Within the framework of the genera insurance against the adverse effects of illness (basic insurance) according to the KVG, benefits in case of illness, maternity and accident are covered, provided that no accident insurance pays for them (cf. Art. 1a Para. 2 KVG). Thus, basic insurance is not only a social insurance in case of illness, but also a health insurance for people without accident insurance. Maternity is integrated into the health insurance coverage because it triggers similar benefit needs to those for diagnosis and treatment of health conditions.

The legal definition of the term “disease” in Art. 3 para. 1 ATSG applies as a catch-all provision for all health impairments not caused by an accident. First of all, there must be an impairment of health, i.e. a physical, mental or psychological dysfunction. This must not be the result of an accident and must lead to a need for examination or treatment i.e. an incapacity for work. Whether a fundamental impairment meets the definition of illness in Art. 3 para. 1 ATSG also depends on the benefits provided by the health insurance: Payment of the costs of medical examinations and treatment as well as daily allowances in the event of incapacity for work. However, whether a health impairment reaches the qualification of a ‘disease’ is a matter of judgment and thus cannot be determined completely objectively.

However, the KVG does not conclusively regulate health insurance. Health insurance companies may offer private supplementary health insurances and other types of private insurance as a secondary activity (cf. Art. 14 KVV). These are subject to the Insurance Contract Act (VVG) (cf. Art. 12 Para. 3 KVG) and not to the KVG.

Unlike general basic insurance, daily allowance insurance is not mandatory and can be taken out with a different insurance carrier than the chosen health insurance. The main reason for this is that daily allowance insurance is often taken out in connection with an employment relationship. An insurer may therefore not terminate the daily allowance insurance if an insured person cancels the mandatory basic health insurance