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Excess and deductible

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:

  • Excess
    Fixed annual contribution.
    The legal minimum excess is 300 Swiss francs for adults; there is no excess for children.
  • Deductible
    10% of the costs exceeding the excess 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 an excess? What is a deductible?

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 excess.
You can save up to 44% on your basic insurance premiums by increasing your annual excess. The maximum annual excess is 2,500 Swiss francs.

ADULTS CHILDREN
CHF 300.- CHF 0.- (without annual excess)
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 excess 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 deductible. The maximum annual deductible is 700 Swiss francs for adults and 350 Swiss francs for children, independent from the chosen annual excess.


What is the legally required excess?

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


When will the excess be deducted?

Your health insurance company will deduct the entire excess 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 excess?

For a reduction or an increase of the excess to be legally valid, we need the signature of the insured person or his/her legal representative before the 30th of 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 2009, the retention and the deductible of the year 2009 apply. Even if the invoice will not be issued until February 2010.

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