Swiss LAMal physiotherapy for expats : a plain-English guide

You moved here three months ago. You hurt your back. You go to the doctor (a friend recommended one near the UN), you walk out with a piece of paper marked « ordonnance », and your colleague says « oh, you can use LAMal ». You nod. You have no idea what just happened.

Half of our English-speaking patients have been through this scene. The Swiss healthcare system works extremely well, but the vocabulary and the flow are particular. Here is a complete walkthrough.

What LAMal is, in one paragraph

LAMal (Loi sur l’Assurance Maladie) is the compulsory health insurance every Swiss resident must have. You picked a provider when you arrived (Helsana, CSS, Visana, Groupe Mutuel, etc.). They all cover the same baseline of treatments, defined by federal law. Price varies a bit by canton and provider, but the coverage is identical. Physiotherapy is part of the LAMal baseline.

Why you need an « ordonnance »

LAMal covers physiotherapy only if a doctor prescribes it. The piece of paper your doctor gave you is the « ordonnance » (prescription). Without it, the session is not reimbursed.

One prescription covers 9 sessions over 12 weeks. Renewable once by the same doctor (for another 9). Beyond that, the doctor sends a request to your insurance’s medical consultant (« médecin-conseil »). For chronic conditions or post-surgery, getting 36+ sessions in a year is routine.

Franchise and quote-part : what you actually pay

Two costs come out of your pocket :

• Franchise (annual deductible) : between CHF 300 and 2500 depending on your contract. The lower the franchise, the higher the monthly premium. Most expats start with CHF 300 by default ; finance executives often pick the highest (CHF 2500) for tax efficiency, betting they will rarely use healthcare.
• Quote-part (co-payment) : 10% of every treatment, capped at CHF 700 per year. Once you have hit the cap, everything is 100% reimbursed.

Concrete example : you have a CHF 300 franchise, no other healthcare cost this year, and you need 9 physio sessions at CHF 52 each = CHF 468 total. You pay : CHF 300 (the franchise) + CHF 16.80 (10% of the CHF 168 above franchise) = CHF 316.80. Your insurer pays the rest.

Same scenario but with a CHF 2500 franchise : you pay the full CHF 468. Your insurance kicks in only after CHF 2500 of yearly costs.

Tiers payant : the secret weapon

The default flow is : you pay the physio, you send the bill to your insurer, your insurer reimburses you 4-8 weeks later. Cash-flow unfriendly.

The alternative is the tiers payant : the physio bills the insurer directly. You only ever pay the franchise + quote-part. No advance, no chasing reimbursements.

Most conventional physios offer it (they have to opt in, but most do because patients prefer it). When you book, just ask : « Vous pratiquez le tiers payant ? » If yes, you are set. Our network at Genève Domicile uses tiers payant by default.

Cabinet vs domicile : same price, different convenience

Under LAMal, the rate is essentially identical whether the physio comes to you or you go to the clinic. In Geneva canton, in-home does not carry a kilometric surcharge for standard zones.

In private rates (without prescription), in-home is slightly more expensive : CHF 150 / hour with travel included vs CHF 100-130 / 30 min in clinic. For most people, the convenience and time saved on travel makes it worthwhile, especially in the acute phase when moving hurts.

The expat traps to avoid

• Trap 1 : assuming « LCA » covers what LAMal does not. LCA is supplementary insurance, sold by the same providers. It covers things outside LAMal : private rooms in hospital, alternative medicines, lifestyle prevention. But it does NOT replace LAMal for basic care. Check your contract carefully.
• Trap 2 : skipping the doctor visit. Without a prescription, you pay full private rates. The doctor visit is reimbursed by LAMal (after your franchise), so it is not an additional cost — just an extra step.
• Trap 3 : not asking for tiers payant. Some physios still bill the patient by default. Always ask before booking.
• Trap 4 : worrying about « my doctor is not in Geneva ». Any Swiss-licensed doctor (medical registry RCC) can write an ordonnance. Telemedicine consultations (Medgate, Soignez-Moi) also work and are LAMal-reimbursed.
• Trap 5 : believing the LAMal-rate physio is « worse » than the private one. The clinical content is identical. The conventional rate is set by federal contract. Many of the best physios in Geneva work primarily on LAMal.