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Health For Members

EXPLAINED: Which Swiss health insurance deductible makes most sense?

Helena Bachmann in Geneva
Helena Bachmann in Geneva - [email protected] • 12 May, 2023 Updated Fri 12 May 2023 11:49 CEST
EXPLAINED: Which Swiss health insurance deductible makes most sense?
You can determine your deductible by how frequently you need medical help. Photo: Pixabay

If you are a foreigner, understanding Switzerland’s health insurance system may not be easy. And figuring out which ‘out of pocket’ option you should choose can be a real brain twister.

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If you come from a European, or any other country with a nationalised health care service, then you will find Switzerland’s scheme vastly different.

The same applies to the United States as well. 

Even if you do understand the basics of the Swiss system, including the difference between the obligatory insurance — KVG in German, and LaMal in French and Italian — and the complementary policies, you may still have trouble wrapping your head around the out-of-pocket expenses (the so-called franchise) that you will have to pay yourself.

The deductible

It is not unusual for various policies, such as car or home insurance, to include a deductible — the amount you will have to pay yourself before the insurance starts covering incurred costs. But it is usually a fixed amount, determined by the insurance company.

Not so with the Swiss health insurance.

When you take out a policy, you will have to choose the amount of your annual franchise — ranging from the lowest, 300 francs, to the highest, which is 2,500 francs. (There are various other amounts in between as well, but these two are the most common).

Whichever amount you choose, you will have to pay it yourself before you can claim benefits from the insurance provider.

Highest versus lowest

At first glimpse, the 300-franc deductible is a more attractive option, because it means you will reach the franchise threshold quicker.

However, opting for this amount means that your monthly premiums will be quite a bit higher than if you choose the highest deductible, that is, 2,500 francs.

As an example, if you select the latter option, your monthly premium may be 300 francs or even less. With the former one, it could go up to 450 francs or more. (Keep in mind, though, that this is only a rough estimate of costs; the actual amount depends on your age and your canton of residence).

READ ALSO: Why do Swiss healthcare premiums vary so much per canton?

These amounts, by the way, apply to adults only. For children up to the age of 18, they go from 100 to 600 francs a month.

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So which amount should you choose?

The rule is: the higher the deductible, the cheaper the premiums, and vice-versa.

However, before you base your decision on this statement alone, there are two important things to take into account: your health and finances.

People who are young and healthy, and who never or rarely get sick, visit doctors, take medications, or need medical treatments in general, most commonly choose the highest franchise, which means they will be paying lower premiums.

On the other hand, if you are older (which implies, statistically, that you are more likely to seek medical help), or if you have chronic health problems requiring medications and frequent doctor visits, then you are better off with the lower franchise.

That’s the health factor. In terms of finances, having the high deductible means that if all of a sudden you need medical help, you will have to pay 2,500 francs out of your own pocket before insurance steps in.

Which deductible you choose will depend on health and money. Photo: Claudio Schwarz on Unsplash

But that is not all.

Before you do the math to calculate which deductible makes most sense to you, also consider the cost of co-insurance.

What exactly is this?

It is the money you pay out of pocket towards health insurance costs — 10 percent in total.

In other words, after you use up your franchise, you still have to pay 10 percent of the cost for medical treatment (though different rules apply to children, accidents, and maternity).

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The co-insurance cost is capped at 700 francs a year, meaning that even if you have frequent, and costly, medical procedures, you will not be charged the 10-percent co-pay after you reach the 700-franc mark.

So when you sit down to figure out which franchise makes most financial sense for you, this is the thing to remember:

If you choose the highest, that is, the 2,500-franc deductible, add to it the 700-franc co-insurance cost. This means that on top of your monthly premiums, you should put aside 3,200 francs a year per adult, to be used toward health costs.

Conversely, if you have a 300-franc deductible, and add the 700-franc co-pay, then you should have 1,000 francs available each year to pay for out-of-pocket medical expenses.

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When can you change your deductible — if you decide to do so?

You can switch to a lower deductible at the beginning of the calendar year.

However, you must inform your health insurer of the change in writing by November 30th of the previous year.

The same applies to a higher deductible — it will take effect at the beginning of the calendar year. Here, the deadline for informing the insurance provider is December 31st.

If you don’t notify the insurers of either change by those dates, it will be assumed that your current deductible remains as is.

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