How is the co-payment calculated?

Each new calendar year, the cost for medications, doctor visits and hospital stays are added to the deductible. This means you pay the initial treatment costs yourself, until you have reached the amount of the deductible you chose. Once your medical costs exceed your deductible, then we as your health insurer will assume some of these costs. You will only be required to pay the legally prescribed excess.

During a hospital stay, basic insurance covers not only the costs of treatment, but also the costs of accommodation and meals. According to the Federal Health Insurance Act (KVG), however, the hospital cost contribution of CHF 15 per day must be charged to the insured person for inpatient stays.

Exceptions to this are:

• Children up to the age of 18
• Young adults up to the age of 25 who are undergoing education or training
• Women with maternity benefits
• Women receiving treatment for illness, accident and congenital defect during the period between the 13th week of pregnancy and 8 weeks after birth.

The hospital cost contribution is not charged for a stay in an institution such as a retirement or nursing home. If during this time the insured person must be moved to a hospital, the hospital cost contribution of CHF 15 per day will be charged.

Once you reach the amount of your deductible, you only pay 10% of the costs that are covered by basic insurance. This excess amounts to no more than CHF 700 per year for adults, and CHF 350 for insured persons under age18. As your health insurer, we will pay the remaining 90%.

Good to know: If you choose to take a brand-name medication for which there is a similar cheaper generic version available, your co-payment will increase by 40%.

Switzerland has a statutory minimum deductible for insured persons aged 19 and over of CHF 300 a year. Together with an excess of up to CHF 700, you will pay at most CHF 1,000 per calendar year. Choose a CHF 2,500 deductible – this is the highest amount possible under basic insurance – and we will give you a discount on your premium. You can increase or decrease your deductible on 1 January of the following year. There are some rules that you need to observe, however:

• You must lower your deductible by: 30 November
• You must raise your deductible by: 31 December

If you decide to raise/lower your deductible, you must inform us of this decision by no later than the last business day in November or December.

There is no mandatory legal annual deductible for children. This means that parents only have to pay the amount of the excess which exceeds the treatment costs. The excess can amount to no more than CHF 350 a year.

If you have more than one child insured with us, and if the ordinary annual deductible for all children amounts to CHF 0, then the excess for all children together for one year will not exceed CHF 1,000.

You have the option of raising the deductible for your child to CHF 500. Doing this will lower your premium. The excess in this case amounts to a maximum of CHF 350 from January to December.

If you have more than one child insured with us and you have set the annual deductible at CHF 500 for all children, the maximum amount of the costs you will have to pay per year is CHF 1,700.

Special case: maternity

• The co-payment of medical costs does not apply during the period between the 13th week of pregnancy and 8 weeks after birth.

Special case: prevention

• The deductible is not applicable for individual measures in conjunction with the national and cantonal preventative medicine programmes.

Special case: accident cover

• If you have included accident coverage in our health insurance policy, you are responsible for the co-payment. If you have accident coverage through your employer, then you are not responsible for the co-payment.
• You are also responsible for some of the costs arising from an accident that you did not cause (third-party liability accident). You can then claim back the co-payment from the liability insurance of the person responsible.