The health insurance issue for Swiss expatriates
For Élisabeth Schneider-Schneiter, National Councillor for the Centre Party, the Swiss government has missed an opportunity to rethink its principles. In her opinion, the current policies no longer reflect the reality. For the authorities, moving abroad means that Swiss nationals can no longer access the national health insurance system. Switzerland is not the only country applying this principle. We all know that when moving abroad, expats are affiliated with their host country's health system. However, the problem arises for Swiss citizens living abroad who are taken aback by excessively high international health insurance premiums. They prefer to return home for treatment, where they can be automatically reinsured upon their return. But many have been faced with the reluctance of the cantons.
In 2022, the case of Swiss retirees immigrating to Thailand prompted the Swiss Confederation to reiterate its principles. These retirees faced difficulties when they fell ill, as their low pensions prevented them from returning to Switzerland for treatment. The problem has worsened since health insurance regulations were tightened: Thailand now requires basic coverage of at least $100,000, or about $110 to $220 per month, which is too expensive for retirees. But the government, to which they appealed, made it clear that it doesn't have to intervene in such situations.
Proposal for a special fund for Swiss expats
To solve this problem, Élisabeth Schneider-Schneiter proposed a health insurance fund for the Swiss abroad. In her view, the current system encourages medical tourism, with Swiss nationals returning home for treatment. The National Councillor considers this a costly undertaking. She advocates the creation of a special fund, managed in Switzerland, which would guarantee health care for Swiss citizens in their host country. Élisabeth Schneider-Schneiter believes that treatment in the host country is considerably cheaper. The measure would also affect a limited number of people.
However, the government maintained its position, recalling the principle of residence. Health insurance can only be taken out at the place of treatment. It is, therefore, not possible to pay for treatment in another country with Swiss funds. The State also points out that Swiss accounts must be balanced from one year to the next, which would prevent the creation of such a fund. As far as the Swiss government is concerned, there is no such thing as an "individual account". What remains is the option of very expensive private insurance, a non-solution, according to the National Councillor.
The importance of health insurance for expats
What about other countries? What should you do if you're on vacation in your home country?
In general, most countries also recommend taking out private insurance in case your host country's health insurance does not cover you as an expat. Canada, for example, points out that its health insurance is only valid in Canada. It is not designed for extended stays abroad. Healthcare received abroad may not be covered at all or only with a waiting period. The Canadian government states it will not pay for medical expenses its citizens incur abroad. It recommends purchasing travel health insurance for any stay outside Canada, whether short or long (including vacations).
The same principle applies in France, where health insurance is linked to residence. However, if there is a bilateral agreement between France and the expatriate's country of residence, the latter will take into account the duration of membership of the French health insurance scheme when calculating the benefits to which the expatriate is entitled. In the absence of such an agreement, everything depends on the host country's healthcare system. The French government adds that it is still possible to remain affiliated with the French health insurance system by taking out voluntary insurance, such as the Caisse des Français de l'étranger (CFE). The CFE, a private company that provides a public service, is responsible for health, maternity, disability, industrial accident, occupational disease and retirement insurance.
Is international health insurance compulsory for expats?
Voluntary insurance (or supplementary health insurance without solidarity, such as international health insurance) is sometimes confused with mutual insurance (or supplementary health insurance with solidarity). States often refer to voluntary health insurance as a supplement to health insurance in the destination country.
The problem is that the cost of international health insurance is often too high because it does not take into account the same elements as mutual insurance. First of all, international health insurance covers several countries, while mutual health insurance focuses on a single country. International health insurance offers 100% coverage, while a mutual offers only partial coverage (the rest is covered by social security).
In addition, international health insurance is risk-based (e.g., accident risk) and doesn't cover everyday health problems. Its rates vary according to the age and medical profile of the insured. This explains the high cost of international insurance for retired expatriates. This is perhaps why many expats prefer to return home for healthcare.
