Health insurance co-payment: deductible & more explained

Health insurance is compulsory in Switzerland. That means, with a few exceptions, all persons resident or employed in Switzerland must have basic insurance. The Federal Health Insurance Act (KVG) stipulates the co-payment of medical costs. This consists of a deductible, excess and hospital cost contribution. 

The deductible is a fixed annual amount that you have to pay before your health insurance company will contribute to the cost of your medical treatment. The minimal deductible offered by health insurance companies is 300 francs for insured persons aged 19 and over. The maximum deductible is 2500 francs. 

Which deductible should you choose at your health insurance company?

If you expect to have many visits to the doctor and medical treatments, a low deductible makes sense. This means you pay less out of your own pocket for these healthcare costs. If, on the other hand, you anticipate having low medical costs, a high deductible with your health insurance company is worthwhile. This will help you to save money on your monthly premiums.

Example: If you choose a deductible of 2500 francs with your health insurance company, you can expect a co-payment of up to 3200 francs under your basic insurance. This is the deductible of 2500 francs plus the maximum excess of 700 francs. The hospital cost contribution may also be added. 

The following table shows how the deductible affects the maximum amount that adults must pay per calendar year:

What is the deductible offered by health insurance companies for children up to the age of 18?

The law does not stipulate an annual deductible for children up to the age of 18. Parents only pay the excess, which amounts to a maximum of 350 francs per year for a child.

If you have more than one child insured with us and the ordinary annual deductible for all of them amounts to 0 francs, the maximum excess per year for all of them together is 1000 francs. 

If you wish, you can increase the deductible for your child to 500 francs. This will reduce the premiums. The excess in this case also amounts to a maximum of 350 francs per calendar year.

If you have more than one child insured with us and you have chosen an annual deductible of 500 francs for all children, the maximum amount of the costs you will have to pay per year is 1700 francs. 

Accident insurance with health insurance companies: does the deductible apply?

If you work at least eight hours a week for the same employer, you are automatically insured through their accident insurance and you do not need to pay a deductible or excess for this insurance. This applies to both private and occupational accidents. If, on the other hand, you work less than eight hours a week, you are only insured for occupational accidents. You also do not need to make a co-payment of medical costs in this case. 

If you are unemployed or retired, you must insure yourself against accidents through your health insurance company. In this case, you pay the deductible, excess and co-payment of medical costs for the hospital.

Once you have reached your deductible amount, you usually only pay 10% of the costs that are covered by basic insurance. As your health insurer, we will pay the remaining 90%. For adults, the excess charged by the health insurance company is a maximum of 700 francs per year. For insured persons under the age of 18, the excess for children applies: the health insurance company charges a maximum of 350 francs for this.

Example: You have selected a deductible of 1000 francs with your health insurance company. At the beginning of the year, you require medical treatment that costs 8000 francs. First, you pay your deductible of 1000 francs yourself. You still have 7000 francs (8000–1000) left over for you and your health insurance company. You can calculate the excess by working out 10% of 7000 francs. You therefore pay an additional 700 francs (0.1×7000). We will cover the rest, which is 6300 francs (7000–700). You have now reached the maximum excess of 700 francs with your health insurance company. If you require further medical treatment three months later, for example, the excess will be waived.

Did you know: when it comes to the co-payment of medical costs, the medication you take also plays a role. If you choose to take original medication for which there is a similar cheaper generic version available, your excess will increase by 40%.

Is it possible to change the excess at your health insurance company?

It is not possible to change the excess you pay to your health insurance company. Co-payment is governed by the Federal Health Insurance Act (KVG), a law that determines the amount of the excess.

Excess in the event of an accident: who pays the health insurance company?

If your accident insurance is through your health insurance company, you pay the excess. If, on the other hand, you have accident insurance through your employer, there are two possible scenarios: if you work at least eight hours a week, the excess for occupational and private accidents is waived. If you work less than eight hours, you pay an excess amount of 10% only for private accidents.

During a hospital stay, basic insurance covers not only the costs of treatment, but also the costs of accommodation and meals. The hospital contribution to the health insurance company is 15 francs per day. Insured persons pay this amount themselves in the event of an inpatient stay.

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 receiving maternity benefits
• Women who are receiving benefits for illness, accident or congenital defects from the thirteenth week of pregnancy until eight weeks after the birth

If you are staying in an institution such as a retirement home or nursing home, you do not have to pay the hospital cost contribution. However, this is not the case if you are admitted to hospital by a specialist during your stay. The usual amount of 15 francs per day would then apply.

The deductible, excess and hospital contribution are part of basic insurance. They form the portion that you pay yourself. Ideally, you should choose a deductible with your health insurance company based on how high your anticipated healthcare costs will be.