Assurance pour les médecins
Does my health insurance cover me if I can no longer practise?
LAMal (the Swiss Federal Health Insurance Act) reimburses care, not your income.
Table of contents
- Why this myth circulates among established doctors
- "LAMal covers my loss of income in the event of illness"
- "The AI will step in straight away"
- "I'm insured through my former fund or the hospital I used to work
- "The 30-day waiting period is enough, I have reserves"
- "My allowance will be calculated on what I really earn"
- "Mental illnesses are covered like any other"
- Key takeaways
- Frequently Asked Questions
Why this myth circulates among established doctors
The myth stems from a confusion between three distinct types of cover: basic LAMal insurance, the employer's collective loss-of-earnings insurance and the self-employed person's individual cover. During the hospital years, the employer funded a daily allowance. On setting up in practice, it disappears without a sound. Yet LAMal provides for no compulsory daily allowance.
A first figure to set the stakes. Take a primary care doctor who has set up in Lausanne, with an annual AVS (Old-Age and Survivors' Insurance) income of CHF 240'000, or CHF 20'000 per month, and CHF 9'000 of monthly fixed practice costs (rent, two medical assistants, equipment leasing). Three months of incapacity without cover: CHF 60'000 of lost income and CHF 27'000 of costs that continue. This typical case recurs in the points below.
| Indicator | Value | Context |
|---|---|---|
| Income lost over 3 months | CHF 60'000 | AVS income of CHF 240'000/year, i.e. CHF 20'000/month (typical case: primary care doctor in Lausanne) |
| Fixed costs that continue | CHF 27'000 | CHF 9'000/month for rent, two medical assistants and equipment leasing, with no invoicing at all |
| Total cost of 3 months without cover | CHF 87'000 | CHF 60'000 of income not received + CHF 27'000 of costs to finance |
| Monthly gap between income and AI pension | ~CHF 17'500 | Income of CHF 20'000/month against a full AI pension of approximately CHF 2'520/month (order of magnitude, to be checked against the FSIO scale for the year) |
| Gross loss over 12 months of waiting | CHF 240'000 | No AI benefit during the year of incapacity preceding the possible opening of entitlement to the pension (art. 28 LAI) |
Income lost over 3 months
ValueCHF 60'000
ContextAVS income of CHF 240'000/year, i.e. CHF 20'000/month (typical case: primary care doctor in Lausanne)
Fixed costs that continue
ValueCHF 27'000
ContextCHF 9'000/month for rent, two medical assistants and equipment leasing, with no invoicing at all
Total cost of 3 months without cover
ValueCHF 87'000
ContextCHF 60'000 of income not received + CHF 27'000 of costs to finance
Monthly gap between income and AI pension
Value~CHF 17'500
ContextIncome of CHF 20'000/month against a full AI pension of approximately CHF 2'520/month (order of magnitude, to be checked against the FSIO scale for the year)
Gross loss over 12 months of waiting
ValueCHF 240'000
ContextNo AI benefit during the year of incapacity preceding the possible opening of entitlement to the pension (art. 28 LAI)
Key takeaway
Without individual loss-of-earnings insurance, an established doctor finances their fixed costs alone while their fees stop, and the AI steps in at the earliest only after 12 months.
Source: LAMal (RS 832.10), art. 67 ff.; LAI, art. 28; FSIO pension scales — ofas.admin.ch
"LAMal covers my loss of income in the event of illness"
FALSE. Under the Federal Health Insurance Act (LAMal, RS 832.10), compulsory health insurance covers treatment, not income. If you are bedridden for 90 days, the physiotherapist's or hospital's bill is reimbursed. The practice rent, meanwhile, keeps falling due.
The daily allowance exists within the LAMal framework, but it is optional (art. 67 ff. LAMal). In practice it falls under the Insurance Contract Act (LCA), which changes two things. The insurer may impose health reservations and refuse an application. It may also terminate the contract after a claim, according to the general terms and conditions.
A LAMal daily allowance taken out on its own may therefore prove less protective than an individual LCA policy negotiated with the right parameters. Benefits vary considerably from one product to another: to be checked with the insurer, with the contract in hand.
For an overview of the cover surrounding basic insurance, see our guide to insurance for doctors in Switzerland: compulsory and optional.
"The AI will step in straight away"
FALSE. Under the Federal Disability Insurance Act (LAI), entitlement to a pension arises at the earliest after one year of incapacity for work averaging at least 40% (art. 28 LAI), and only if the degree of disability reaches 40%. Nothing is paid to you during those twelve months, apart from rehabilitation measures.
The AI pension is then calculated on prior AVS income, within the limits of the AVS/AI pension scale. The ceiling on the maximum pension sits well below the income of an established doctor. The amounts are published by the FSIO (OFAS): consult the scales in force at https://www.ofas.admin.ch/fr/home.html.
Calculation of the gap for our typical case. Monthly income of CHF 20'000. A full AI pension capped at around CHF 2'520 per month (order of magnitude of the maximum pension, to be checked against the FSIO scale for the year) leaves a gap of approximately CHF 17'500 per month. Over twelve months of waiting with nothing, the gross loss reaches CHF 240'000 before entitlement to the pension even opens.
Sickness loss-of-earnings insurance is precisely designed to cover this period, then to top up the AI pension according to the contract's coordination clauses. For the disability layer, see our guide to disability insurance for doctors in Switzerland.
"I'm insured through my former fund or the hospital I used to work
PARTLY TRUE. The employer's cover ends with the employment contract, but the law allows a switch to individual insurance. Under the LCA and the general terms and conditions of collective policies, this right to switch must be exercised within a short period, often 30 days after leaving the collective scheme. After that period, the right is lost.
Points to check in your departure file:
- the exact end date of the collective cover
- the switching period stated in the general terms and conditions
- the benefits carried over without a new health examination
- the insured amount, calculated on an employee's salary and not on practice income
Switching in principle avoids a new health declaration, but it often carries over an employee-level benefit amount. A doctor who earned CHF 150'000 at the hospital and then generates CHF 240'000 in private practice remains underinsured by CHF 90'000 a year if they do not readjust. Switching is therefore a safety net, not cover suited to setting up in practice.
For the overall logic of setting up a practice, see our guide to health insurance for doctors setting up in Switzerland.
"The 30-day waiting period is enough, I have reserves"
FALSE, or at least to be qualified. A longer waiting period reduces the premium, but it is paid for in cash flow: during those days, your fixed practice costs continue and your fees stop. According to the FSO (OFS), the costs of a medical practice absorb a significant share of turnover. Here, CHF 9'000 per month.
Calculation for the typical case (income CHF 20'000 per month, fixed costs CHF 9'000 per month), assuming the practice invoices nothing more:
- 30-day period: CHF 9'000 of costs to finance, plus CHF 20'000 of income not received
- 60-day period: CHF 18'000 of costs, plus CHF 40'000 of income not received
- 90-day period: CHF 27'000 of costs, plus CHF 60'000 of income not received
Moving from 30 to 90 days saves a share of premium, within an indicative range to be checked with the insurer, but exposes the practice to CHF 18'000 of additional costs and CHF 40'000 more in income not received. The right question is not "do I have reserves?" but "how many months of fixed costs do my reserves cover?".
A partner, a locum or a cover agreement changes the calculation: the practice can continue to invoice. These arrangements need to be documented before a claim occurs.
| Criterion | 30-day period | 60-day period | 90-day period |
|---|---|---|---|
| Fixed costs to finance (CHF 9'000/month) | CHF 9'000 | CHF 18'000 | CHF 27'000 |
| Income not received (CHF 20'000/month) | CHF 20'000 | CHF 40'000 | CHF 60'000 |
| Total loss exposed | CHF 29'000 | CHF 58'000 | CHF 87'000 |
| Premium saving | Reference (highest premium) | Indicative range, to be checked with the insurer | Indicative range, to be checked with the insurer |
Fixed costs to finance (CHF 9'000/month)
30-day periodCHF 9'000
60-day periodCHF 18'000
90-day periodCHF 27'000
Income not received (CHF 20'000/month)
30-day periodCHF 20'000
60-day periodCHF 40'000
90-day periodCHF 60'000
Total loss exposed
30-day periodCHF 29'000
60-day periodCHF 58'000
90-day periodCHF 87'000
Premium saving
30-day periodReference (highest premium)
60-day periodIndicative range, to be checked with the insurer
90-day periodIndicative range, to be checked with the insurer
Key takeaway
Each additional month of waiting period costs the practice CHF 29'000: from 30 to 90 days, the potential loss rises from CHF 29'000 to CHF 87'000, i.e. CHF 58'000 more, for a premium saving to be checked with the insurer.
Source: Typical case from the article: AVS income CHF 240'000/year (CHF 20'000/month), fixed costs CHF 9'000/month, practice invoicing nothing more. Difference 30 vs 90 days: +CHF 18'000 of costs and +CHF 40'000 of income not received. Daily allowance contract governed by the LCA (RS 221.229.1); premium saving to be checked with the insurer.
"My allowance will be calculated on what I really earn"
PARTLY TRUE. Most contracts for self-employed people are based on income subject to AVS. Under the Federal Act on the General Part of Social Insurance Law (LPGA), the notion of income relies on supporting documents: tax assessments, certificates from the compensation fund. The insurer requires these documents when a claim is made.
Two pitfalls for the established doctor. First pitfall: fluctuating income. In the start-up phase, your declared AVS income may be CHF 120'000 while you are aiming for CHF 240'000 from the third year. An insured amount set at CHF 120'000 caps the allowance, even if the practice grows. Check whether the contract provides for an adjustment without a new health examination.
Second pitfall: the link with invoicing. The Tardoc point value, set by canton and by tariff agreement, directly influences the practice's turnover, and therefore future income. Tardoc does not change your cover, but it changes the insured value of your practice: recalculate it. The tariff structure can be followed at https://www.fmh.ch/.
Typical case: daily allowance insured at 80% of income of CHF 240'000, i.e. CHF 192'000 per year and around CHF 526 per day. If the insured income remains at CHF 120'000, the allowance falls to CHF 96'000 per year, a shortfall of CHF 96'000.
"Mental illnesses are covered like any other"
TO BE QUALIFIED. Psychological disorders, burn-out included, are generally covered, but with contractual safeguards. Three clauses to read:
- exclusion or reduced duration for certain conditions, according to the general terms and conditions
- a health reservation imposed at conclusion of the contract, which excludes a declared pathology
- maximum benefit period, often 720 days over a period of 900 consecutive days in standard products, a value to be checked in your contract
The most underestimated risk lies in the health declaration. Under the LCA (art. 6), a non-disclosure, that is, an omission or inaccuracy about a material fact, allows the insurer to terminate the contract within four weeks of becoming aware of it. A psychotherapy consultation forgotten three years ago can resurface at the time of a leave of absence for exhaustion. The cover then lapses retroactively, at the worst possible moment.
The practical rule: answer the questionnaire with your personal medical file in front of you, and keep a dated copy of the declaration. The text of the LCA can be consulted at https://www.fedlex.admin.ch/fr/home.
Key takeaways
Four points to check before signing:
- Insured amount: align it with actual AVS income, with an adjustment clause without a new health examination.
- Waiting period: quantify it in months of fixed practice costs, not in premium savings.
- Duration of benefits: check the ceiling (for example 720 days) and the treatment of mental illnesses.
- Health declaration: answer completely, keep a copy, and settle the matter before setting up in practice.
For an overview of the compulsory layer, see our article on health insurance for self-employed doctors in Switzerland. Compare two to three offers, with the contract and general terms and conditions in hand, before signing.
"This article, published by MedCourtage (FINMA F01502264), is provided for information purposes only and does not constitute personalised legal, tax or insurance advice; for any decision concerning your loss-of-earnings insurance, consult a qualified professional based on your situation."
FAQ
No. LAMal reimburses care, not income. The LAMal daily allowance is optional and falls under the LCA: the insurer may impose health reservations. You need dedicated sickness loss-of-earnings cover.
One year of incapacity for work averaging at least 40%, then a degree of disability of at least 40% to open entitlement (art. 28 LAI). During those twelve months, no pension is paid: sickness loss-of-earnings insurance covers this period.
Compare the cost of the waiting period with your fixed costs: with CHF 9'000 per month of rent, staff and leasing, moving from 30 to 90 days exposes the practice to CHF 18'000 of additional costs. Adjust according to your reserves.
Generally on income subject to AVS, evidenced by tax assessments or certificates from the compensation fund. Where income fluctuates, check the adjustment clause for the insured amount to avoid underinsurance.
Often yes, but with limits: exclusions or reduced duration for certain conditions, health reservations, a maximum duration of 720 days in many products. Non-disclosure in the health declaration may lead to termination of the contract (art. 6 LCA).
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4 November 2026
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