Understanding LAMal
The whole logic of the comparison rests on one point of law: the catalogue of basic benefits is set by statute, and it binds every insurer identically.
One obligation, one single catalogue
Anyone taking up residence in Switzerland, or born there, must take out insurance within three months. In exchange, the federal health insurance act sets the list of covered benefits: consultations, hospital stays in the general ward of your canton, medicines on the specialities list, maternity, and the rest.
An insurer may neither remove anything from that list nor add to it within basic cover. Which is why comparing benefits makes no sense, and comparing prices makes a great deal.
What the law forbids insurers
- Refusing basic cover, whatever the age or state of health.
- Asking medical questions for basic cover.
- Making a profit on basic cover: it must be run separately and at break-even.
- Charging different premiums by sex or state of health.
What then explains the price gaps
Three things: the canton and premium region where you live, the insurer’s cost structure and membership, and the model and deductible you choose. Nothing else. A higher premium buys no better basic benefits.
The three age brackets
Children up to 18, young adults from 19 to 25, adults from 26. The move from one bracket to the next takes effect on the 1 January following the birthday, and it explains most of the “unexplained” premium jumps within a family.