Coinsurance in basic insurance


Application
Coinsurance is the percentage the policyholder has to pay out of his/her pocket when claiming benefits for medical treatment, hospital treatment and medication. This amount cannot be chosen freely as is the case with the deductible. Coinsurance means that the policyholder has to bear a percentage of the costs whereas the deductible is charged in full.

Calculation: 10 percent of medical costs minus deductible
Medical costs are the cost of medical treatment, hospital treatment and medication. As soon as the health care costs exceed the amount of the deductible, the policyholder has to pay coinsurance of 10 percent, up to a maximum of CHF 700 (please note the exception for medication), i.e. coinsurance only comes into effect once the deductible has been paid off (see sample calculation).

Coinsurance for children and families
The maximum coinsurance for children is CHF 350. If more than two children of the same family are insured with the same health insurance provider, the total coinsurance is limited to CHF 700 for all children together.

Exception: medication
With effect from 1 January 2006, the coinsurance for proprietary drugs is 20 instead of 10 percent if a generic product is available. The coinsurance for the generic drug remains at 10 percent.

Exceptions:

  • If there is a medical reason for not using the generic product.
  • If the price difference between the proprietary and the generic drug is less than 20 percent, the coinsurance stays at 10 percent.

Maternity
For maternity, neither deductible nor coinsurance are due if the course of pregnancy is "normal".

Sample calculations
You can find sample calculations for out-of-pocket expenses here.

Accident coverage according to the Accident Insurance Act (UVG)
Employees working for the same employer for more than 8 hours per week are insured against accidents through their employer. Accident insurance according to the UVG is not subject to a deductible or coinsurance.

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