Even after paying your monthly basic insurance premiums (LAMal), you are responsible for a portion of the medical expenses generated. These expenses are divided into Excess and Part Fee (Copayment).
The Franchise (Franchise)
The deductible is the annual amount you must pay entirely out of your own pocket for medical visits and medications before the insurance begins to reimburse.
- The legal minimum for adults is 300 CHF.
- The maximum for adults is 2500 CHF.
- If you choose a low deductible (CHF 300), your monthly premium will be high. If you choose the highest one (CHF 2,500), you will pay less each month for insurance, in the hope of not getting sick.
Statistical tip: It is not usually profitable to take intermediate franchises. Generally, you opt for 300 (if you think you will have a lot of expenses) or 2500 (if you are very healthy).
Co-payment (Quote-part / Selbstbehalt)
Once you exhaust your deductible (for example, you have already spent CHF 2,500 on doctors), the insurance covers the costs, but you must pay the 10% of the remaining amount. This is the co-payment.
Fortunately, this 10% is capped annually at 700 CHF for adults (350 CHF for children).
Hospital Expenses
If you are hospitalized, you will have an additional fixed charge of CHF 15 per day of hospitalization (contribution to living expenses), applicable regardless of the deductible or co-payment.