Health insurance

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Health insurance: deductible rate and franchise

As I think the most important and yet most difficult insurance. In contrast to some other countries, in Switzerland everyone is responsible for their own health insurance. This means not only choosing the insurance, but also the general conditions and the transfer of the premiums is up to each person. Health insurance is one of the compulsory insurances.

Basic insurance and supplementary insurance

The benefits of basic insurance are defined by law and are the same for all health insurance companies. If you would like more benefits, special treatment or single rooms in hospital, you can take out supplementary insurance.

The level of contributions for the basic insurance depends on several factors. These include the level of the deductible rate, place of residence, doctor's model (family doctor system, etc.) and age. The salary is not a factor in Switzerland. There is no family insurance; health insurance must be taken out for each individual. Lower contribution rates apply for children and young people.

Health insurance companies differ not only in premiums, but also in the billing system, repayment period and additional services. The basic insurance can be changed every year to 31 December, the health insurance company is obliged to include everyone in the basic insurance. The cancellation must be received by 30 November. Be careful with supplementary insurance, however, as the health insurance company does not have to admit you to this insurance. The period of notice for the supplementary insurance depends on the contractual provisions.

Deductible and additional coinsurance

Very important for the insurance is the determination of a deductible rate. This is always between 300 and 2500 Swiss francs for adults. This amount determines up to what percentage you pay yourself before the insurance is even taken out. For children and young people up to 18 years of age, the deductible rate can be set between 0 and 600 Swiss francs.

As an example, I have a deductible of 300 francs and have received two medical bills of 200 francs each. I have to pay the first doctor's bill completely by myself and for the second bill, the health insurance will cover the 100 francs and will pay me back 90 francs. As the additional coinsurance is 10% after reaching the deductible rate, the insurance only pays me back 90 instead of 100 francs. The percentage of 10% is fixed and, unlike the additional coinsurance, is not selectable. The additional coinsurance is a maximum of 700 francs (children 350.-) per year. For medicines, the additional coinsurance is 20% if there is also a generic version of the original medicine.

It is therefore very advisable to build up your own reserves for the case of illness and to plan for it, so that you can pay the deductible rate and the additional coinsurance in case of an emergency and it will not ruin you. The higher the deductible rate you set, the more reserves you should set aside in case of an emergency. Important for accidents covered by non-workplace accident insurance and for general medical treatment from the 13th week of pregnancy until 8 weeks after the birth, no deductible rate and additional coinsurance need to be paid. For better illustration I will list a few case studies:

Example 1: deductible rate 500 francs and medical bills totalling 450 francs
450 invoice - 500 deductible = remaining deductible of 50
In this case, you'll pay for everything yourself.

Example 2: deductible rate 500 francs and medical bills totalling 1,000 francs
1'000 Invoice - 500 deductible = 500 reimbursable - 10% additional coinsurance = 450 payment
450 swiss francs will be returned to you by your health insurance

Example 3: Franchise 500 francs and hospitalisation and total invoices of 10'000 francs
10'000 Invoice - 500 deductible = 9'500 Refundable - 10% additional coinsurance (but maximum 700) = 8'800 Payout
8,800 swiss francs is refunded by the health insurance and accepted medical bills are covered by the health insurance for the rest of the year.

Supplementary dental insurance

As a rule, normal dental bills must be paid by the patient. Unless the dental treatment is the result of an accident or it is a serious unavoidable disease of the masticatory system. Most of the time you can rather assume that you are allowed to pay the bill yourself. If you want to insure yourself, you can take out supplementary dental insurance. But beware, the health insurance companies require a medical certificate about the state of health of the teeth for these services, so you usually only get this additional insurance if all teeth are healthy. Moreover, these insurances are quite expensive for adults and usually only cover a certain amount of treatment costs per year. They are therefore usually only worthwhile for children and young people.

Exemptions from compulsory health insurance in Switzerland

If one of the following situations applies, a person is exempt from compulsory insurance:

  • Employment exclusively in the EU/EFTA or simultaneous employment in Switzerland, which is less than 25%.
  • Pension from the EU/EFTA and no pension from Switzerland
  • Unemployment benefit from the EU/EFTA
  • Non-working family members of these persons, if they are either entitled to benefit assistance or have insurance cover equivalent to that provided under the KVG (Basic insurance)
  • Non-working family members of a person insured in the EU/EFTA in general, provided they are entitled to benefit assistance

 

My hint

If you are unsure about the model, it is best to choose Standard or Family Doctor. If you are employed by a single employer for more than 8 hours a week, choose "None" for accident coverage, as in this case the accident insurance is already covered by the employer.

I can give a personal tip for setting the deductible rate. If the medical costs are higher than 1'800 per year, it is best to choose 300 Swiss francs as a deductible and if you expect less than 1'800 medical costs, it is best to take 2'500 Swiss francs as a deductible. Basically, choosing a deductible is a bet on your own health. At the bottom line, when premiums and healthcare costs are added together, the right choice of personal deductible makes a maximum of 1,000 francs per year.

If required, I can arrange health insurance offers from my cooperations. If required, they offer you detailed advice and a very good price-performance ratio.