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Deductible and excess

What is cost sharing?

Members must pay a portion of the costs for the benefits by the basic insurance plan (mandatory health care insurance) (KVG Art. 64). The costs shared consist of:
  • Deductible
    Fixed annual contribution.
    The legal minimum deductible is 300 Swiss francs for adults; there is no deductible for children.
  • Excess
    10% of the costs exceeding the deductible must be paid by the insureds.
    The annual maximum sum is 700 Swiss francs for adults and 350 Swiss francs for children.
  • Hospital cost contribution
    15 Swiss francs per day.

What is a deductible? What is an excess?

When costs are incurred for a doctor, hospital or medication, insureds are required by law (KVG) to take over a certain portion of these costs themselves each calendar year. This first cost sharing arrangement is called the annual deductible. 
You can save up to 44% on your basic insurance premiums by increasing your annual deductible. The maximum annual deductible is 2,500 Swiss francs.

 

Adults  Children 
CHF 300 CHF 0 (without annual deductible)
CHF 500 CHF 200
CHF 1,000 CHF 400
CHF 1,500 CHF 600
CHF 2,000  
CHF 2,500  


When the costs exceed the agreed deductible during the calendar year, the health insurance company takes over 90% of the additional costs. You will pay 10% of these costs. This cost sharing is called excess. The maximum annual excess is 700 Swiss francs for adults and 350 Swiss francs for children, independent from the chosen annual deductible.

What is the legally required deductible?

Law requires an annual deductible of 300 Swiss francs for the mandatory health care insurance (basic insurance). There is no deductible for children (until the end of the calendar year of the 18th year of life).

When will the deductible be deducted?

Your health insurance company will deduct the entire deductible from the reimbursement of the first doctor's bill or you will receive an invoice for the costs incurred, if the doctor's bill was sent directly to your health insurance company.

When can I change my deductible?

For a reduction or an increase of the deductible to be legally valid, we need the signature of the insured person or his/her legal representative before 30 November.

Which date is relevant for the payment of benefits? The date of the treatment or the date of the invoice?

The relevant date is the one of the treatment. An example: If a treatment is provided in December 2016, the deductible and excess of the year 2016 apply. Even if the invoice will not be issued until February 2017.