The health insurance jargon explained simply and clearly. Become an insurance expert on the subjects of deductible and excess.
Each calendar year every adult in Switzerland has to pay a fixed amount to contribute to treatment costs: the deductible. The minimum deductible for adults in basic insurance is CHF 300 per year. If you choose a CHF 300 deductible, for instance, then you pay the first CHF 300 yourself.
Choice of deductibles in basic insurance:
- CHF 300
- CHF 500
- CHF 1,000
- CHF 1,500
- CHF 2,000
- CHF 2,500
There is no legally stipulated annual deductible for children in Switzerland. The health insurance company pays a share of the costs from the start. At Helsana the deductible for children can also be increased to CHF 500. In this way, premiums can be saved.
The benefit of a higher deductible
Helsana, in common with all insurers, grants its insured persons a discount if they choose a higher deductible. The higher your deductible in basic insurance, the lower your premium. If you choose the highest deductible of CHF 2,500, you benefit from a discount of at least 19% on your premiums. Further information and an overview of all discounts can be found here. You can also calculate your premium right now.
What is the excess?
The excess is charged as soon as your selected deductible for a given calendar year has been used up. From this point onwards, the health insurance company covers 90% of the costs. Provided they are covered by the basic insurance and are incurred in the same calendar year. You yourself pay the remaining 10%. This amount is known as the excess. It is likewise part of your co-payment of medical costs.
The excess, too, has a limit: this is CHF 700 for adults and CHF 350 for children per calendar year. As soon as you have paid the maximum excess, the health insurance company pays for the full amount of all further costs covered by the basic insurance.
Deductible and excess – an example
Let’s assume that your deductible under the basic insurance is CHF 300. You now receive your first doctor's bill in the calendar year, amounting to CHF 400. Of this amount you pay your deductible of CHF 300 and – of the remaining CHF 100 – the excess of 10%, so CHF 10. Overall, therefore, you pay CHF 310 yourself.
If you receive another bill from your GP in the same calendar year for CHF 200, of this you pay only the 10% excess, so CHF 20.
Hospital cost contribution: also part of the co-payment of medical costs
For inpatient hospital stays, insured persons pay the legally prescribed hospital cost contribution. This is CHF 15 per day. This amount corresponds to the living costs for electricity, meals, etc. that you would have to pay if you were at home. You therefore pay the hospital cost contribution even when you have already used up all of your deductible and excess and the basic insurance covers the costs of accommodation and meals. Find out who is exempt from the hospital cost contribution here.
Excluded from co-payment of medical costs
There are medical benefits that are paid for in full by your health insurance company. That means that you are exempt from the deductible and excess. These benefits include, for example, maternity benefits such as (a maximum of seven) check-ups or birth preparation courses. In addition, from their thirteenth week of pregnancy and up to eight weeks after the birth, women do not have to contribute to the costs of general benefits or of care in the event of illness.