An unexpected visit to the emergency room, prolonged physiotherapy or regular medication can completely change the real cost of your annual coverage. That's why understanding how the deductible works in Switzerland is not an administrative detail: it is one of the decisions that most influences what you pay for your basic health insurance.
The deductible does not define what treatments are covered by the insurance. The mandatory coverage is the same within the basic insurance, regardless of the insurer. What changes is the part of the expenses you assume before the insurer starts participating and, in return, the monthly premium you pay.
What is the basic insurance deductible
The deductible is the annual amount of covered medical expenses that you must pay on your own before basic insurance contributes to the costs. It operates per calendar year, from January 1 to December 31.
For an adult, the ordinary deductible is CHF 300. A higher deductible can also be chosen, up to CHF 2,500. For minors, the excess can be CHF 0 and go up to CHF 600.
The logic is straightforward: a high deductible usually lowers your monthly premium, while a low deductible usually increases your monthly premium. But a lower premium doesn't automatically equate to a lower total expense. The right choice depends on how often you're expected to use covered medical benefits and your ability to take on an unexpected expense.
How franchising works in Switzerland, step by step
Imagine you've chosen a deductible of CHF 1,500. During the year you receive medical bills covered by basic insurance totalling CHF 1,500. You pay that amount, following the billing process applicable to your insurer, doctor or pharmacy.
From that point on, the percentage share of the costs, known as the share fee, comes into play. Normally, the insured pays 10% of the additional costs covered. This fee has an annual limit of CHF 700 for adults and CHF 350 for minors.
In other words, for an adult, the usual maximum exposure for covered treatments can reach the chosen deductible plus CHF 700 share. If you have chosen a deductible of CHF 2,500, you should be able to afford up to CHF 3,200, in addition to monthly premiums.
In the event of hospital admission, a daily contribution may also be applied to the costs of stay for adults. There are exceptions, including those related to maternity and certain family cases. It is therefore useful to always check the invoice and the specific conditions before assuming that a cost must be paid in full.
A simple example
With a deductible of CHF 300, a person who has CHF 2,000 of covered medical expenses would pay the CHF 300 first. On the remaining CHF 1,700, they would pay 10%, i.e. CHF 170. Their share of these costs would be CHF 470, not counting the monthly premium and any applicable hospital costs.
With a deductible of CHF 2,500 and those same CHF 2,000 of expenses, the person would bear the full CHF 2,000. The advantage of this second option only appears if the reduction in the annual premium compensates for the increased risk of direct payment.
What expenses count towards the franchise
The deductible applies to benefits covered by statutory health insurance. These may include medical consultations, prescribed treatments, covered medicines, analyses, authorised therapies and certain hospital treatments.
Not all health expenses come in automatically. A medication without coverage, a benefit not recognized by basic insurance, comfort treatments or services covered exclusively by complementary insurance may follow different rules. It is also not advisable to confuse the health insurance excess with accident coverage, which may depend on your employment situation and the applicable policy.
The invoice also matters. In some cases, the supplier sends it directly to the insurer and you then receive your share. In others, you pay first and request reimbursement. Keeping invoices, explanations of benefits and receipts prevents you from losing sight of the amount already consumed from your excess.
The franchise restarts every year
On January 1, the deductible returns to zero. If you had already reached your annual amount in December, that advance does not carry over to the following year. This rule has a practical consequence: it is not enough to look at how much you have spent this year to decide on next year's deductible. You need to think about the likely use of medical care throughout the new year.
Changing your excess is usually possible for the following year, but it's subject to communication deadlines. Reducing the excess and increasing it may have different deadlines. Waiting until the end of the year can leave little room, especially if you're also reviewing the insurer or insurance model. Confirming dates ahead of time is a simple way to preserve options.
Excess, premium and insurance model: three different decisions
The excess is only one piece of the budget. The premium also depends on your age, your canton and premium region, accident coverage and the insurance model you choose.
Family doctor, HMO or telemedicine models may involve a different premium because they establish a first point of contact before going to certain specialists. They do not reduce mandatory benefits, but they do change the path you must follow so that care is managed according to the contracted model.
That's why two people with the same deductible can pay different premiums. One lives in another premium region, another has chosen telemedicine, and another needs to include accident coverage. Looking at just one figure doesn't allow you to understand the full cost.
A neutral comparator should show these variables separately and understandably. Clarity is not about showing a closed recommendation, but about allowing you to see why the price changes and what condition accompanies each option. No sponsored rankings. No business contacts requested by default.
How to Choose a Franchise That Fits You
There is no right franchise for everyone. The choice depends on a combination of foreseeable expenses, risk tolerance and available liquidity.
A low deductible can make sense if you plan for frequent consultations, ongoing treatments, regular medication or a well-known medical follow-up. It can also provide peace of mind if an unexpected expense of several thousand francs would affect your family budget.
A high deductible is usually more consistent for those who use covered medical care little and can set aside the amount necessary to deal with an eventuality. The key is not to assume that being healthy today guarantees a cost-free year, but to assess whether you could pay the difference without compromising rent, savings or essential expenses.
Before deciding, review your bills from the last year or two, but don't turn them into an accurate prediction. A year with few consultations may be followed by another with an injury, intervention, or unexpected therapeutic need. Prudent decision combines personal data and financial margin.
Errors that make the decision more expensive
The most common mistake is to choose the highest deductible only because of the monthly premium. The premium is visible every month; the extraordinary expense is not. If you do not have a sufficient reserve, the premium savings can feel limited when several bills arrive in a row.
It is also common to believe that a low deductible eliminates all payments. After the deductible is reached, the fee usually starts at 10% up to your annual limit. And if the treatment is not covered by the basic insurance, it may not enter into the calculation at all.
Another mistake is to ignore the conditions of the insurance model. Choosing telemedicine, HMO or family doctor can be a useful decision, but only if you are willing to respect the care circuit. In non-urgent situations, going directly to a specialist without following the procedure can raise doubts about reimbursement.
Frequently asked questions about the franchise
Does the deductible depend on the insurer?
Excess amounts are regulated for basic insurance. What may vary between insurers is the premium, digital experience, billing process, and service models available in your region.
Can I change the franchise during the year?
As a rule, no. The deductible is chosen for the calendar year and changes are made for the following period within the scheduled time frames.
Does a high deductible always reduce annual spending?
Not necessarily. It lowers the premium, but increases what you pay if you need medical care. It's worth comparing the annual premium savings with the additional cost you might assume in a high-usage scenario.
A good decision is not about guessing at the future doctor. It is about you understanding the favorable scenario, the probable scenario, and the difficult scenario before signing. When the data is verifiable and the conditions are clearly seen, the franchise is no longer a confusing figure and becomes a choice that you control.