In Switzerland, insureds pay a share of their treatment costs. This cost share includes the deductible, copayment and hospital contribution. The deductible is the fixed annual amount that insureds pay towards their treatment costs.
Insureds can choose each year how high their deductible should be based on predefined increments. In this way, you fix the amount you will contribute to your treatment costs in a calendar year. The following applies: The higher you set the deductible and thus your cost share, the lower your basic insurance premium will be – and vice versa.
How high is the deductible in Switzerland?
Insureds can choose one of the following deductibles for basic insurance.
Child and adult deductibles (in CHF)
The deductible you choose influences your basic insurance premium. You can opt for a higher deductible to benefit from attractive premium discounts. You can find more information on changes in premium here.
Which deductible should I choose?
You are free to choose your deductible. A high or low deductible may be your best option depending on your situation.
When should you choose a high deductible?
It makes sense to choose a high deductible for health insurance when your health costs tend to be low. You benefit from an attractive discount on your basic insurance premium.
Example: Person A has basic insurance with Sanitas with a deductible of CHF 2,500. She receives a medical bill for CHF 2,000.
|- Deductible (remaining deductible CHF 500)||- CHF 2,000||To be paid by person A
||- CHF 0||To be paid by person A
||CHF 0||To be paid by Sanitas
Person A also receives a physiotherapy bill for CHF 600.
|- Deductible (the deductible has now been used up.)||- CHF 500||To be paid by person A
|- Copayment (10% of CHF 100, up to max. CHF 700)||- CHF 10||To be paid by person A
||CHF 90||To be paid by Sanitas|
Person A pays CHF 2,510 for both bills. Sanitas covers the remaining CHF 90.
When should you choose a low deductible?
It makes sense to choose a low deductible for health insurance when your health costs tend to be high. This means that basic insurance contributes more to your health costs. In case of a claim, the costs you have to pay will be lower.
Example: Person B has basic insurance with Sanitas with a deductible of CHF 300. She receives a medical bill for CHF 2,000.
|Medical bill||CHF 2,000|
|- Deductible||- CHF 300||To be paid by person B
|- Copayment (10% of CHF 1,700, up to max. CHF 700)||- CHF 170||To be paid by person B
||CHF 1,530||To be paid by Sanitas|
Person B also receives a physiotherapy bill for CHF 600.
| - Deductible (the deductible has been used up.)
||- CHF 0|
|- Copayment (10% of CHF 600, up to max. CHF 700)||- CHF 60||To be paid by person b
||CHF 540||To be paid by Sanitas|
Person B pays CHF 530 (CHF 300 + CHF 170 + CHF 60) for both bills. Sanitas covers the remaining CHF 2,070.
What deductible applies during pregnancy?
During pregnancy, health insurers cover maternity benefits without applying the deductible or copayment. This means that during pregnancy, no deductible is applied to maternity-related benefits. For health insurance purposes, maternity begins at the 13th week of pregnancy and ends eight weeks after the birth. This also applies to illnesses and complications related to pregnancy and the birth.
Important: Let Sanitas know in good time if you are pregnant so that you are not charged the deductible and copayment.
How can I change my deductible?
You can choose a new deductible for basic insurance each year. You can change your deductible for basic insurance without a health check and regardless of your state of health and ongoing medical treatments.
If you want to reduce your deductible, your notification must reach Sanitas by 30 November. Requests to increase your deductible must reach us by 31 December. Your deductible can only be changed with effect 1 January of the following year.
You can change the deductible for your basic insurance quickly and easily yourself in the Sanitas Portal. Interested? Sign up now and give it a go! Or you can adjust your deductible by filling out the form on our website.
Important: You can also choose a higher deductible for your supplementary hospital insurance and save money. However, you will have to answer the health questions gain if you want to reduce your deductible at a later date.
What is the difference between the deductible and copayment?
The copayment is the annual percentage you pay if the treatment costs exceed the deductible.The copayment is 10% of the treatment costs up to a maximum of CHF 700. It cannot be changed.
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:
|+ Copayment||+ CHF 170|
|Insured’s total costs
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:
You can use the Sanitas Generic drug finder to find out whether you have to pay an increased copayment for your medication.