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 Smith CHF 1,300
Dr Williams CHF 700
Medication:
- generic products CHF 200
- proprietary drugs CHF 200
Total CHF 2,400

Health insurance statement
Your medical costs: CHF 2,400
- deductible CHF 300
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.