If you, as an insured person, claim benefits such as a doctor's appointment, or if you need medication, you pay a share of the costs. However, you can decide how much of healthcare costs you wish to pay each calendar year. The amount that you pay is divided into the deductible and the retention fee. The level of deductible is laid down in law. The statutory minimum deductible (standard deductible) for adults is CHF 300 per year. The standard deductible does not apply to children under the age of 18. The amount refers to one year in each case. If your healthcare costs exceed your deductible, you still pay the retention fee of 10%.
Your choice of deductible
Instead of the standard deductible, you are free to choose a higher selectable deductible. Children may also choose a deductible and thus receive a premium reduction. It is worth mentioning here that the higher your deductible, the lower your premium.
As an insured person, you pay a fixed sum per calendar year (deductible) and a retention fee (10%, up to a maximum of CHF 700 per calendar year for adults over the age of 18, and CHF 350 for children) for outpatient and inpatient treatment.
You will also pay a retention fee on the costs that exceed the deductible.
Example of co-payment
Outpatient treatment; adult with ordinary deductible CHF 300
of which 10% is retention fee
Total co-payment billed
to the insured person
The next time the customer falls ill (in the same year), he or she pays only the retention fee.
There are a number of exceptions that apply to children and young people in education, for example, as well as to maternity benefits. Please refer to the customer information sheet on Calculation of co-payment.
Frequently asked questions
What deductible should you choose?
You should take the following points into consideration when deciding which deductible is best for you. If you decide in favour of a low co-payment, your health insurance premium will be somewhat higher. To help you reach a decision, we recommend taking a look at your healthcare costs over the past few years. This will allow you to determine whether you would prefer to choose a low deductible or pay a greater share of your healthcare costs out of your own pocket.
How can the deductible be changed?
You can change your deductible with effect from 1 January each year. Please note the period of notice.
What does a higher deductible mean?
You need to have money set aside to cover your deductible should the worst case scenario arise. This is the amount up to which you, as policyholder, must pay the costs out of your own pocket. If the total costs are higher than the deductible, the general health insurance company will pick up the tab for the remaining amount after deducting the retention fee.