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Do all health insurance funds have to offer daily allowances? Can you get reservations there, for example, if you are already ill?

March 14, 2025

Liability and Insurance Law

Open in Omnilex

Yes, all health insurance companies that operate as insurers according to Article 2 paragraph 1 or Article 3 of the KVAG (Health Insurance Supervision Act) must offer daily allowances if the insured person has residence in Switzerland or is employed and has completed the age of 15 but has not yet reached the age of 65 (Art. 67 para. 1 KVG). The insured party can also choose a different insurer than for the mandatory health insurance (Art. 67 para. 2 KVG).

However, it is possible that exclusions for pre-existing conditions may be applied. Insurers can exclude conditions that exist at the time of enrollment through an exclusion clause. The same applies to previous conditions that are likely to lead to relapses (Art. 69 para. 1 KVG). These exclusions will expire after five years at the latest, although insured individuals can provide evidence before the end of this period that the exclusion is no longer justified (Art. 69 para. 2 KVG).

The exact conditions of the exclusion must be communicated in writing, and the start and end of the exclusion period must be clearly specified (Art. 69 para. 3 KVG). In case of an increase in the insured daily allowance and a shortening of the waiting period, these regulations apply accordingly (Art. 69 para. 4 KVG).

The GP thus has the duty to accept but may limit insurance coverage for certain illnesses.

Sources

Federal Law of March 18, 1994 on Health Insurance (KVG) > Title 3: Voluntary Daily Allowance Insurance > Membership

Art. 67 Sec. 1 KVG

1 Anyone who has residence in Switzerland or is employed and has completed the 15th but not yet the 65th year of age may take out a daily allowance insurance with an insurer according to Article 2 Section 1 KVAG or Article 3 KVAG.

Art. 67 Sec. 2 KVG

2 He may choose a different insurer for this than for the mandatory health care insurance.

Art. 67 Sec. 3 KVG

3 The daily allowance insurance may be concluded as group insurance. Group insurances can be concluded by: a. Employers for themselves and their employees; b. Employer organizations and professional associations for their members and the employees of their members; c. Employee organizations for their members.

Federal Law of March 18, 1994 on Health Insurance (KVG) > Title 3: Voluntary Daily Allowance Insurance > Membership

Art. 67 Sec. 1 KVG

1 Anyone who has residence in Switzerland or is employed and has completed the 15th but not yet the 65th year of age may take out a daily allowance insurance with an insurer according to Article 2 Section 1 KVAG or Article 3 KVAG.

Art. 67 Sec. 2 KVG

2 He may choose a different insurer for this than for the mandatory health care insurance.

Art. 67 Sec. 3 KVG

3 The daily allowance insurance may be concluded as group insurance. Group insurances can be concluded by: a. Employers for themselves and their employees; b. Employer organizations and professional associations for their members and the employees of their members; c. Employee organizations for their members.

Federal Act of March 18, 1994, on Health Insurance (KVG) > Title 3: Voluntary Daily Allowance Insurance > Insurance Exclusion

Art. 69 Abs. 1 KVG

1 Insurers can exclude illnesses that exist at the time of acceptance from coverage by means of an exclusion clause. The same applies to pre-existing conditions that can lead to recurrences based on experience.

Art. 69 Abs. 2 KVG

2 The insurance exclusion clause expires no later than five years. Insured persons can provide evidence before this period expires that the exclusion is no longer justified.

Art. 69 Abs. 3 KVG

3 The insurance exclusion clause is only valid if it is communicated in writing to the insured person and the excluded illness as well as the start and end of the exclusion period are exactly specified in the communication.

Art. 69 Abs. 4 KVG

4 In case of an increase in the insured daily allowance and a reduction in the waiting period, paragraphs 1–3 apply accordingly.

Federal Act of March 18, 1994, on Health Insurance (KVG) > Title 3: Voluntary Daily Allowance Insurance > Insurance Exclusion

Art. 69 Abs. 1 KVG

1 Insurers can exclude illnesses that exist at the time of acceptance from coverage by means of an exclusion clause. The same applies to pre-existing conditions that can lead to recurrences based on experience.

Art. 69 Abs. 2 KVG

2 The insurance exclusion clause expires no later than five years. Insured persons can provide evidence before this period expires that the exclusion is no longer justified.

Art. 69 Abs. 3 KVG

3 The insurance exclusion clause is only valid if it is communicated in writing to the insured person and the excluded illness as well as the start and end of the exclusion period are exactly specified in the communication.

Art. 69 Abs. 4 KVG

4 In case of an increase in the insured daily allowance and a reduction in the waiting period, paragraphs 1–3 apply accordingly.

comparis.ch/krankenkassen/leistungen/krankentaggeldversicherung

Those wishing to join must be accepted by the health insurance into the daily allowance insurance according to the KVG. However, a health questionnaire must be completed for admission to the insurance. The provider may impose reservations for pre-existing conditions for a maximum of five years.

comparis.ch/krankenkassen/leistungen/krankentaggeldversicherung

Those wishing to join must be accepted by the health insurance into the daily allowance insurance according to the KVG. However, a health questionnaire must be completed for admission to the insurance. The provider may impose reservations for pre-existing conditions for a maximum of five years.


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