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I am a UK resident and while visiting Switzerland I went for a health check. I have a EHIC and wonder how I can apply for a refund. On the EHIC website it says that one can apply for a refund but I can't find an actual form or any information where or how I can apply for a refund.

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If you have paid upfront for an eligible service under Swiss compulsory insurance law (KVG/LAMal), you will need to send a claim to Gemeinsame Einrichtung KVG, with your bill, EHIC, bank information along with possibly other required documents.

You will need to pay a patient contribution depending on the length of your treatment. Currently the amount is

The lump sum amounts to CHF 92.00 per 30 days for adults and CHF 33.00 for children up to the completed age of 18.

https://www.kvg.org/en/domicile-in-eu-efta-_content---1--1046.html

Generally, a physical examination motivated by specific concerns are certainly an eligible service, while a general routine checkup is not necessarily one depending on your age, medical history, the services provided etc. You can ask the doctor/clinic if the service is an eligible one.

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I was unable to find a link but IIRC there is (literally) an app for that, with country-by-country information. Since you are from the UK, you can also refer to this page from the NHS (especially “If you're abroad and do not have your EHIC with you” and “Claiming a refund”). There is a phone number you can call.

Note that while it is sometimes possible to fix things after the fact and get a refund, this is not how the EHIC is supposed to be used. It doesn't necessarily cover “health checks” either, except if you were facing some sort of emergency or unexpected complaint.

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    In some countries (e.g. Switzerland), local residents can be required to pay upfront as well, so EHIC in those cases is supposed to be used to claim refund after the fact as permitted by the equal treatment rule. – zhantongz Jun 22 at 12:45
  • @zhantongz Yes good point, I have experienced that in France or Austria too but I assumed the OP was talking about something else, i.e. failing to present the EHIC when seeking help. Even if some medical professional might not be willing to bill their national insurance system, I would still expect that to be the exception rather than the rule, that's not the way the system is designed to work. How common is tiers payant in Switzerland? – Relaxed Jun 22 at 14:20
  • Swiss health insurance scheme imposes an individual mandate without any public insurer(s). Tiers garant is the legal default, although in practice all insurance companies have tiers payant for in-patient treatment, and most allow tiers payant for out-patient treatments at a hospital. Most physicians unaffiliated with hospitals operate on tiers garant but recently it has become much more common for medical cabinets to send bills to insurance companies directly but only if they have an agreement in place with a compatible eletronic billing system. – zhantongz Jun 22 at 15:06
  • I couldn't find how common tiers garant vs payant are at the moment, but the largest (and cheapest) insurer Assura (>1 million insured persons) operates on tiers garant for almost everything but inpatient care. For EHIC, you are supposed to claim from Gemeinsame Einrichtung KVG (lit. Common Institution under Health Insurance Law) which is a private foundation made up of all private providers of basic health insurance in Switzerland and shares the costs among members (and bills other countries collectively). – zhantongz Jun 22 at 15:12
  • @zhantongz Does that mean that tiers payant is never available on EHIC? I am familiar with the basic structure of the Swiss system but I didn't realize this precluded electronic billing. For example, the Dutch system is similar but tiers payant still very common there. Many insurers have networks of preferred hospitals but I am not aware of any insurer that just doesn't offer tiers payant, the constraint is mostly on the healthcare provider's side. – Relaxed Jun 22 at 16:34

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