Health insurance deductible: which deductible makes sense?
When taking out basic insurance, you have to choose your deductible. Comparis explains what a deductible is, and which one makes sense for you.
25.07.2023
iStock/FJZEA
1. Definition: what is a deductible in health insurance?
The deductible is the part of your healthcare costs that you pay yourself. It costs between 300 and 2,500 francs depending on the model, and between 0 and 600 francs for children.
Together with your coinsurance, the deductible forms your out-of-pocket expenses for medical services covered by basic insurance.
What is the difference between the deductible and coinsurance?
The deductible is the amount you have to pay yourself in case of healthcare costs.
Coinsurance only comes into play once you have paid the full deductible amount. According to this principle, you contribute 10% towards further healthcare costs. This applies up to a maximum annual amount of 700 francs for adults and 350 francs for children. Your health insurance usually covers all further costs.
Health insurance deductible explained for immigrants
Basic insurance in Switzerland differs from health insurance in many other European countries, especially with respect to out-of-pocket expenses. In Switzerland, coinsurance only applies to certain medical services or medication, for example.
Deductibles are also typical of the Swiss system. You normally have to pay the costs of healthcare up to the deductible yourself. Any further doctors’ fees and treatment costs in the calendar year are covered by the insurance.
2. What annual deductibles are available for adults and children?
You can choose a new deductible every year. Keep in mind: the higher the deductible, the lower your premiums.
Deductibles are regulated by the Health Insurance Ordinance (Art. 92 KVV, link not available in English).
Deductible for adults aged 18 and over
| Elective deductible | Maximum premium discount per year |
|---|---|
| CHF 300 | No discount |
| CHF 500 | CHF 140 |
| CHF 1,000 | CHF 490 |
| CHF 1,500 | CHF 840 |
| CHF 2,000 | CHF 1,190 |
| CHF 2,500 | CHF 1,540 |
Deductibles for children up to the age of 18
| Elective deductible for children | Maximum premium discount per year |
|---|---|
| CHF 0 | No discount |
| CHF 100 | CHF 70 |
| CHF 200 | CHF 140 |
| CHF 300 | CHF 210 |
| CHF 400 | CHF 280 |
| CHF 500 | CHF 350 |
| CHF 600 | CHF 420 |
With the exception of minimum deductibles, health insurance companies decide for themselves which basic insurance deductibles they offer.
Compare health insurance and deductibles
The Comparis health insurance comparison tool gives you a quick overview of the price of various health insurers, health insurance models and deductibles.
3. Which deductible makes sense for me?
Which deductible is right for you depends on how high your healthcare costs are in the following insurance year.
A general rule of thumb
| Minimum deductible of 300 francs | if you expect healthcare costs in excess of 2,000 francs, choose the lowest deductible possible. This means you pay more for your basic insurance, but in the event of illness, you have to contribute less to your healthcare costs. |
|---|---|
| Maximum deductible of 2,500 francs | If you expect healthcare costs below 2,000 francs and can afford to pay 3,200 francs in one go in the event of illness, choose the highest deductible possible. These 3,200 francs consist of the maximum deductible (2,500 francs) and the maximum coinsurance (700 francs). |
Is it worth choosing a deductible somewhere in the middle?
Deductibles between the minimum and maximum options are usually not worthwhile for policyholders. They result in a discount that is too low.
Should I increase the deductible for my child?
As a rule, it makes sense to choose the lowest deductible of 0 francs for children. The reason: children have to see a doctor relatively often – and potential medical costs are difficult to predict.
4. Changing your deductible – when and how?
If you want to change your deductible, you must comply with certain deadlines and formalities.
Reduce your deductible by the end of November
It is possible to switch to a lower deductible with effect from the beginning of the following calendar year. You must tell your health insurer that you want to reduce your deductible by the last business day in November.
Increase your deductible by the end of December
You can also request a higher deductible with effect from the beginning of the following calendar year. You must tell your health insurer that you want to increase your deductible by the last business day in December.
There are two conditions if you wish to cancel your basic insurance at the end of June. By doing so, you can also change your deductible. In this case, you must notify your health insurance company by the last working day in March.
Conditions:
Standard model insurance and
the lowest deductible of 300 francs
If you switch to a different health insurer in the middle of the year, your new insurer will take into account any deductible and coinsurance already paid.
5. Health insurance deductible: FAQs
The minimum deductible is 300 francs for adults and 0 francs for children.
The maximum deductible is 2,500 francs for adults and 600 francs for children.
You must pay the total amount of the deductible at most once per calendar year for each person receiving benefits.
If you do not receive any health benefits, you will not incur any costs.
The same applies to costs in pregnancy: pregnant women do not pay any out-of-pocket expenses from the 13th week of pregnancy until eight weeks after the birth. Pregnant women are also exempt from the cost of check-ups before the 13th week of pregnancy.
Out-of-pocket expenses for supplemental insurance are regulated differently.
Compare deductibles
Not sure which deductible to choose? With Comparis, you can compare various deductibles and health insurance models free of charge.
This article was first published on 12.07.2022
