Health & Benefit Blog
Accidents happen quickly and can happen to anyone. A cut, a fall or an accident during a sport session may occur every day to insured people.
Workers in Switzerland are lucky to have optimal accident insurance with full coverage of medical costs under the third-party payment principle. The person only has to provide the medical care providers with the claim number and the bills will be directly sent to the insurer. The insured person will not have to pay anything, and the administrative part is done directly between the insurer and the provider.
In Switzerland, we benefit from a 100% coverage of the costs, without any deductible or co-payment, unlike health insurance.
In the event of an accident abroad, the person will generally be asked to pay the medical costs upfront but will be reimbursed afterwards. In the event of hospitalization, a guarantee of coverage will be sent to the hospital and the insured person will usually not have to advance the costs.
According to the law, the costs of treatment abroad are only reimbursed up to a maximum of twice the costs of the most expensive hospital in Switzerland. Apart from the USA and Canada, this is generally sufficient to be fully covered by the compulsory accident insurance LAA/UVG. If the costs are higher than that, the subscription of a complementary accident insurance allows to avoid any participations.
In theory, compulsory accident insurance provides sufficient coverage abroad. However, Switzerland has signed bilateral agreements with the European Union which have changed the rules quite a bit, so beware of unpleasant surprises. Until now, these agreements were commonly not applied by private insurers as costs abroad are generally lower. As of 1 January 2021, SUVA has been entrusted with the administration of the foreign social security systems in Switzerland and it is no longer possible to ignore them.
These agreements provide an equal treatment between all residents of the EU and the treaty countries. In short, this means that a French insured person who has an accident in Greece will be insured under the same conditions as a Greek insured person and vice versa. In theory, this is a good intention. But when a person is better insured in his country of residence than in the country of accident, the situation can quickly become Kafkaesque.
This is typically the case with medical costs in France. Indeed, in this country non-work-related accidents are considered as an illness which is insured through the health insurance system and are not covered at 100%. In addition, certain services are not reimbursed by the Social Security. This is also the case to a lesser extent in Germany and Austria. Each country's social security system will apply its own rules; there are therefore dozens of different types of coverage, which makes management even more complex and difficult for insured people and the human resources of the employers concerned.
It is also important to specify that this practice does not only concern cross-borders, but everyone who is insured through the Swiss obligatory accident insurance. However, cross-borders will often find it easier to continue their treatment on the other side of the border.
The UVG/LAA specifies that it is not possible to pay an excess or a deductible. The insured person is therefore left to bear any deductibles or costs not covered.
However, some insurers agree to cover emergency costs under the compulsory insurance to avoid cumbersome administrative procedures for a small amount. But this only concerns the first invoice and is limited to a certain amount. Subsequent invoices will be subject to the standard procedure.
As an employer, to remedy these situations and to ensure optimal coverage for your employees, you could offer supplementary accident insurance that includes medical costs in a private or semi-private ward. Indeed, the insurer will pay for the part not covered and any benefits not insured by the compulsory insurance, including an excess if applicable.
In addition to the financial aspect, a significant administrative burden will be placed on the person. The reimbursement of costs must be done via the social security system of the country in question (e.g., the CPAM in France). The Swiss insurer will initiate the procedures and provides the insured person with an ad hoc form which must be completed and sent to the competent foreign office. The health care providers will send the invoices directly to the same office, but sometimes the insured people must pay the invoices directly.
Since reimbursement usually takes many months, this can be a significant financial burden. We therefore recommend, whenever possible, to get treated in Switzerland when it is not an emergency.
It is also of interest to note that if a person schedules an operation abroad, the same procedure will apply. The costs are only insured if the Swiss insurer has given its approval before the operation.
