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Copayment – your share of the costs

In Switzerland, insureds pay a share of their treatment costs. This cost share includes the deductible, copayment and hospital contribution. The copayment is the share of costs that insureds pay towards the cost of their treatment once their deductible has been exhausted.  

Definition of copayment

The copayment is the percentage share of the costs that insureds pay for insurance benefits. Once the health costs exceed the amount of the deductible, health insurance pays 90% of the costs under basic insurance. Insureds have to pay the remaining 10% of the costs. This share is known as the copayment.

Why do I have to pay a copayment?

The Health Insurance Act (KVG/HIA) stipulates that insureds must contribute to their health costs. This cost share includes the annual deductible and copayment.

How high is the copayment?

The copayment is 10%. For original drugs for which a generic is available, the copayment is 20%. 

The maximum copayment per year is CHF 700 for adults and CHF 350 for children. Once more than two children in a family are insured with the same company, the copayment is limited to CHF 700 for all children. 

Good to know: Health insurance companies do not apply a deductible or copayment to maternity benefits.

How is the copayment calculated?

Here is an example: An insured has health costs of CHF 2,000 a year. He has chosen the minimum deductible of CHF 300.

Total health costs CHF 2000
minus deductible - CHF 300
Remaining costs CHF 1700

Of the remaining costs, the insured has to pay a copayment of 10% (up to a maximum of CHF 700 per year).

10% copayment of CHF 1,700.– = CHF 170.–

In this case, the insured’s healthcare costs amount to:

CHF 300
+ Copayment + CHF 170
Insured’s total costs
CHF 470

For which medicines do I not have to pay a higher copayment?

The copayment for generic drugs is usually 10%, compared to 20% for original drugs.

The higher copayment for original drugs does not apply:

  • If no generic is available.
  • If an original drug cannot be replaced by a generic drug for medical reasons. In this case, a special prescription is required from the doctor.
  • If the price difference between the original drug and the generic is less than 20%.

You can use the Sanitas Generic drug finder to find out whether you have to pay an increased copayment for your medication.