Franchise health insurance

Health insurance deductible and co-payment: What is the difference?

Many search queries revolve around “health insurance deductible,” “health insurance deductible,” or “deductible.” This shows that confusion often exists in this area. The two terms are related, but they don’t mean the same thing.

The deductible is the first fixed cost component you pay yourself each year. Once your eligible healthcare costs exceed this deductible, the co-payment begins. In basic health insurance, this is generally 10 percent of the remaining costs, but no more than CHF 700 per year for adults. For children and adolescents, this limit is CHF 350.

In short:

The franchise is the fixed initial amount per year.
The deductible is the percentage share thereafter.

This also clearly answers the question about the definition of the health insurance deductible: The deductible is not the same as the co-payment, but rather the first part of your cost sharing. The co-payment only applies after the deductible has been reached.

Health insurance franchise model: Why does this system exist?

The deductible in health insurance is intended to make insured individuals contribute to healthcare costs and simultaneously create an incentive to be more cost-conscious. The mandatory health insurance system in Switzerland is financed through premiums, deductibles, co-payments, and other sources of funding such as cantonal premium subsidies.

For policyholders, this means in practice that they can influence how ongoing premiums and potential costs in case of illness are distributed by choosing the deductible. Those who opt for a high deductible usually pay lower premiums but initially bear more of the costs themselves in the event of illness. Those who choose a low deductible generally pay higher premiums but reduce their own risk when making a claim.

What franchises are available in Switzerland?

In everyday life, many people talk about the annual deductible or ask what it means. It always refers to the amount you pay yourself each calendar year. For adults, the standard deductible is CHF 300. Higher deductibles are also available, depending on the insurer. Children and teenagers have their own rules, particularly because they don’t have the same standard deductible of CHF 300 as adults and are also treated differently regarding the maximum out-of-pocket expenses.

For adults, the most relevant question in practice is whether the lowest or the highest franchise fee makes more sense. This is precisely where a franchise calculator is particularly valuable, because it considers not only the monthly premium but also the total annual costs.

What do the deductibles in health insurance mean in practice?

Theory is important, but the practical impact on everyday life is even more crucial. If you receive medical services through basic health insurance, the eligible costs are first applied to your deductible. For example, if you have chosen a high deductible and only have a few doctor’s visits, medications, or examinations per year, this option can be more economical due to the lower premium.

If healthcare costs rise, the picture changes. A lower deductible can then become more financially advantageous because you bear a smaller share of the direct treatment costs. This is precisely why many people search for terms like “deductible” and “co-payment explanation” or “health insurance deductible co-payment,” because the decision shouldn’t be based solely on gut feeling, but on actual figures.

Franchise calculator: not just explaining, but comparing in concrete terms

On this page you will find a franchise calculator that allows you to calculate the total annual cost per franchise for one person. This calculation considers not only the annual premiums, but the effective total cost including the annual premium, franchise fee, and deductible.

This is crucial. When deciding which health insurance deductible is best, it’s not enough to just look at the monthly premium. The overall picture is what really matters:

• Annual bonus
• chosen franchise
• Deductible
• Estimated annual healthcare costs
• Age or category
• Place of residence
• Model
• Accident coverage

This is precisely how a realistic picture of your effective annual costs emerges.

Why the highest or lowest franchise is often the most relevant

In practice, the lowest and highest franchise levels are usually the most attractive. The reason is simple: While the middle franchise levels often seem like a sensible compromise at first glance, they aren’t always the most financially appealing solution. Frequently, the best economic choice lies between the lowest and highest levels.

Our calculator therefore provides a clear classification and a break-even point. This figure shows up to which annual healthcare costs the high deductible is cheaper and from which point the low deductible becomes the more economical choice.

A typical example from the computer:

For healthcare costs up to CHF 2,010.67, the highest deductible of CHF 2,500 is more advantageous. For healthcare costs exceeding this amount, the lowest deductible of CHF 300 is more advantageous.

This is particularly helpful for users because the question no longer remains abstract. Instead of just reading about what a franchise is, they receive direct, comprehensible decision-making support.

Example for classification: Swiss health insurance franchise

Let’s take a person residing in 6005 Lucerne, born in 2004, with the Premed-24 model policy from Helsana, accident coverage, and annual healthcare costs of CHF 2,000. The calculator shows in this example that the highest deductible of CHF 2,500 is cheaper overall than the lowest deductible of CHF 300.

Why? Because in this case, the savings on the annual premium are greater than the additional out-of-pocket costs for healthcare. At the same time, the break-even point clearly shows where the turning point lies. This is exactly the kind of information people are looking for when they Google terms like “health insurance franchise,” “Switzerland franchise,” or “health insurance franchise.”

Health insurance franchise: Consider not only the premium, but also the risk.

Even if a high deductible seems advantageous on paper, it must be financially manageable. Those opting for the highest deductible should have sufficient reserves in case of emergency. Individuals with a high deductible should be prepared to pay up to CHF 3,200 out of pocket in the event of illness, i.e., CHF 2,500 deductible plus a maximum co-payment of CHF 700.

That’s an important point. The best health insurance deductible isn’t just the mathematically cheapest option, but the one that also suits your financial stability. A low premium is of little use if high medical bills suddenly become a burden when you’re sick.

Deductible: What else is important when it comes to medications

Regarding health insurance deductibles and co-payments, there is one point that is often forgotten: For certain medications, instead of the usual co-payment of 10 percent, an increased co-payment of 40 percent may apply if a more expensive original preparation is obtained, even though an interchangeable drug with the same active ingredient composition is available.

This is important in practice because it shows that cost sharing is not only made up of the franchise and normal deductible, but can be higher in individual cases.

Deductible and accident: when deductible and excess apply

If you have accident insurance through your health insurance provider, deductibles and co-payments also apply to accident treatments covered by your health insurance. This differs if a separate accident insurance policy is responsible for coverage. In that case, these cost-sharing arrangements under the accident insurance policy do not apply in the same way as those covered by your health insurance. Deductibles and co-payments therefore only apply if the accident is covered by your health insurance.

Special rules during pregnancy and maternity

Another important point to consider when looking at a good Swiss health insurance deductible website is the exemptions to cost sharing. For specific maternity services, there is no deductible, co-payment, or hospital contribution. From the 13th week of pregnancy until eight weeks after birth, cost sharing is also waived for general medical and nursing care services in case of illness.

This is particularly relevant for expectant families, because franchise planning often needs to be reassessed during this phase of life.

Vaccinations since 2026: Deductible eliminated, co-payment remains

Since January 1, 2026, certain prophylactic vaccinations are no longer subject to a deductible. However, the 10 percent co-payment remains due.

This is a good example of how current regulatory developments can always play a role in the topic of health insurance deductibles.

When can the franchise be changed?

A franchise change is only possible at the beginning of a new calendar year. The franchise cannot be freely adjusted during the year.

For the change to be implemented effectively, it’s crucial that the application reaches the health insurance company in a timely manner. In practice, a distinction is made between increasing and decreasing the deductible. Since deadlines and formal requirements must be strictly adhered to depending on the situation, the application should always be submitted well in advance. Anyone wishing to change their deductible shouldn’t wait until the last minute.

Why a franchise calculator is better for making a decision than general tips

On the internet you often read simple statements like:

The high franchise fee is worthwhile for healthy people.
A low deductible is worthwhile when healthcare costs are high.

That’s generally true, but it’s too simplistic. The right decision always depends on the specific premium, the policy model, the place of residence, age, and expected healthcare costs. A deductible calculator is therefore significantly more precise than general rules of thumb.

He makes visible:

• how high your annual premium is per franchise
• how much the net monthly premium changes
• what total costs you will incur in your healthcare expenses
• where the break-even point lies between low and high franchise
• which franchise is most affordable in your specific case

Especially for search queries like “franchise health insurance”, “health insurance franchise” or “franchise Switzerland”, this is the most practical form of decision support.

For whom is a high franchise worthwhile?

A high deductible can be advantageous if you anticipate low healthcare costs, have financial reserves, and consciously prefer a lower monthly premium. This is particularly attractive if your healthcare costs are below the break-even point indicated by the calculator.

However, this doesn’t automatically mean that a high deductible is the best choice. Those with predictable, ongoing medications, who frequently require medical services, or who have to manage a tight budget may find a lower deductible more convenient, even if the monthly premium is higher.

For whom is a deep franchise beneficial?

A low deductible is often advisable if higher healthcare costs are expected or if financial predictability is more important than the lowest possible monthly premium. It reduces the risk of high out-of-pocket expenses in case of illness and can be the more economical solution, especially for regular treatments.

People who consciously want to avoid a high cost risk often choose the lowest deductible. Even if the annual premium is higher, their maximum payout in the event of a claim is clearly limited.

What makes this page better than a simple dictionary explanation?

Many websites simply define what a franchise is. That’s no longer sufficient for a good user experience and strong SEO. Those searching for “franchise health insurance definition,” “what franchise health insurance means,” or “franchise and deductible explanation” are usually looking for three things at once:

• an understandable definition
• a practical classification
• a help in making one’s own decision

That’s precisely why this page combines explanation and calculator. Users not only receive knowledge, but also a concrete application. This improves both the relevance for search engines and the usefulness for AI systems that evaluate content based on clarity, completeness, and practical usability.