Policy responses for Switzerland - HSRM

Switzerland


Policy responses for Switzerland

4.2 Entitlement and coverage

All medical or medically prescribed measures are covered by mandatory health insurance. The usual cost sharing rules (deductible rate and coinsurance) apply. As a result, if patients did not have prior medical contact in the year, they will likely have to cover the full costs of initial testing and treatment up to the limit of their deductible (see online HiT, section 3.4).

Since March 4, health insurers have been obliged to cover the costs of testing for coronavirus in patients with severe symptoms. The general cost sharing rules apply, i.e. the deductible and co-insurance have to be covered by the insured person. If a canton orders the test, it assumes the full costs.

On April 22, the FOPH published an updated fact sheet on the reimbursement of costs of diagnostic analyses for SARS-CoV-2. In summary, it specifies that:
- All medically indicated care is covered by compulsory health insurance under the usual conditions (including cost-sharing requirements).
- Costs of tests for people who are not ill but need to be tested are covered by Cantons
- If persons request a lab test without clinical need, they have to cover the costs from their own resources.

On April 29, the Federal council announced that costs of testing persons with mild symptoms who do not belong into a high-risk group were to be covered by the cantons. Testing of persons with severe symptoms or an increased risk of complications were to be continued to be covered by the mandatory health insurance. Additionally, due to rapid technical advances, the Federal Department of Home Affairs decided to reduce the tariff for the analyses charged under mandatory health insurance to CHF 95 starting from April 30.

At its meeting on September 11, the Federal Council decided to reduce the tariff for the analyses (PCR test) from the initial CHF 95 to CHF 82, and the tariff for a serological analysis (antibody test) from CHF 39 to CHF 25.

Since June 25, the federal government assumes the costs of all coronavirus tests. This puts an end to the different cost-sharing requirements faced by patients depending on who covered the costs. If testing was covered by mandatory health insurance, the deductible and the retention fee applied. If testing was covered by the cantons, those tested bore no costs. As such, there was a risk that people would be reluctant to get themselves tested if they had to bear the costs themselves.

Starting September 18, the federal government will pay up to the following maximum amounts for molecular biological analysis for SARS-CoV-2:

• If the analysis is conducted by laboratories on behalf of another approved service provider: up to a maximum of CHF 106. This sum is made up as follows: CHF 82 for the analysis and CHF 24 for order processing, overhead costs and sampling materials.
• If the analysis is conducted by hospital laboratories for the hospital’s own use: up to a maximum of CHF 87. This sum is made up as follows: CHF 82 for the analysis and CHF 5 for order processing, overhead costs and sampling materials.
The federal government will pay up to the following maximum amounts for serological analysis for SARS-CoV-2:
• If the analysis is conducted by laboratories on behalf of another approved service provider: up to a maximum of CHF 49. This sum is made up as follows: CHF 25 for the analysis and CHF 24 for order processing, overhead costs and sampling materials.
• If the analysis is conducted by hospital laboratories for the hospital’s own use: up to a maximum of CHF 30. This sum is made up as follows: CHF 25 for the analysis and CHF 5 for order processing, overhead costs and sampling materials.

If the same person undergoes both molecular biological and serological analysis for SARS-CoV-2 on the same day, the federal government will pay the cost component for order processing, overhead costs and sampling materials of CHF 24 (for tests on behalf of another approved service provider) or CHF 5 (for tests for the hospital’s own use) only once.

The service provider may not charge persons tested any further costs for analysis for SARS-CoV-2 and associated medical services. If on the same order additional analyses are requested for the person tested, the laboratory may not charge to compulsory health insurance any order charge in addition to the order processing, overhead costs and sampling materials covered by the federal government. What is generally covered by the federal government are maximum amounts, which means that lower costs may, or must, also be invoiced.

Starting November 2, 2020, the costs of immunological analyses for Sars-CoV-2 antigens in persons who meet the FOPH’s criteria for suspicion, sampling and reporting of 28 October 2020 (see 1.5 Testing) are also covered by the Confederation in accordance with Covid-19 Ordinance 3. The analysis for Sars-CoV-2 antigen by means of a rapid test may be carried out in doctor’s offices, laboratories, pharmacies, hospitals and in test centres operated by the canton or on its behalf.

On January 27, 2021, the Federal Government decided to cover the costs for testing asymptomatic persons (see section 1.5).

Status 11.02.2021: The federal government covers the costs of PCR tests and rapid antigen tests provided that one of the following criteria is met:

• A person has symptoms matching Covid-19.
• A person receives a notification from the SwissCovid App that he/she has been in contact with an infected person.
• The cantonal office or a doctor orders a test as part of the quarantine or an outbreak investigation.
• A person is called for a test to prevent a large-scale outbreak, for example in schools, ski areas, in certain regions, etc.
• A person has to have a test to protect vulnerable people, for example before visiting a hospital or retirement or care home.

The federal government will not cover the costs of the test if:

• A person wants to leave quarantine early and get tested from day 7.
• A person needs a negative test result for travel.
• A person is being tested at the request of their employer.
• The test is carried out abroad.
• The test is part of precautionary measures for hotels, fairs, international conventions, concerts and sporting events or at the workplace.

Sources and links:

• Health System in Transition (HiT) review: Switzerland, section 3.4: https://www.hspm.org/countries/switzerland25062016/livinghit.aspx?Section=3.4%20Out%20of%20pocket%20payments&Type=Section 
• Reimbursement of costs of diagnostic analysis for SARS-CoV-2 from 22 April 2020: https://www.bag.admin.ch/dam/bag/en/dokumente/kuv-leistungen/leistungen-und-tarife/Analysenliste/faktenblatt-coronavirus-verguetunganalyse.pdf.download.pdf/Factsheet_COVID-19_Reimbursement_of_costs_of_diagnostic_analysis_for_SARS-CoV-2_from-22-April-2020.pdf
• Reimbursement of costs of diagnostic analysis for SARS-CoV-2 from 24 june 2020: https://www.newsd.admin.ch/newsd/message/attachments/61861.pdf
• Factsheet: Covid-19 (novel coronavirus disease) - Rules for coverage of the costs of testing for SARS-CoV-2 and of associated medical care – 18.09.2020: file:///C:/Users/MantwilS/AppData/Local/Downloads/Factsheet%20%E2%80%93%20Coronavirus%20%E2%80%93%20coverage%20of%20cost%20of%20the%20analyses%20and%20associated%20medical%20care.pdf
• Coronavirus: health insurance arrangements: https://www.bag.admin.ch/bag/en/home/krankheiten/ausbrueche-epidemien-pandemien/aktuelle-ausbrueche-epidemien/novel-cov/regelung-krankenversicherung.html 
• FAQ - extension of the testing strategy: https://www.newsd.admin.ch/newsd/message/attachments/65160.pdf  
• Coronavirus: Tests: https://www.bag.admin.ch/bag/en/home/krankheiten/ausbrueche-epidemien-pandemien/aktuelle-ausbrueche-epidemien/novel-cov/testen.html