Cost Sharing Health Insurance: What You Pay Yourself
Basic insured persons in Switzerland must participate in their healthcare costs. Compando calculates insurer-neutrally how cost sharing is composed of deductible, co-payment and hospital contribution.
1. What is cost sharing?
When you receive a medical service from basic insurance, you must participate in the costs. This own contribution is incurred annually and is billed by the treatment date, not by the invoice date.
Since the benefits of basic insurance are identical at all insurers, switching to a cheaper insurer is worthwhile without loss of benefits. Your chosen insurance model and your deductible determine the annual burden much more strongly than just a provider change.
Good to know: From the 13th week of pregnancy until eight weeks after the birth, no cost sharing applies for you. Neither deductible nor co-payment nor hospital contribution is levied during this period, also in case of illness or accident without relation to the pregnancy.
2. How is cost sharing at the insurer composed?
In the Swiss health insurance system, cost sharing is composed of three building blocks: deductible, co-payment and, with inpatient hospital stay, additionally the hospital contribution.
Deductible
You pay the deductible once per calendar year. For adults, it amounts to a minimum of CHF 300 and a maximum of CHF 2'500. With a low deductible, you pay less treatment costs yourself, but the premium is higher. With a high deductible, the premium is lower, but your own burden in case of illness is higher. Only after using up the deductible does the insurer take over the further costs minus co-payment.
Which level fits mathematically depends on the expected healthcare costs. The deductible choice takes premium savings and maximum own costs into account together.
Co-payment
As soon as the deductible is used up, you take over 10 percent of the further treatment costs up to a maximum of CHF 700 per year for adults. For children, the maximum is CHF 350 per year. If several children are insured with the same insurer, the co-payment for all children together is limited to CHF 1'000 annually.
Important: For medically prescribed medications, a co-payment of 10 percent applies. But if you obtain an original preparation although a cheaper generic would be available, your co-payment rises to 40 percent. An exception applies if the doctor prescribes the original preparation for medical reasons (note "aut idem" on the prescription).
Hospital contribution
In case of a hospital stay, basic insurance covers not only the treatment, but also accommodation and meals. You participate in accommodation and meals with CHF 15 per overnight stay. Exempt are minors and persons under 25 in education. The age brackets regulate these exceptions in detail. For maternity benefits, the hospital contribution likewise lapses.
Which deductible pays off for you?
Compando compares all Swiss insurers with all deductible levels. This way the comparison shows for place of residence and life situation the mathematically suitable combination.
3. How high is the maximum cost sharing in basic insurance?
The upper limit of your annual cost sharing depends on your chosen deductible. This table shows the maximum for adults without hospital stay:
Deductible | Co-payment max. | Maximum burden |
|---|---|---|
CHF 300 | CHF 700 | CHF 1'000 |
CHF 500 | CHF 700 | CHF 1'200 |
CHF 1'000 | CHF 700 | CHF 1'700 |
CHF 1'500 | CHF 700 | CHF 2'200 |
CHF 2'000 | CHF 700 | CHF 2'700 |
CHF 2'500 | CHF 700 | CHF 3'200 |
With an inpatient hospital stay, the hospital contribution is added. A two-week hospital stay means for example CHF 210 additional costs (14 × CHF 15).
Special regulation for children and families
For children under 18 years, no minimum deductible is prescribed. The deductible can be freely chosen between CHF 0 and CHF 600. The maximum co-payment is CHF 350 per child. If several children are insured with the same insurer, most providers limit the total co-payment to CHF 1'000 per year.
Good to know: Self-borne illness costs can be claimed in the tax return. If deductible, co-payment, dentist and glasses costs exceed the threshold value applicable in the canton of residence for the tax deduction (frequently 5 percent of net income, cantonally different), the excess amount is deductible from taxable income. With low income, additionally check the premium subsidy of your canton of residence.
4. Which cost sharing applies for accident and abroad?
Accident
If you are insured against accidents through your employer (UVG), no cost sharing applies. This applies to all employees with at least eight hours per week. If you are insured against accidents through the insurer, deductible, co-payment and hospital contribution apply as for illness. Anyone insured as an employee through UVG can additionally suspend the accident coverage in the insurer and thus reduce the premium.
Treatment abroad
For emergencies abroad, basic insurance pays at most twice the Swiss reference tariff. You bear the difference yourself. In high-price countries like the USA, Japan or Canada, an emergency operation can quickly cost over CHF 100'000. A supplementary insurance for treatment abroad closes the gap. Note: basic and supplementary insurance are subject to different laws (KVG or VVG).
5. Example calculation of cost sharing
An insured person with deductible CHF 300 has treatment costs of CHF 2'500 in the calendar year. This is how the billing is composed:
Treatment costs:
Item | Amount |
|---|---|
Treatment at doctor 1 | CHF 1'500 |
Treatment at doctor 2 | CHF 800 |
Medications (generics) | CHF 200 |
Total | CHF 2'500 |
Insurer billing:
Item | Amount |
|---|---|
Treatment costs | CHF 2'500 |
minus deductible | - CHF 300 |
minus co-payment 10 % | - CHF 220 |
Insurer covers | CHF 1'980 |
Your cost sharing in this example is CHF 520. To this come the annual premiums for the insurance. A change of the deductible can change the annual burden by over CHF 1'000.
Optimise your cost sharing
Which combination of deductible, model and insurer lowers your annual burden? Compando compares all Swiss insurers for your place of residence and shows the premium difference.
