Health insurance: Co-payment for persons resident in Switzerland

Policyholders’ co-payment takes the form of a deductible, a retention fee and a contribution to the costs of hospital stays. 

Co-payment

Services are subject to co-payment by policyholders. This comprises:

• Standard deductible: CHF 300 per year (children and adolescents under 18 are exempt). For insurance models with reduced premiums, optional higher deductibles may be chosen.
• A retention fee of 10% of the costs exceeding the deductible, up to a maximum of CHF 700 per year (CHF 350 for children and adolescents under 18).
  
• Contribution to the costs of a hospital stay: CHF 15 per day (with no time limit). Children and adolescents under 18, young adults up to the age of 25 in education/training, and women receiving maternity-related services are exempt.
  

Services not subject to co-payment

Certain services are not subject to co-payment:

• Specific maternity-related services, such as routine examinations during and after pregnancy (including ultrasound scans), childbirth, obstetric care, antenatal classes and breastfeeding consultations.
• From the 13th week of pregnancy until 8 weeks after childbirth, women are exempt from co-payment for general medical services. This includes the costs of treatment for non-pregnancy-related illness.
• Certain preventive measures are also fully covered.
  

Increased retention fee for certain medicines

A retention fee of 40% is applicable for certain medicines, except in cases where a branded product is specifically prescribed by a physician for medical reasons.

Links

FAQ cost sharing

Legislation

Ordinance on Health Insurance (OAMal; RS 832.102), 103 - 105

Last modification 18.07.2024