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InsuranceHealth insuranceGlossary
Health insurance

Out-of-pocket expenses for basic insurance

If costs for medication, medical treatment by a doctor or hospital treatment occur, the policyholder must contribute to these costs. This out-of-pocket payment is defined by law and includes the deductible ("franchise") and coinsurance. For inpatient hospital treatment, an additional hospital fee has to be paid.

No deductible is due in case of maternity. The same applies to accidents (including non-occupational accidents) if the employee is insured against accidents by his/her employer (according to the Accident Insurance Act UVG).

 

Example

A policyholder has a deductible of CHF 300 and expenses of CHF 2,400 for medical treatment in one calendar year:

 

Doctors' bills
Dr SmithCHF1,300
Dr WilliamsCHF700
Medication:
- generic productsCHF200
- proprietary drugsCHF200

TotalCHF2,400

Health insurance statement
Your medical costs:CHF2,400
- deductibleCHF300
Subtotal for coinsuranceCHF2,100
- 10% of doctors' bills*CHF170
- 10% of generic productsCHF20
- 20% of proprietary drugsCHF40

Your health insurance paysCHF1,870

*On the assumption that the medical bills exceed the deductible of CHF 300, i.e. the coinsurance of 20% for proprietary drugs takes full effect.

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