Compulsory Health Insurance and Healthcare Financing
What compulsory insurance is
Compulsory health insurance is statutory and administered by HZZO. Insured status arises from employment, self-employment, or one of the categories listed in the law, and it is proven by a valid insurance card. Contributions are calculated on statutory bases and paid by the insured or the employer. The basket of rights includes a chosen general practitioner, referral-based access to specialists, prescribed medicines under the lists, hospital care and a participation (co-payment) that is limited and from which defined groups are exempt. Supplementary insurance covers the part that compulsory insurance does not.
How the money moves
Contributions flow to HZZO, which contracts providers and pays them according to agreed plans, prices and service volumes. This is why the same service can be free at a contracted provider and chargeable at a non-contracted one.
Traps
Do not assume that a valid card makes every service free: referral rules, waiting lists, medicine lists and co-payment still apply. Do not confuse compulsory with supplementary insurance, or the payer with the provider. Emergency care and certain public health services are not blocked by missing documents. Another frequent distractor is the idea that paying contributions buys unlimited choice of provider.
Rule of thumb
Follow the money: contribution, then HZZO, then contract, then provider, then payment by plan or service. For any entitlement question, first establish insured status, then the contracted provider, then the rule on referral or co-payment.