Deductible - Franchise

This is how the deductible in compulsory health insurance works

Compulsory health insurance is compulsory for all persons living in Switzerland. The basic insurance covers part of the costs in the event of illness. As soon as a claim occurs, the policyholders themselves must contribute to the costs incurred. This cost sharing consists of the annual deductible and a deductible. The amount of the cost sharing influences the amount of the monthly insurance premiums.

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The annual deductible in compulsory health insurance

If you visit a doctor, need medication or a hospital stay is necessary, you must contribute to the costs incurred. The regular deductible for basic insurance is 300 Swiss francs for adults. Children up to the age of 18 do not have to pay a deductible.

The amount of the premiums can be reduced by means of freely selectable cost sharing. The Health Insurance Act (KVG) provides for a gradation between 0 and 600 Swiss francs for children and young people up to 18 years of age. Young adults and adults aged 26 and over can choose from the following gradations: 300, 500, 1,000, 1,500, 2,000 and 2,500 Swiss francs. However, not every health insurance scheme offers all deductible (franchise) levels.

There are no fixed deductible (franchises) in supplementary health insurance. Instead, the health insurance covers the agreed benefits up to a fixed maximum annual amount.

The additional deductible

You pay the deductible (franchise) once a year. If your health care costs exceed the fixed amount, the health insurance company will cover all other amounts. However, you will have to pay a deductible of 10 percent of the treatment costs, a maximum of 700 Swiss francs per year for adults and 350 Swiss francs for children. For a hospital stay, adults aged 26 and over pay an additional meals and accommodation allowance of 15 Swiss francs per day.

If, for example, you have decided to pay a regular share of the costs, you pay the doctor's and medication costs up to 300 Swiss francs yourself. You then contribute 10 percent of the costs incurred.

By the way: If you change your basic insurance in the middle of the year, the new insurer will take your already paid cost sharing into account.

When is there no cost sharing?

Between 13th week of pregnancy and the eighth week after the birth in the event of illness and hospitalization, mothers do not have to pay a cost contribution. The cost sharing also does not apply to accidents if you have taken out accident insurance through your employer. This also applies to non-occupational accidents.

When can you change your deductible?

A higher cost sharing can reduce the premium contributions by up to 44 percent. It is possible to change to a higher or lower cost sharing at the beginning of each calendar year.

If you want a lower deductible (franchise) level, you must inform your health insurance company of this by 30 November of each year at the latest. If you wish to change to a higher deductible (franchise) level, it is sufficient for your letter to be received by the health insurance company by the last working day in December.

Compare deductible (franchises) and find a good health insurance company

If you rarely fall ill, you can save premiums by choosing a higher deductible (franchise). On the other hand, if you have to see a doctor more often or regularly or need medication, you will benefit from a lower cost sharing with higher premiums. We will be happy to help you find the optimum deductible (franchise) level for you. With an insurance comparison, you can find out how you can save the most.

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