Understanding the Deductible (Franchise) in Swiss Health Insurance

In Switzerland, the deductible, known as the franchise, is a key component of your health insurance plan. It directly affects how much you pay out of pocket before your insurance starts covering your medical expenses. Choosing the right deductible can significantly impact your overall healthcare costs.

What Is the Deductible (Franchise)?

The deductible, or franchise, is the amount you must pay each year for your medical expenses before your health insurance starts contributing. Once you've reached this amount, your insurance will cover a portion of the remaining costs, typically with some form of cost-sharing, like a copayment or coinsurance.

Available Deductible Options

In Switzerland, you can typically choose from six deductible levels for adults (18 years and older):

• CHF 300 (minimum)
• CHF 500
• CHF 1,000
• CHF 1,500
• CHF 2,000
• CHF 2,500 (maximum)

For children, the deductible options range from CHF 0 (no deductible) to CHF 600.

How Does the Deductible Work? An Example

Let's say you choose a deductible of CHF 2,500. Here's how it would work in practice:

1. Annual Medical Costs Below the Deductible:
   If your total medical costs for the year amount to CHF 2,000, you would pay this entire amount out of pocket. Since you haven't reached your deductible, the insurance company doesn't contribute.
2. Annual Medical Costs Above the Deductible:
   If your total medical costs for the year are CHF 4,000, you would pay the first CHF 2,500 out of pocket (your deductible). After reaching this amount, your insurance would cover the remaining CHF 1,500, subject to any copayment (usually 10%, with a maximum of CHF 700 per year).

Choosing the Right Deductible: What to Consider

When deciding on the right deductible, consider the following factors:

1. Your Health and Medical Needs:
   • Frequent Medical Visits: If you anticipate regular doctor visits or have ongoing medical conditions requiring frequent care, a lower deductible (CHF 300 or CHF 500) might be more cost-effective. You'll reach your deductible quickly, and the insurance will cover more of your expenses.
   • Rarely See the Doctor: If you're generally healthy and rarely need medical care, a higher deductible (CHF 2,500) could be beneficial. You'll pay lower monthly premiums but will need to cover more of your initial costs out of pocket.
2. Monthly Premiums:
   The deductible you choose directly influences your monthly premium:
   • Lower Deductible (CHF 300): Higher monthly premiums, but lower out-of-pocket costs when you need care.
   • Higher Deductible (CHF 2,500): Lower monthly premiums, but higher out-of-pocket costs before your insurance starts to contribute.
3. Risk Tolerance:
   Consider how comfortable you are with potentially higher out-of-pocket expenses. If you prefer financial predictability and are willing to pay more each month for peace of mind, opt for a lower deductible.
4. Budget:
   Assess your budget and how much you can afford to pay both monthly and in case of unexpected medical expenses. A higher deductible might save you money on premiums but could strain your finances if you suddenly need extensive medical care.

Example Scenarios

• Scenario 1: Low Deductible (CHF 300)
  • Monthly Premium: CHF 400
  • Annual Medical Costs: CHF 5,000
  • Out-of-Pocket Costs: CHF 300 (deductible) + CHF 700 (maximum copayment) = CHF 1,000
  • Insurance Covers: CHF 4,000
• Scenario 2: High Deductible (CHF 2,500)
  • Monthly Premium: CHF 200
  • Annual Medical Costs: CHF 5,000
  • Out-of-Pocket Costs: CHF 2,500 (deductible) + CHF 250 (10% copayment on remaining CHF 2,500) = CHF 2,750
  • Insurance Covers: CHF 2,250

In this example, the lower deductible results in less out-of-pocket spending when you require significant medical care, but it also comes with higher monthly premiums.

Making the Decision

To choose the right deductible, weigh your personal health needs, financial situation, and risk tolerance. Consider using an insurance calculator or consulting with a broker to compare different scenarios and find the best balance between monthly premiums and out-of-pocket costs.

Contact our trusted recommended agents and brokers to get your best rates and customized quotes.

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