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InsuranceHealth insuranceGlossary

Coinsurance in basic health insurance

  • What is coinsurance?
  • Coinsurance for maternity
  • Coinsurance for children and babies
  • Coinsurance for medicine
  • Coinsurance for accidents
  • Coinsurance in supplemental insurance
  • Out-of-pocket expenses for hospital stays

What is coinsurance?

Coinsurance is the amount policyholders must pay out of pocket towards health insurance costs. It is payable under both basic and supplemental insurance.

In basic insurance, coinsurance is payable when the selected deductible has been used up. It comprises 10% of the treatment costs. The amount is limited to 700 francs per calendar year. Different rules apply with respect to children, medicine, accidents and maternity.

Unlike the deductible, the coinsurance amount in basic insurance cannot be freely chosen. In supplemental insurance, depending on the insurer, you can choose from different coinsurance amounts in order to reduce your premiums.

This example illustrates how out-of-pocket expenses, including the deductible and coinsurance, are calculated.

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Coinsurance for maternity

Women who fall ill (e.g. in case of complications) do not have to pay out-of-pocket expenses from the 13th week of pregnancy until 8 weeks after the birth. In addition, other maternity benefits are paid for during and after pregnancy.

Coinsurance for children and babies

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

Tip: you can register a child with a health insurer before it is born.

Coinsurance for medicine

Coinsurance for proprietary drugs is 20% if a generic product is available. Coinsurance for generic drugs is 10%.

Exceptions: coinsurance remains at 10% in the following cases:

  • There is a medical reason for not using the generic product.
  • The price difference between the proprietary and the generic product is less than 20%.

Coinsurance for accidents

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

Coinsurance in supplemental insurance

In supplemental insurance, the coinsurance amounts stated in the policy apply.

Out-of-pocket expenses for hospital stays

Under basic insurance, the daily contribution to the cost of a stay in hospital is 15 francs. Exempt from this payment are children under the age of 18, young adults under the age of 25 still in education or training and anyone claiming maternity benefits.

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