums in the premium calculator.

What to do

1. In an emergency, get help first: you can sort out the costs afterwards. The limits of basic health insurance do not change the fact that you call the ambulance emergency number in an emergency.
2. Report an accident: if it was an accident and you are employed, report it to your employer or the accident insurer.
3. Submit the invoice: submit the rescue or transport service’s invoice to your health insurer, even if the amount is below the deductible. The contribution counts towards the deductible and retention fee.
4. Include supplementary insurance: the health insurer first checks basic health insurance and then any supplementary insurance. If your supplementary insurance is with a different insurer, send it the statement from basic health insurance afterwards.
5. Check before travelling: before your holiday, find out whether your supplementary or travel insurance covers rescue and repatriation from abroad.

Common mistakes

• Assuming the ambulance is free. Basic health insurance only pays half, at most CHF 500 a year for transport, and the deductible and retention fee are applied on top.
• Confusing transport and rescue. The higher limit of CHF 5,000 only applies to rescues, and only in Switzerland.
• Forgetting accident insurance. After an accident, accident insurance pays for employees; the health insurer is then not responsible.
• Keeping invoices below the deductible. Contributions that are not submitted are later missing from the deductible and retention fee.
• Travelling abroad without cover. Basic health insurance does not pay for a rescue abroad.

You will find the insurers’ key figures and supplementary offers in the health insurer profiles, and other benefits from glasses to physiotherapy in the overview What does health insurance cover?.