Deductible and Co-pay Explained
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What do deductible and co-pay mean?
The deductible is a fixed annual amount that insured individuals must pay out of pocket before the health insurance provider starts covering costs. In Switzerland, adults can choose between CHF 300.-, 500.-, 1’000.-, 1’500.-, 2’000.-, and 2’500.-.
Once the selected deductible is reached, a 10 % co-pay applies to the remaining costs — capped at a maximum of CHF 700.– per year.
Example: If total healthcare costs amount to CHF 4’000.- in a calendar year and the maximum deductible of CHF 2’500.- was chosen, the cost breakdown is as follows:
Deductible: CHF 2,500.-
Co-pay: 10% of (CHF 4,000.- minus CHF 2,500.-) = 10% of CHF 1,500.- = CHF 150.-
Total out-of-pocket payment: CHF 2,650.-
Attention with medications
If a branded original drug is used when a generic version is available, the co-pay increases to 40 % of the medication cost, resulting in a significantly higher personal expense when opting for the more expensive original product.
Premium Discount with the Highest Deductible
By selecting the maximum deductible of CHF 2’500.-, policyholders can save up to CHF 1’540.- in annual premiums. This corresponds to the legally allowed maximum of 70 % discount on the difference in premiums between the lowest and highest deductible.
Which Deductible Makes Sense?
Practical analyses show that only the lowest deductible (CHF 300.-) or the highest deductible (CHF 2’500.-) are worthwhile in the long run. Mid-range options typically offer too small a discount to justify their drawbacks.
The maximum deductible (CHF 2’500.-) is advantageous if annual healthcare costs are below CHF 1’800.-
The minimum deductible (CHF 300.-) is more appropriate if annual healthcare costs are above that threshold, as the lower co-pay outweighs the smaller premium saving.
A simple calculation shows:
someone with CHF 1’800.- annual expenses will pay less with the high deductible because the premium savings exceed the additional out-of-pocket cost. If costs are higher, the lower deductible is the better choice
Deadlines for Changing the Deductible
To reduce the deductible (e.g., from CHF 1,500.- to CHF 300.-)
the request must be submitted to the insurer by the last working day in November.
To increase the deductible (e.g., from CHF 300.- to CHF 2,500.-)
the written application must reach the insurer by the last working day in December.
The change becomes effective on January 1 of the following year.
Tip: To avoid missing deadlines, submit your request well before the end of the month — ideally by mid-November or December — rather than waiting until the very last day.
Risks with the Maximum Deductible
Choosing the highest deductible means being prepared to pay up to CHF 3’200.- out of pocket (deductible plus maximum co-pay) in case of high medical costs.
If that amount cannot be covered immediately, the lower deductible may be the safer choice despite the smaller premium discount.
Conclusion
Choosing the right deductible is an effective tool for managing health insurance costs. Individuals who rarely use medical services benefit from the highest deductible (CHF 2’500.-) – despite the risk of paying up to CHF 3’200.- out of pocket in a single year.
For those with frequent doctor visits or chronic conditions, the lowest deductible (CHF 300.-) is generally more cost-effective due to lower co-pays.
The annual option to change the deductible enables adaptation to personal and financial circumstances, ensuring balanced and flexible cost management.
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