Update: 21.07.2011

Compulsory health insurance also valid for denied asylum seekers

All people in need of assistance in an emergency shall in future be covered compulsorily by health insurance. On 6 July 2011, the Federal Council took this decision in its revision of the Health Insurance Regulations (KVV), reacting to a call from the civil society which has continuously been voiced for some years now. Ever since the introduction of the emergency aid system for rejected asylum seekers and asylum seekers with a decision to dismiss an application without entering into the substance of the case (DAWES) in 2008, NGOs have been pointing out that persons should not be allowed to be dismissed from basic insurance cover because otherwise their right to access to health care is disproportionately limited.

From 1 August 2011, the KVV will include Art. 92d stating that everyone in need of emergency aid is compulsorily health insured. Rejected asylum seekers or DAWES cases therefore remain under the control of the compulsory health insurance system until their departure from Switzerland.

5,800 people affected

In a first reaction, the Swiss Supervisory Board for Asylum and Aliens Law (SBAA) welcomes this revision and expresses its hope that «this change of practice which was long overdue will really be impemented in the cantons». According to SBAA around 5,800 persons are at present living in precarious conditions from emergency aid, and in today's practice there are big differences between the cantons - also with respect to medical basic care which is effectively granted. Some of the persons have a health insurance whereas others do not, even though as long ago as 2008 various NGOs and the Federal Office of Public Health (FOPH) pointed out that compulsory health insurance is also applicable for asylum seekers and DAWES cases.


No change in practice in spite of early pressure in cantons

Since the beginning of 2008 rejected asylum seekers only receive emergency aid from the cantons. This measure which is to be traced back to the new asylum law is aimed at minimising the costs in the asylum sector. Some cantons went one step beyond and decided to exclude asylum seekers from health insurance. They only grant persons concerned access to the public health system in case of emergency. The situation is quite similar for DAWES cases: Since 2004 they have only been receiving emergency aid and in some cantons they, too, can only visit a doctor in case of an emergency.

According to IGA SOS Racisme, the exclusion from the health insurance is contrary to the law, since the Health Insurance Act decrees that everybody living in Switzerland must be insured. The Health Insurance Act takes as a starting point that all insured are treated the same way. The conclusion of a health insurance therefore is also compulsory for rejected asylum seekers and DAWES, and they should have normal access to health care.

Exclusion is still practised in at least five cantons

Thousands of people are affected by this measure, said Françoise Kopf of IGA SOS Racisme. Failed asylum seekers or those whose application for asylum has not been considered, receive only emergency health care. Ms Kopf can prove that the cantons of Solothurn, Zurich, Vaud, Berne and Grison cancel compulsory health insurance of denied asylum seekers. In a circular letter the hospitals and doctors of those cantons were informed that from now on failed asylum seekers should not be treated anymore, except in emergency situations. The changes mean that if such a person falls ill he or she must visit a social welfare first in order to get authorisation for a consultation with a doctor. 

Federal Office of Public Health announced to take measures in 2008

In March 2008, IGA SOS Racisme filed a written complaint with then Minister of Justice Eveline Widmer-Schlumpf and then Federal President Pascal Couchepin against the changes in practice. While Widmer-Schlumpf saw no possibility of intervening at a cantonal level, the FOPH's former director, Thomas Zeltner, showed some understanding and said he was shocked and surprised by the situation. He promised to assure that the FOPH would get the cantonal authorities and the insurers to apply the Health Insurance Act accordingly, in order to guarantee the protection provided by the law.

In a media relase of 14 May 2008, IGA SOS Racisme expressed its content with the FOPH's recommendation. The organisation now is waiting for the cantons to take the necessary action. In concrete terms this means that the cantons are now expected to re-register the affected persons again, and that they do away with the emergency medicine system since it does not comply with the Health Insurance Act. If necessary, cantons also might have to make amendments to their laws.


© humanrights.ch / MERS - Hallerstr. 23 - CH-3012 Bern - Tel. +41 31 302 01 61