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:

The deductible defined in your insurance policy is shown on the first page of the benefit statement. In this example, the deductible for the current calendar year has already been used up.

Excess:

The invoice amount is CHF 3,044.10 in the example above. Any remaining deductible is applied to that amount. In this case, no deductible is applied. We pay 90% of the invoice amount; you have to pay 10%.

You will be charged 10% of CHF 3,044.10, i.e. CHF 304.40.

Hospital cost contribution:

You will be charged for eight days of hospital cost contributions at CHF 15, which comes to CHF 120.

Total co-payment for the treatment:
Deductible CHF 0
Excess CHF 304.40
Hospital cost contribution CHF 120
Total CHF 424.40

Detailed statement 2 – outpatient medical invoice

Abrechnung im Detail  2 – ambulante Arztrechnung

The deductible defined in your insurance policy is shown on the first page of the benefit statement. In this example, the deductible for the current calendar year has already been used up.

Excess:

You are required to pay a 10% excess for each invoice, up to a maximum of CHF 700 per calendar year. In this case, the excess is calculated as follows:

(10% x 28.55 = 2.85) + (10% x 17.40 = 1.75) + (10% x 31.30 = 3.15) = CHF 7.75

Total co-payment for the treatment:

CHF 7.75 to pay

Co-payment overview

Übersicht Kostenbeteiligung Deductible:
Deductible:

The summary shows your current co-payment balance. In this example, the full CHF 300 deductible had already been applied before the current statement.

Excess:

Your maximum excess is CHF 700 per calendar year. You will be charged the amounts shown above – hospital CHF 304.40 plus CHF 7.75 for medical treatment. The co-payment overview shows the new excess balance. The co-payment of CHF 304.40 + CHF 7.75 = CHF 312.15 has been offset against the amount from earlier invoices in this calendar year. During this calendar year, you can only be required to pay an additional excess of up to CHF 131.90.

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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