Accident Coverage in Health Insurance: Who Really Needs It and Who Pays Twice
In Switzerland, anyone who suffers an accident is insured either through their employer (UVG) or through health insurance providers (KVG). Who pays in the event of a claim depends on your personal life situation. It is therefore all the more important to review your own situation when changes occur. Because time and again, insured persons pay for accident coverage in their health insurance that they do not need, or mistakenly assume they are automatically protected. A quick check is particularly worthwhile if you change jobs, adjust your working hours, or plan to become self-employed.
Accident Coverage Simply Explained
Occupational and Non-Occupational Accidents
The Federal Act on Accident Insurance, or UVG for short, distinguishes between two types of accidents. Occupational accidents (BU) include accidents at work and on the way to work. What many do not know: occupational diseases are legally equivalent to occupational accidents. Affected individuals therefore receive the same comprehensive benefits. Non-occupational accidents (NBU) are accidents that occur during leisure time.
In Switzerland, all employees are automatically insured against occupational accidents through their employers. For non-occupational accidents to also be covered by the employer, you must work at least 8 hours per week for the same company. Important to note: This limit applies per employer. Multiple part-time positions with different companies are not added together. If you are not insured against non-occupational accidents through your employer, appropriate coverage must be included in your basic insurance. Accident insurance is therefore mandatory in Switzerland.
The premium for occupational accident insurance is fully covered by the employer. As an employee, you generally pay the premium for non-occupational accident insurance (NBU) yourself via a payroll deduction. Nowadays, however, many employers voluntarily cover the cost of non-occupational accident insurance.
What Does Accident Coverage in Health Insurance Cover and Not Cover?
In the event of an accident, basic insurance covers treatment costs. The benefits are the same as for illness. Deductible and coinsurance also apply here. Unlike accident coverage through the employer, daily allowances for loss of earnings or disability pensions are not included in basic insurance.
Anyone who is insured through their employer for both BU and NBU should exclude accident coverage from their basic insurance. This can usually save around 5–7% of the basic insurance premium. Coverage can be re-included at any time. Exclusion is generally possible with confirmation from the employer, effective the first of the following month.
Accident Protection in Practice
Whether it’s studying, a part-time job, a career change, or self-employment: each phase of life brings its own requirements for accident protection. The following four practical examples show what matters in each case.
Lara, 28, new full-time position after studies
Lara has just completed her studies and is now starting her first full-time position. Through her employer, she is fully insured against occupational and non-occupational accidents under UVG. Treatment costs, daily allowances, and pensions are included without cost sharing. The accident coverage in her basic insurance is therefore superfluous. Lara therefore informs her health insurance and excludes accident coverage from her basic insurance. As soon as her employment level changes or she changes jobs, she should immediately review her coverage and re-include it if necessary.
Jonas, 22, student, 6 hours per week at a café
Jonas works alongside his studies for 6 hours per week in a café. Since this workload is below the 8-hour limit, he is only insured against occupational accidents through his employer. Accidents on the way to work are also included in this case. For leisure accidents, for example, while playing football, cycling, or skiing, he needs accident coverage in his basic insurance. If Jonas also works for a second employer, these hours do not count together. The limit still applies per employer, not cumulatively. If Jonas changes his job or works more hours at the café, he should review his insurance coverage.
Sofia, 34, job change with a three-month gap
Sofia resigns from her job and will only start her new position in three months. With the end of her salary entitlement from her old employer, her UVG protection also expires. This is followed by a statutory post-coverage period of 31 days for non-occupational accidents. Within this period, Sofia can take out an interim insurance policy (Abredeversicherung) with her previous UVG insurer. This is a voluntary extension of UVG protection for up to 6 months, with full benefits (daily allowance, pensions, no cost sharing). The interim insurance must be taken out and the premium paid before the 31-day period expires. For a three-month gap, interim insurance is generally the better solution than merely including accident coverage in basic insurance, as the latter does not cover loss of earnings. If the gap lasts longer than 6 months or no interim insurance is taken out, the inclusion of accident coverage in basic insurance is mandatory.
Marco, 41, stepping into self-employment
Marco gives up his employment and starts his own company. As a self-employed person, he is no longer automatically insured under UVG. For him, there are now essentially two options. Either he includes accident coverage in his basic insurance. In this case, treatment costs are covered, but with a deductible and coinsurance, and without daily allowances or pensions. Or he voluntarily insures himself under UVG. This allows him to benefit from daily allowances and a disability pension in the event of a claim, without cost sharing. The pure basic insurance solution does not include loss of earnings. For the self-employed, this is a risk that can be specifically covered with a suitable solution.
Your Checklist: Am I Properly Insured?
Answer these six questions to check your insurance coverage.
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Do you work at least 8 hours per week for the same employer?
If yes: You are insured against occupational and non-occupational accidents under UVG. -
Do you work less than 8 hours per week for one or more employers?
Under UVG, you are only insured against occupational accidents. Non-occupational accidents must be included in the basic insurance coverage. -
Do you know whether accident coverage is currently included or excluded from your basic insurance?
If not, check your policy or ask your health insurance provider. -
Are you planning to change jobs, take a sabbatical, or reduce your workload?
Clarify your coverage situation before the change and keep an eye on the 31-day deadline to take out an agreement insurance policy (Abredeversicherung). -
Are you planning to become self-employed?
Consider voluntary UVG insurance. This includes daily allowances and pensions. Basic insurance coverage alone does not.
Whether your accident coverage suits your current life situation can often be clarified in a brief conversation. simply will be happy to advise you without obligation, in person in Gümligen or conveniently via video consultation.
Fact sheet on outpatient supplementary insurance 