Demystifying Swiss Insurance
LaMal vs Accident Insurance
Navigating the Swiss healthcare system can be complex, especially when it comes to understanding the different types of insurance available and their implications for your health care. Two key components of this system are LaMal (L’Assurance Maladie) and accident insurance. Although they both provide essential coverage, they serve distinct purposes. In this post, we’ll clarify the differences between LaMal and accident insurance, helping you make informed decisions about your healthcare options.
LaMal (L’Assurance Maladie)
LaMal is Switzerland’s mandatory basic health insurance aimed at ensuring that all residents have access to essential medical care. Here are some key points to understand about LaMal:
Mandatory Coverage: LaMal is compulsory for all Swiss residents, regardless of age or health condition. Every individual must have this basic coverage to access necessary medical services.
Choice of Insurer: While LaMal is mandatory, you have the freedom to choose from various insurance providers. Although the basic coverage is standardised, premiums may vary based on the insurer and your canton of residence.
Premiums and Costs: LaMal premiums can fluctuate based on factors such as your age, health status, and the level of deductible you choose. Individuals are responsible for paying these monthly premiums, which can be a significant cost.
Supplementary Insurance Options: While LaMal covers essential medical services, you may need supplementary insurance for additional services, which may not be fully covered by the basic plan.
Deductible/Co-Pay: LaMal comes with a deductible which the insured person has to pay (from 300chf to 2,500chf) followed by a co-pay of 10percent up to 700chf.
Accident Insurance
While LaMal takes care of your general health needs, accident insurance specifically addresses injuries resulting from accidents, whether at work, during sports, or in everyday life. Here’s what you need to know:
Focused Benefits: Accident insurance provides coverage for the costs associated with accidental injuries, including medical treatment, hospitalisation, rehabilitation, and disability benefits. This insurance ensures that you receive prompt and comprehensive care in the event of an accident.
Contribution by Employers: If you are employed, your employer pays the portion of the accident insurance premium covering occupational accident insurance (AAP - Assurance Accidents Professionels). For accidents outside of work you will see a deduction on your payslip as LAA (L'Assurance-Accidents) or AANP (Assurance Accidents Non Professionnels).
Deductible/Co-Pay: LAA comes with no deductible, all costs are covered by insurance. If you are unable to work, the insurance will also cover a portion of your missed salary.
Duration: You continue to receive coverage for 28 days following the end of your employment contract, after which you would need to take out your own accident insurance, which is normally possible via your LaMal provider.
Key Differences Between LaMal and Accident Insurance
Scope of Coverage: LaMal focuses on general health needs, while accident insurance specifically targets injuries sustained in accidents.
Claim Procedures: The claim processes may differ significantly, with LaMal typically involving consultations and treatments by healthcare providers, while accident insurance is activated by your employer upon injury due to accidents. Your employer will then provide you with a Numero de Sinistre which you can pass on to healthcare providers.
Understanding the differences between LaMal and accident insurance is crucial for navigating the Swiss healthcare system effectively. LaMal ensures that all residents have access to essential medical care, while accident insurance provides coverage for injury-related expenses. By familiarising yourself with these two types of insurance, you can make sure you get access to healthcare that you are entitled to.
If you have questions about your insurance or need guidance on navigating the Swiss healthcare system, don’t hesitate to reach out. At PhysioBagnes, we’re here to support you in understanding your coverage and accessing the care you need.
