Franchise

How the Franchise Works in Mandatory Health Insurance

The mandatory health care insurance in Switzerland partially covers medical expenses. Policyholders pay an annual franchise and a coinsurance. Choosing a higher franchise leads to lower monthly premiums.

The Annual Franchise in Mandatory Health Insurance

When you avail medical services in Switzerland, such as doctor's visits, medications, or hospital stays, you contribute to the costs. In basic insurance, the standard franchise for adults is 300 Swiss Francs. For children under 18, there is no franchise.

With customizable cost-sharing options, you can effectively control your health insurance premiums in Switzerland. Within the framework of mandatory health care insurance (KVG), you as a policyholder have various franchise options to choose from. For children and adolescents up to 18 years, the range is from 0 to 600 Swiss Francs. Adults from 26 years can choose from franchises of 300, 500, 1'000, 1'500, 2'000, and 2'500 Swiss Francs, though the offerings may vary by insurance company.

In supplementary insurance, however, the conditions are differently structured. Here, there are no fixed franchises; instead, the health insurance covers the agreed services up to a certain annual maximum limit. This allows for a flexible and needs-based arrangement of your insurance benefits.

The Additional Coinsurance

The annual franchise is your first cost share for medical expenses. Once your health costs exceed this amount, the health insurance steps in, but with a coinsurance of 10% of the further costs, up to a maximum of 700 Swiss Francs for adults or 350 Swiss Francs for children. For a hospital stay, adults also pay a daily fee of 15 Swiss Francs.

For instance, if a franchise of 300 Swiss Francs is agreed upon, you cover the costs up to this amount yourself. Beyond that, you contribute with 10% to the further costs.

When switching basic insurance mid-year, your previous cost participation is taken into account.

When Is There No Cost Participation?

For mothers, cost participations are waived from the 13th week of pregnancy until eight weeks after birth. Also, for accidents, if there's accident insurance through the employer, no cost participation is required.

When Can You Change Your Franchise?

An adjustment of the franchise, whether an increase or decrease, is possible at the start of each year. The notification of a desired decrease must be submitted to the health insurance by no later than November 30th, for an increase by the last working day in December.

Comparing Franchises and Finding an Affordable Health Insurance

If you are rarely sick, a higher franchise can significantly lower your premiums. More frequent doctor visits or regular medication intakes make a lower franchise more sensible despite higher premiums. To find the ideal option for you, we support you with a comparison of insurance options.