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).
A policyholder has a deductible of CHF 300 and expenses of CHF 2,400 for medical treatment in one calendar year:
|- generic products||CHF||200|
|- proprietary drugs||CHF||200|
|Health insurance statement|
|Your medical costs:||CHF||2,400|
|Subtotal for coinsurance||CHF||2,100|
|- 10% of doctors' bills*||CHF||170|
|- 10% of generic products||CHF||20|
|- 20% of proprietary drugs||CHF||40|
|Your health insurance pays||CHF||1,870|
|*||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.|