Daily sickness benefits - soon to be compulsory insurance?

After the Federal Council requested that Marco Romano's motion 21.4209 in favour of the introduction of daily sickness benefits insurance be rejected, the National Council adopted the motion. Since then, the matter has been discussed in the Social Security and Health Committees of the National Council and the Council of States.

What is at stake? Employees and their employers are obliged to take out accident insurance. This means that there is compulsory insurance to cover loss of earnings due to accidents. However, the situation is different for loss of earnings due to illness. In this case, disability insurance does pay out, but only after a minimum of 40% incapacity to work for one year. Furthermore, experience shows that the procedures take considerably longer than a year. During this time, those affected wait for their benefits.

In the initial phase of (involuntary) incapacity for work due to illness, employers are obliged to continue paying wages. They have often taken out insurance in the event that their employees fall ill for a longer period of time. After a waiting period, usually 30 or 60 days, the daily sickness benefits insurance usually pays for up to 730 days, i.e. around two years.

However, it is not compulsory to take out such insurance. Employers are free to fulfil the obligation to continue to pay wages themselves in accordance with the Swiss Code of Obligations, which is associated with significantly shorter benefit periods for employees. Sooner or later, long-term sick people will have to register with social welfare if they have few savings and the disability insurance has not yet made a decision, whereby the award of disability insurance benefits requires incapacity for work(Art. 7 ATSG), which is not the same as incapacity for work(Art. 6 ATSG).

It has been reported in the media for some time that SMEs in particular are confronted with massive premium increases after a case of illness or do not receive insurance offers that are affordable for them. As a result, their employees are poorly insured against prolonged incapacity for work. This means, for example, that a person who has a bicycle accident through their own fault and suffers a complex fracture is compulsorily insured against prolonged incapacity to work and receives a daily allowance, but not a person who is unable to attend work for an extended period due to cancer and suffers a loss of earnings.

As part of its examination of the Romano motion, the Council of States committee formulated various questions for the FOPH, whose answers are now available. Above all, these show that little is known about the current insurance situation, as daily sickness benefits insurance is now largely organised under private law (in accordance with the VVG). The FOPH and FINMA do not collect any more detailed information on the insured persons or policyholders. The FOPH also points out that Parliament has weakened the position of policyholders by giving insurance companies the option of cancelling collective contracts(Art. 35a para. 4 VVG).

Finally, the FOPH does not provide a satisfactory answer to the question of whether there are any solid justifications other than the historical origins for the fact that accident and illness are treated differently with regard to entitlement to daily benefits, but instead refers to the statutory provisions that subject the two situations to different legal systems. However, there do not appear to be any comprehensible objective reasons - apart from the historical ones - for this unequal treatment. In order to provide employees with equal financial protection in the event of both accident and illness, a compulsory daily sickness benefit scheme, as called for in the Romano motion, would therefore appear to be the logical consequence.