Compulsory health insurance

According to the Health Insurance Act (KVG), anyone who lives or works in Switzerland must take out health insurance. People who live abroad but have a residence permit for at least three months are also obliged to take out insurance – as are cross-border commuters. In exceptional cases, exemption from compulsory insurance is possible.

Applications for exemption to the SVA Zurich

The SVA Zurich has been responsible for applications for exemption from compulsory health insurance since 1 October 2023. For all information on compulsory health insurance and applications for exemption, please contact the SVA Zurich.

Overview of premiums

Premiums for compulsory health insurance are calculated by the insurers. The Federal Office of Public Health (FOPH) approves and publishes the premiums.

Due to different costs, the municipalities in the canton of Zurich are divided into three premium regions. The regions are determined by the Federal Department of Home Affairs (FDHA).

Entitlement to premium reduction

Health insurance companies charge premiums regardless of income and assets. Insured persons in modest economic circumstances are supported with a contribution to the premiums for compulsory health insurance. This is called the individual premium reduction (»individuelle Prämienverbilligung”, IPV). For persons with a low to middle income, the cantons must reduce the premiums for children by at least 80 % and the premiums for young adults in education by at least 50 %. The premium reduction is financed by the Confederation and the canton.

The IPV in the canton of Zurich is implemented by the SVA Zurich. IPV is granted on application only and is paid directly to your health insurance. The SVA identifies those eligible to premium reduction based on the tax data. Every year, in early summer, application forms are sent out for the following year. Information regarding implementation of the IPV, namely entitlement, amount, calculation, or payment is the exclusive responsibility of the SVA.

New system as of premium reduction year 2021

On 1 April 2020, the Government Council enacted the new Introductory Act to the Health Insurance Act (EG KVG). This means that starting from premium reductions for the year 2021, the former tiered model will be replaced by a system proportional to assets and income.

In addition to a basic contribution, insured persons will pay a percentage of their income for health insurance premiums, to be determined by the Government Council (so-called »Eigenanteil”, i. e. personal contribution). The difference between the personal contribution and the individually owed health insurance premium constitutes the premium reduction and is paid for by the canton.

The IPV amount will also in future depend on the assets and income: The lower the assets and income, the higher the IPV amount. From now on, the IPV amount will however be determined provisionally based on the last available tax assessment. This tax data usually relates to a tax period dating several years back.

In a second step, the final IPV amount is calculated based on the final tax assessment for the respective year of entitlement. Any difference between the provisional and final IPV amount is settled via health insurers. To keep such differences between the provisional and the final IPV amount as small as possible, at the beginning, only 80 % percent of the provisionally determined IPV will be paid out.

The new system is very differentiated and takes into account the increasing demands of the population for a case-by-case fairness of their IPV. For as long as the number of entitled persons remains stable, the new regulations shall improve the equity in terms of needs and therefore lead to some redistribution of the available funds: To determine young adults’ IPV amount, the income and assets of the parents liable for maintenance are from now on also considered. With their overall financial situation taken into account, some young adults in education might no longer receive IPV. In the case of cohabiting couples, the amount of the premium reduction for minor children in the joint household is determined based on the assets and income of the parent with the higher assets and income.

Social welfare recipients

From the application year 2021 on, all social welfare recipients must apply for IPV themselves or through the responsible municipality. Under the new law, social welfare recipients are furthermore required to take out affordable health insurance, insofar as this is possible and acceptable. If they refuse to switch to an insurance company offering lower premiums or to an insurance model with a lower premium, even though this would be acceptable and possible, the social welfare benefits will be reduced in accordance with the social welfare legislation.

An overview of the low-cost insurance models per insurance (so-called enforcement assistance, »Vollzugshilfe”) can be found in the Social Assistance Authorities Handbook (»Sozialhilfe-Behördenhandbuch”).

Persons who would be entitled to social welfare benefits can continue to apply for payment of the remaining premium without having to apply for social welfare at the same time.