Insured persons are required to bear a portion of the costs of treatment (doctor, hospital, medication, etc.) themselves. These out-of-pocked expenses include the deductible (referred to as franchise in Switzerland) as well as an additional coinsurance of 10 per cent. The composition of the out-of-pocket expenses is specified in the Health Insurance Act (KVG, Art. 64).
The deductible must only be paid once per calendar year if any compensation is claimed, and is at least 300 francs for adults (CHF 0 for children). If you switch insurers during the year, your new insurer will take into account both the deductible and the coinsurance already paid in the same year.
Since 1 March 2014, women who fall ill during or after pregnancy (e.g. in case of complications) have no longer been subject to any out-of-pocket payments starting from the 13th week of pregnancy until 8 weeks after birth. Other events that are not subject to cost sharing are accidents (including non-occupational accidents) if the employee is insured against accidents by his/her employer (Accident Insurance Act).
Lowering the deductible
It is possible to switch to a lower deductible with effect from the beginning of each calendar year. The health insurance provider must be notified in writing of the desired lower deductible by 30 November or by the last business day in November (the day the insurance company receives the letter is relevant).
Raising the deductible
It is possible to choose a higher deductible with effect from the beginning of each calendar year. The health insurance provider must be notified in writing of the desired higher deductible by 31 December (check holidays) or by the last business day in December (the day the insurance company receives the letter is relevant).
The regular or statutory deductible for adults is 300 francs, for children 0 francs.
Policyholders are entitled to raise the deductible in order to benefit from a premium reduction. In any case, the reduced premium may not be less than 50% of the basic premium (deductible 300/0, with accident cover). This also applies to alternative insurance models.
Children (up to age 18):
- CHF 0
- CHF 100
- CHF 200
- CHF 300
- CHF 400
- CHF 500
- CHF 600
- CHF 300
- CHF 500
- CHF 1000
- CHF 1500
- CHF 2000
- CHF 2500
It is up to the individual health insurance company whether or not they offer all levels of deductibles. It is therefore possible that not all deductible levels are offered by every insurance company.
Company A offers all levels of deductibles (300, 500, 1000, 1500, 2000, 2500).
Company B only offers the basic deductible (300) and two optional deductibles (1,000, 2,500).