First there is the ordinary, legally prescribed annual deductible of CHF 300.
The franchise is a fixed annual amount and therefore a base fee that all adults aged 19 and over have to pay for their own healing costs each year.
The annual deductible applies to all services that are paid for from basic insurance, i.e. for doctor and hospital bills, medication, glasses, nursing home and Spitex bills as well as for gynecological preventive medical examinations, but also for r Accident treatment if no compulsory accident insurance pays.
Tip: Children up to the age of 18 do not have to pay a franchise (parents can, however, voluntarily conclude a franchise for their children).
The rules of the deductible
In addition to the annual deductible, there is a deductible of 10 percent, which is also required by law, also for children.
This means: If the insured has already paid off his franchise in the calendar year in question, he must continue to take over 10 percent of each invoice himself (in exceptional cases 20 percent).
This deductible is open to adults over 19 limited to a maximum of 700 francs per calendar year (350 children per year).
Three examples
Example 1: If you go to the doctor once a year and receive an invoice for CHF 290, you pay everything yourself.
Example 2: Anyone who presents a single medical bill of CHF 400 per year will receive a refund of CHF 90 rather than CHF 100 (400th minus annual deductible, 300th minus 10 percent deductible, based on the remaining amount).
Example 3: If the medical costs are CHF 2,000 per calendar year, you pay an annual deductible of CHF 300, plus a deductible of CHF 170 (10 percent of € 1,700). This results in a total cost sharing of CHF 470. The rest of CHF 1,530 is covered by health insurance.
Exceptions in the overview
All services in the event of maternity or for certain measures of medical prevention are exempt from paying the franchise fees and the deductible. In the context of inpatient treatment in a hospital, there is also a cost contribution of CHF 15 per day as hospital amount. Children up to the age of 18, trainees up to the age of 25 and expectant mothers for medical services during maternity are also exempt from paying the amounts.
Franchise and deductible: the intention
In addition to the premiums, the franchise and deductible model has proven itself as an additional financing instrument for social health insurance. The primary aim of this is to support policyholders' personal responsibility and cost awareness.
Already compared? No?! Arrange health insurance comparison and save CHF 1,000!
