Health

Everything you need to know about deductibles and excesses

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Everyone living in Switzerland must have health insurance. If you start looking into health insurers, you’ll soon come across the words “deductible,” “excess” and “health insurance premium.” We’re here to tell you everything you need to know.

How the Swiss healthcare system is funded

Deductibles, excesses and premiums are key financing elements of the Swiss healthcare system. In addition to paying a monthly insurance premium to their health insurer, insured people in Switzerland also help fund the healthcare they receive.

They do this through these three main forms of payment: 

  • Deductible: A deductible is a fixed amount insured persons pay each year toward the cost of any healthcare treatment received. Insureds can choose a deductible of between CHF 300 and CHF 2,500.
  • Excess: If they go over their deductible, insureds must pay 10% of the healthcare and treatment costs up to an annual maximum of CHF 700 for adults and CHF 350 for children.
  • Hospital co-payment: Insureds pay CHF 15 per day for a hospital stay. Exception: Insureds who are younger than 18 or students under the age of 25.

What is a deductible?

A deductible is a fixed amount that each insured must pay every year toward their medical costs.

In Switzerland, deductibles range from a minimum of CHF 300 to a maximum of CHF 2,500. Once you exhaust your deductible, your health insurance will pay all further costs up to your excess.

The deductible amount you choose influences the amount of your mandatory monthly health insurance premium. Deductibles and premiums are inversely related: 

  • low deductible = high premium
  • high deductible = low premium

In other words, by choosing a higher deductible, insureds pay a greater share of treatment costs, but have a lower insurance premium in return.

Conversely, insureds with a low deductible pay higher monthly premiums. So with a low deductible, an insured person will only have to pay their monthly premium plus the costs of any treatment up to the amount of their chosen deductible (e.g. CHF 300). Children under the age of 18 do not have to pay a deductible. That said, for children it’s also possible to choose a higher deductible of up to CHF 600.

When and how can I change my deductible?

Deductibles can be changed on January 1 of the following calendar year.It’s important to know that you must inform your insurer that you want to lower your deductible by the last business day in November. If you want to raise your deductible, you must notify them by the last business day in December.Most health insurers let you do this online.

AXA’s switching service does this for you – and we can find you a cheaper health insurer if you would like us to.

What is an excess?

The excess is the share of treatment costs that you have to pay yourself once you max out your deductible.

How much is the excess?

Once the deductible is exhausted, your health insurance pays for all healthcare and treatment costs, with the exception of the excess. The excess you have to pay amounts to 10 percent of what you owe up to a maximum of CHF 700 for adults and CHF 350 for children under 18.

Here’s an example: Your deductible is CHF 300. You receive an invoice for CHF 500 for your treatment. In this case, you pay the first CHF 300 yourself because this is the amount of your deductible. Of the remaining CHF 200, your health insurer pays CHF 180, while you are liable for 10% or CHF 20.

The deductible you choose has no impact on the percentage of the excess. But there is one exception: certain medications for which a generic version is available may require a deductible of 20 percent for the name brand medication.

What the …? Health insurance: What's the difference between a deductible and a co-payment?

What is a hospital stay co-payment and how much is it?

As the name implies, hospital stay co-payments are owed when you stay in a hospital. Insureds pay CHF 15 a day for their stay in a hospital. There is no limit to this hospital co-pay. Which means that no matter how long you spend in the hospital, you must pay CHF 15 for each day of your stay. 

Children under the age of 18, students up to age 25 and women who are drawing maternity benefits are exempt from this hospital co-pay. 

Hospital co-pay during pregnancy: key information

Certain maternity benefits are exempt from the hospital co-pay. Some examples are prenatal and postnatal checkups, the birth itself, obstetric care or courses on how to prepare for having or nursing a baby. 

The 13th week of pregnancy to the 8th week after birth are fully exempt from this hospital co-pay – regardless of whether the benefits being drawn are maternity benefits or not. You can read more about this in the article “Pregnancy: What does your health insurance cover?”.

What is a premium and how much is it?

In addition to paying a deductible, insureds must also pay a certain amount to their health insurer every month. This payment is known as an insurance premium, or just premium. In exchange for paying this premium, the insured receives insurance protection.In Switzerland, insurance coverage and the benefits that the health insurer must provide under basic health insurance are regulated by the government. In other words, regardless of which health insurance company you go with, the benefits you receive from your basic health insurance will be the same.Premiums are calculated based on various factors such as where you live, the excess you choose and the type of insurance plan you have. The premiums are lower for young people under the age of 25 and for children. 

But even if the benefits are the same everywhere, the premiums vary greatly from health insurer to health insurer. If you switch to a cheaper health insurer every year, you can save an average of CHF 477 annually.

Takeaway: Deductible, excess, hospital co-payment and premium

The terms and their meaning can be best understood by way of an example: 

Let’s say your current healthcare and medical treatment costs are CHF 1,700 a year. This includes a two-day stay in the hospital. You have the lowest deductible from your health insurer. 

So your share of these healthcare costs can be broken down like this:

  • Deductible = CHF 300: You pay your healthcare costs up to the amount of your chosen deductible.
  • Excess = CHF 137: This amounts to 10 percent of the costs that go over your deductible. In this example, this is 10 percent of CHF 1,400.
  • Hospital co-pay = CHF 30: This is for the two days that you spent in the hospital.

Your health insurance will pay for the remaining CHF 1,233.Ultimately, however, you also pay for your health insurance through your monthly insurance premium.

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