Basic insurance – compulsory health insurance

People with basic insurance in Switzerland must contribute to their treatment costs. These out-of-pocket expenses are made up of the deductible, coinsurance and a contribution towards hospital costs.

The premium is the amount that you must pay the health insurance provider for your insurance benefits. This varies depending on where you live, your age, and your chosen health insurance model and deductible. Learn more about health insurance premiums.

The deductible is the portion of treatment costs you will pay, and you have a degree of freedom in determining how high this is. As a rule of thumb, the higher the deductible, the lower the premium. You only have to pay your treatment costs yourself up to the amount of your chosen deductible, plus the contribution to hospital costs, if applicable.

Once the deductible amount has been reached, you pay only 10% of any further healthcare costs, up to an annual maximum of 700 francs for adults and 350 francs for children. Coinsurance is therefore the second way in which you must pay a share of the costs yourself. This amount is independent of your chosen deductible.

Patients must contribute towards the cost of meals while they are in hospital. This contribution is due only if you are hospitalized overnight, and costs 15 francs per day of care. Children under the age of 18 and adults up to the age of 25 who are still in education and training are exempt from this contribution. Read more about your contribution towards the cost of a hospital stay.

Under the basic health insurance scheme, insured persons must pay a share of the healthcare costs they incur. This example of out-of-pocket expenses will show you what costs you may have to pay.

Although it is guaranteed that bills for treatment covered by basic insurance will ultimately be paid by your provider, you might still have to settle them upfront yourself. The reason for this is that there are essentially two bill payment systems in Switzerland. Comparis explains the difference between tiers payant and tiers garant .

The standard model is the basic variant of basic health insurance. It is offered by all health insurance companies. With this model you are free to choose your doctor and other service providers such as hospitals and pharmacies.

With the family doctor model you must first see your family doctor or GP in case of illness. Premiums for the family doctor model are lower than those for the standard model.

With the HMO model, your first point of contact in the event of illness is your chosen group practice. The HMO model saves you money compared to the standard model. Premiums are up to 25% lower.

With the Telmed model, you are obliged to first call your insurance company’s medical helpline if you have any health problems. The company will tell you which number to call. As a general rule, you will not see a doctor until after that call. You receive a premium discount with the Telmed model .

Some health insurers also offer basic insurance models that have you contact someone other than your family doctor, HMO or medical helpline first. This first point of contact might be a pharmacy, for example. There are also models that specify which service providers you may go to after this first contact.