I'm sure this has been asked, I've done a few searches and I haven't found an answer so if you know it's out there - please direct me.

I have the basic health insurance with a large deductible
As I get older I'll want to have pre-screening's / tests done.

lets say - for example - I want to get a colonoscopy or mammogram or ......

Does my basic health insurance cover this?
Do I only need to pay the deductible?
OR
Is there a "better" insurance that will cover this test.

I'm reaching out to my insurance provider but I seem to walk away with more questions then when I started.

I'm looking for someone that has first hand knowledge of this.

Such tests are covered by the basic medical insurance.... if your doctor deems them necessary.

And u will always have to pay the deductible first.

You have to pay the deductible (TIS, so there will be some exceptions) before the insurance kicks in.
For tests, I have to be referred by my family doctor or the specialist that my family doctor has referred me to (family doctor model),
AFAIK, you cannot just organise tests yourself, but that may depend on your particular scheme. In general, I have had more tests than I would probably choose myself - much easier to get here than in NZ

Here mammograms are free of deductible.

I believe that varies by Canton.

Are you referring to the cantonal screening program?

If so that covers a mammogram every two years between the ages of 50 and 74 and you just have to pay the regular 10% co-pay which is around 18chf.

Mammograms prescribed the the doctor outside of the cantonal screening programme are reimbursed by the health insurance but normal deductible rules apply.

But they are (at least in some places) subject to the deductible or co-pay, not just 100% covered off the top.

OP, if you think you'd like to start having a bunch of tests or maybe needing treatments, you can always drop your deductible for next year and it might be easier. Of course lower deductible = higher premium, so you have to find a balance somewhere.

this is great --- thank you everyone for your answers.

OH one more cost clarification --- If I decrease my deductible "today", can I return it to "normal" whenever I want -- or do I need to wait for a certain time of the year.

Yes, routine mammograms every two years for that age group. I can also choose to go out of Canton, to St Croix.

Even on a traditional insurance scheme where you can theoretically see a specialist on your own (which is what I have) you might find that the specialist or testing centre will not see patients without a referral from the GP or gynaecologist. This has nothing to do with insurance, but rather it's how the specialist or testing centre organises the practice.

Out my way, mammograms are done either at the hospital (ambulatory) or the diagnostic imaging centre. Colonoscopies are done either at the hospital (ambulatory) or the specialist's practice. Both require a referral from the GP or gynaecologist regardless of insurance type.


FYI to the OP: Mammograms are not that expensive, so don't be afraid to get them done even if you have a larger deductible. I don't have my bills to hand but from memory it's under a couple hundred.

I don't think you can change deductible mid-year. You can change it around October or November, effective for the following January. But someone please jump in with correct info if that's not the case.

You can only decrease or increase your deductible on Jan 1st and for the full year for basic insurance. You have to give ample notice (please check your insurance T&Cs) - something like written notice that is received 3 months ahead of Jan 1st. So, whatever change you make will only take effect next year (starting Jan 1st) and the higher premiums will be in effect for 12 months. (I personally have the lower deductible and find it worth it, but this is a very personal choice. You can find out prices from your practice and then do some back-of-the-envelope calculations on whether it'd be worth it.)

Wishing you good health!

I think you can change it in June too but only to reduce it, not to increase it.
I’m not 100% sure on that though.

I know that I pay 18.50 chf for mine here and we only have to pay 10% of the cost as it’s part of the cantonal screening programme so the full price must only be 185chf.

In BL and BS at least, your insurance will cover a colonoscopy once you've reached fifty. Of course, you still pay any franchise.

In Neuchâtel too, they have a cantonal colon cancer screening programme as well as the mammogram one.

<<you still pay any franchise>> I'm not familiar with that term in this comment. Can you help me understand this better.

Does anyone have an idea of how much a procedure would cost.
For example

* Mammogram, based on the comments it could be under 200chf
* Colonoscopy?

I'm in Zurich, and I haven't heard there is a program to reduce my payment for these treatments.

Franchise is the initial part of any treatments you pay in each year, after which the insurance starts paying.

You can choose the level - low franchise --> higher premiums, higher franchise --> lower premiums

Range is something like 500 to 2500 CHF.

The franchise is what you decide to choose when you set up your health insurance cover; it ranges from CHF300 to CHF2,500. What that means is any medical expenses you have will first have to use up your franchise before the insurance starts paying for most of the rest of it, i.e. it comes out of your pocket, not the insurance company's. People in good health will probably choose a higher franchise since it means their insurance premiums will be lower.

So choose wisely. If you have health problems and need regular check-ups, tests, etc, then go for a lower franchise so the insurance will kick in more quickly.

You need to do the calculations as the additional premium was about 70% of the franchise reduction, therefore having a 300 excess yet only having 1200 of expenses is a worse deal than 2500 franchise.