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What does co-payment consist of?

Your contribution consists of the deductible, the statutory excess and a contribution towards hospital costs. It is valid per calendar year.

Deductible (a fixed amount)

Initially you pay the medical costs for medication, visits to the doctor and hospital stays. This initial share of the costs is known as the deductible. You pay all the amounts that are covered by your basic insurance policy until you reach your chosen deductible. From this point onwards we contribute towards the cost of your treatment.

Deductible Adults

The legal minimum deductible for insured persons aged 19 and over is 300 francs per calendar year. With an excess of up to 700 francs, the maximum sum per calendar year amounts to 1,000 francs. You can increase your deductible to up to 2,500 francs on a voluntary basis. If you increase your deductible, we reward you with a discount on the premium.

You can increase or decrease your deductible on 1 January of the following year.

The following deadlines apply:

•When reducing the franchise: 30 November

•When increasing the franchise: 31 December

Please note: the notification of a change in your deductible must reach us on the last working day before the respective date.

Example:

Choice of deductible Excess Maximum amount per calendar year
CHF 500 CHF 700 CHF 1'200
CHF 1'000 CHF 700 CHF 1'700
CHF 1'500 CHF 700 CHF 2'200
CHF 2'000 CHF 700 CHF 2'700
CHF 2'500 CHF 700 CHF 3'200
Deductible Children under the age of 18

There is no legally predefined annual deductible for children. This means that parents only have to pay the amount charged in excess of the treatment costs. The excess in this case amounts to a maximum of CHF 350 per calendar year.

Example:

Standard annual deductible Excess Max. amount per calendar year

CHF 0

CHF 350

CHF 350

If several children from one family are insured with us and all of said children have the standard annual deductible (SAD) CHF 0, together they will pay a maximum excess of CHF 1000 per calendar year.

Example:

Number of children SAD Excess Max. amount per calendar year
1 CHF 0 CHF 350 CHF 350
2 CHF 0 CHF 350

CHF 700

(2x CHF 350)

3 and more CHF 0 CHF 350

CHF 1000

(instead of 3x CHF 350)

However, the parents also have the option to choose a deductible for their child in order to reduce the premiums. In this case the excess also amounts to up to CHF 350 per calendar year.

Example:

Optional annual deductible Excess Max. amount per calendar year
CHF 500 CHF 350 CHF 850

If several children from one family are insured with us and all of said children have a option of annual deductible (OAD) CHF 500, together they pay a maximum co-payment amount of CHF 1,700 per calendar year.

Example:

Number of children OAD Excess

Max. amount per calendar year

1 CHF 500 CHF 350 CHF 850
2 CHF 500 CHF 350

CHF 1700

(2x CHF 500 and 2x CHF 350)

3 and more CHF 500 CHF 350

CHF 1700

(instead of 3x CHF 500 and 3x CHF 350)

The year in which the treatment took place is used as the basis for co-payment calculation rather than the point in time at which the invoice is paid.

Excess (percentage calculation)

The statutory excess is 10%. It is based on the amount by which the treatment costs exceed the selected deductible. Adults pay up to 700 francs per calendar year, insured persons below 18 years of age pay up to 350 francs per calendar year.

If you have exhausted your chosen deductible in the course of this calendar year, the excess will take effect. From this point onwards, adults only pay 10% of the costs covered by the basic insurance policy, up to a total of 700 francs. We pay the remaining 90% for you. If you have reached your maximum excess, we pay 100% of the remaining costs due during this calendar year from the basic insuirance benefit catalogue.

Your share in the costs for original medication increases to 20% if a cheaper generic product (Generika) is available. In this case the law stipulates that we must deduct a 15% exess and that 5% of the costs must be charged directly to the customer. To help you identify these immediately, we include this excess on a separate line:

Detailed Statement

List of medication with a higher excess (PDF, 80KB)

Hospital cost contribution (fixed amount per hospital day)

During a hospital stay, statutory health insurance covers the costs of treatment as well as the costs of accommodation and meals. Pursuant to the Federal Health Insurance Act (KVG), the hospital cost contribution of CHF 15 per day must be charged for an inpatient stay.

The following are excluded from this:

  • Children up to the age of 18
  • Young adults up to the age of 25 who are undergoing education or training
  • Women for maternity benefits
  • Women for benefits in case of illness from the 13th week of pregnancy until eight weeks after the birth

The hospital cost contribution is not charged for a stay in an institution such as a retirement or nursing home. However, if an acute hospital stay becomes necessary during this time, the hospital cost contribution of CHF 15 per day must be charged.

Special cases: maternity and preventative medicine

  • You do not share in the costs in the case of maternity.
  • The deductible is not applicable for individual preventative measures in conjunction with the national and cantonal preventative medicine programmes.

Special case: accident coverage

If you have included accident coverage in your health insurance policy, you will also share in the costs. This is in contrast to the obligatory accident insurance that is taken out via the employer.

You will pay a share of the costs also in the event of an accident caused by a third party (third-party liability accident). You can claim back the co-payment from the liability insurance of the person responsible for the accident.