When costs arise due to medical care or medication, the policyholder must pay a contribution to these costs, i.e. pay a certain amount himself.
This contribution comprises a
deductible rate and
retention
(10 % of costs exceeding the deductible rate). Excepted from the deductible rate and retention are maternity and accidents according to federal laws on accident insurance. All employees who work more than 8 hours per week for one employer are insured against accidents.
For example:
A policyholder has a deductible rate of CHF 300 and his annual bills for consultations and medication total CHF 2400:
Doctors bills
|
|
| a) Dr. Müller |
CHF |
1300 |
| b) Dr. Meier |
CHF |
700 |
c) Medication
Generic medication
Original medication |
CHF
CHF |
200
200 |
| |
|
| Total |
CHF |
2400 |
| |
|
|
|
|
Health insurance settlement
|
|
| His medicinal costs: |
CHF |
2400 |
| - |
Deductible rate |
CHF |
300 |
| |
Subtotal for retention:
| CHF |
2100 |
-
-
- |
10% of doctors bills*
10% generic medication
20% original medication |
CHF
CHF
CHF |
170
20
40 |
| |
|
| The health insurance company will cover |
CHF |
1870 |
| |
|
* Assumption: The doctors bills exceed the deductible rate of CHF 300. This means that the retention of 20% for original medication takes full effect.
| |
