Co-payment

Example of a calculation for a co-payment

  1. How can I calculate my co-payment?
  2. When I calculate my co-payment it amounts to a sum which is 5 rappen more or less than the given amount. Why the discrepancy?
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How can I calculate my co-payment?

The contributions paid by us under basic insurance are relevant for the calculation.

Detailed statement 1- inpatient hospital invoice

Abrechnung im Detail  1 – stationäre Spitalrechnung Deductible:

Your contractual deductible of CHF 500 is charged to you. The deductible for the current calendar year is depleted on the basis of this treatment.

Excess:

10% of the remaining amount is charged as excess:

CHF 4'500 (Invoice amount) – CHF 500 (Deductible) = CHF 4'000

10% of CHF 4'000 = CHF 400 is charged to you.

Hospital cost contribution:

Seven days à CHF 15 = CHF 105 (hospital contribution) is charged to you.

Total co-payment for the treatment:

CHF 500 + CHF 400 + CHF 105 = CHF 1005.40

Detailed statement 2 – outpatient medical invoice

Abrechnung im Detail  2 – ambulante Arztrechnung  Deductible:

Your deductible has been depleted, since it was already set off on „Detailed statement 1“.

Excess:

10% of CHF 425 = CHF 42.50 (for the medical treatment, medication and lab analysis) is invoiced to you.

Total co-payment for the treatment:

CHF 42.50

Co-payment overview

Übersicht Kostenbeteiligung Deductible:

The fact that your deductible was depleted in „Detailed statement 1“ is reflected here with -500.00.

Excess:

The excess is reflected as -442.50, since we accumulate the excess payments in „Detailed statement 1 and 2” (CHF 400 + CHF 42.50).

Hospital contribution:

The hospital cost contribution is not included in the co-payment calculation, since this is invoiced separately.

Remaining co-payment compulsory basic insurance:

The deductible is depleted. The remainder of the excess after this statement amounts to CHF 257.50.

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When I calculate my co-payment it amounts to a sum which is 5 rappen more or less than the given amount. Why the discrepancy?

We calculate the excess according to the type of benefit, and commercially round off the figure by 5 rappen. This method is in compliance with statutory provisions. In the case of invoices with figures related to various types of costs this can lead to rounding differences of 5 rappen. These differences can be in our favour, or in your favour, and balance each other out in the long run.

Category Amount Excess according to total Excess according to type of benefit
Total invoice CHF 308.55 CHF 30.85
Medication CHF 203.95 CHF 20.40
Treatment CHF 55.30 CHF 5.55
Lab analysis CHF 49.30 CHF 4.95
CHF 30.85 CHF 30.90