Co-payment

Example of a calculation for a co-payment

How can I calculate the co-payment?

The co-payment is calculated by reference to the amounts that we pay from the basic insurance policy. We indicate the relevant amount on each invoice:

Kostenbeteiligung

We add these amounts together:

CHF 755.05 + 500 + 554 = 1,809.05

First of all we take into account the contractually agreed deductible. In our example this is 500 francs:

CHF 1,809.05 – 500 = 1,309.05

The deductible for this calendar year has been used up. We take into account a 10% excess from the remaining amount:

10% of CHF 1,309.05 = 130.90

The co-payment account is itemised as follows:

Maximum deductible CHF 500.-
Deductible before this statement CHF 0.-
Deductible on the basis of this statement CHF – 500.-
Remaining deductible after this statement CHF 0.-
Maximum excess CHF 700.-
Excess taken into account before this statement CHF 0.-
Excess after this statement CHF – 130.90.-
Remaining excess after this statement CHF 569.10.-
Total co-payment on the basis of this statement CHF – 630.90.-

When I calculate my co-payment, I come to an amount that is 5 rappen higher or lower. Why is this?

We calculate the excess depending on the type of cost and round the amount off to 5 rappen, in accordance with commercial practice and in order to comply with the legal regulations. For invoices with amounts relating to different cost types, there may therefore be rounding differences of 5 rappen. These differences can be in your favour or our favour. Over the duration of the policy this balances itself out.

Designation Amount Excess by total Excess by type of benefit
Total invoice CHF 308.55.- CHF 30.85.-
Medications CHF 203.95.- CHF 20.40.-
Treatment CHF 55.30.- CHF 5.55.-
Laboratory analysis CHF 49.30.- CHF 4.95.-
CHF 30.85.- CHF 30.90.-

Why can't I see the exact co-payment for each invoice amount? I can only assume that the co-payment is 10%.

You can simply recalculate the co-payment. For more information see "How can I calculate the co-payment?".

We have structured our system so that invoices are sorted chronologically by treatment date and the co-payment is allocated per invoice, in order to comply with the legal regulations. As the invoices are submitted at different speeds, there are often deferrals in this calculation. The example illustrates the effects.

On 20 February we take two invoices into account and illustrate the co-payment per invoice:

Invoice receipt and treatment Amount

Deductible

(CHF 300)

Excess
30 January – hospital CHF 3'000.- CHF 300.- CHF 270.-
15 February – doctor CHF 450.- - CHF 45.-
Total CHF 3'450.- CHF 300.- CHF 315.-

On 25 February another invoice is received relating to a treatment on 15 January. It is positioned ahead of both invoices. The allocation of the co-payment for the hospital invoice on the benefit statement dated 20 February is no longer correct, it is deferred:

Invoice receipt and treatment Amount

Deductible

(CHF 300)

Excess
15 January – doctor CHF 300.- CHF 300.- -
30 January – hospital CHF 3'000.- CHF 0.- CHF 300.-
15 February – doctor CHF 450.- - CHF 45.-
Total CHF 3'750.- CHF 300.- CHF 345.-

For that reason, we always calculate the co-payment on the basis of the overall amount. This has no effect over the course of the year.