Basic Knowledge

Swiss Health Insurance (KVG Lamal) Benefits

KVG Lamal Benefits

Switzerland’s mandatory health insurance (kvg lamal) really covers a lot than you can ever imagine. One thing is that it’s very mandatory for all Swiss indegenes and residents, either coming to live in Switzerland or coming for tertiary education, to at least get KVG Lamal from any insurance company in Switzerland.

Also, if you really want to cut costs and get more insurance, we advise that after getting the basic health insurance that you go for the supplementary as it covers more and allows you to choose your desired treatment (hospital, physician, and medication).

However, you should note that it’s very expensive, depending on the insurance company.

KVG lamal is compulsory for all Swiss residents or indegenes. The government has a law that says everyone in Switzerland gets at least the basic coverage if they can afford the supplementary insurance.

So for basic health insurance (Kvg lamal), we’ve done research on some of the insurance covers.

A)Major Benefits

-Hospital Stay

Swiss basic health insurance (kvg lamal) basically covers all the expenses of your hospital stay in a general ward if it’s a short-term illness. But if the policyholder is to undergo medical surgery in a private ward and not in their canton of residence, the insurance company will ask him/her to pay at least 15 Swiss francs.

If you want a more private ward and want the right to choose your doctor yourself, we recommend you go for the supplementary health insurance.

This includes clinics where patients don’t sleep overnight but only come and go during the day after receiving treatments.

-Nursing Services

The provision of funds to help with the payment of a medical bill in a well-known nursing facility or home.

It depends on the cantons. Some medical doctors do advise home care up to 60 hours per quarter and it has to be stamped by the insurer. This helps reduce the out of pocket expenses in the nursing home. The patient is expected to pay in full for the cost of the room.

-Quick Ambulance And Rescue Services

Basic health insurance (Kvg Lamal) also covers up to half the cost of rescue services. Transport of patients with minor casualties, no less than 5,000 Swiss Francs yearly, amounting to 50% of the fees, has to be paid while the cost of transporting the patient to another specialist hospital or clinic is fully covered by the insurance.

 B) Examination, Nursing, and Treatment

Outpatient tests, nursing, and treatments by physicians (chiropractors) are covered by basic health insurance. For outpatient tests and treatments, patients can generally choose their chiropractor or physician.

These days, most policy holders get insured according to a particular model that limits their service providers’ choice and will have to either reach a medical doctor or physician (family doctor model), call a hotline, or visit a group practice. It allows them to get a reduction with the same medical treatment standard.

-Nursing Care

The cost covered goes with a medical doctor’s prescription or referrals. Full information on this is found in Art. 7-Health Insurance Benefit Ordinance. –

-Nutrition Counselling (with doctor’s predictions

This requires six consultations as advised or prescribed by the doctor. In the event of further consultation, the doctor will have to renew prescriptions.

The doctor in charge is expected to reach the medical adviser of the insurance company after 12 consultations to know if the treatment will continue.

-Nutritional Counseling

Nutritional counselling is covered by the Basic health insurance only for certain medical issues.

-Psychiatric Therapy

Psychiatric therapy is only covered by basic health insurance when they have scientific proof of the efficiency of the methods in use.

About 40 therapy sessions are covered. The doctor treating the patient have to reach out to the insurance medical adviser to notify him on ways the therapy should continue.

You should note that you are going to need to get supplementary insurance for outpatient care if you are treated by a therapist without a degree unless you are being treated in a center by a specialist in psychotherapy under supervision.

When the policy holder goes outside Switzerland, only emergency care is provided. They frequently travel to the USA, Japan, and Canada where basic insurance is a bit less or pays times two the amount paid in Switzerland if it is not from one of these countries.

So, we advise you to get supplementary insurance before you travel out for maximum insurance.

-Spa Therapy

It includes spa therapies in a resort. If the doctor prescribes it but you demand it, you will be charged 10 Swiss francs per day for up to 21 days in a year.Basic health insurance covers the cost of medical tests, therapy, and medication, excluding the out-of-pocket sum paid by the insurer.

-Occupational Therapy

It covers up to 12 or more consultations for every prescription and has a 3-month completion period. In order to renew it, a doctor has to prescribe it. After 61 hours in a year, the doctor in charge needs to reach the medical adviser of the insurance company to tell him about how the treatment is to be continued.

-Diabetes Counseling

After 10 valid consultations prescribed by the medical doctor and requiring a new consultation, the doctor will have to renew the prescriptions. The sum the insurance company pays differs and varies on your place of work or residence’s tarrif charges.

-Occupational Therapy

The cost, excluding the out-of-pocket expenses, is covered by your insurer as long as you use a therapist with a valid license and certification.

You are allowed a maximum of 9 sessions for every prescription by the therapist, in which your first treatment ends 8 weeks from the prescription date. If a new prescription is necessary for reimbursement, your therapist needs to inform the insurance company medical adviser.

C) Disease Prevention:

KVG (lamal) health insurance covers the cost of check-ups to detect disease or illness in their customers earlier.

The test or preventive diagnosis is to be carried out by a medical doctor. These are:

  • Test for HIV/AIDSfor women and infants.
  • Colon cancer screening.
  • Vaccination of children below age 5 to prevent influenz.
  • Vaccination of people above age 65 to prevent the flu.
  • Vaccination of people to prevent hepatitis B.
  • Tetanus vaccination for adults, e.t.c.

D) Legal Abortion

KVG lamal,Basic health insurance also covers legal abortion (as defined by Swiss law).

E) Treatment of Dental Diseases

The insurance covers not only serious medical illnesses but also covers treatment of dental problems caused by accidents if they’re not covered by any insurance at all.

Note that the mandatory health insurance does not cover dental treatments like replacement of teeth, tooth filling, restructuring of teeth, etc. It is only for dental issues caused as a result of an accident.

F) Defects Occurrence During Childbirth

The mandatory health insurance also provides support for child defects. The defects that it covers are available in the ordinary scheme and are available in German, Italy, and French.

G) Glasses and Eye Lens

KVG LAMAL also covers the cost of eye glasses for children with eye defects and issues, except in the case of eye surgery for adults, as it does not cover adults.

However, if you want better eye care services under insurance, then you should consider getting supplementary health insurance as it covers more.

Related Articles

Leave a Reply

Your email address will not be published.

Back to top button