Deductible and copayment

What is the deductible?

The deductible is the fixed annual amount that insured persons pay towards their treatment costs. The deductible ranges between CHF 300 and CHF 2,500 per calendar year. The lower your deductible, the higher your monthly premium, but the lower your cost share will be.

How high is the deductible in Switzerland?

Insureds can choose one of the following deductibles for basic insurance. The amount of the deductible influences the amount of the health insurance premium. You can opt for a higher deductible to benefit from attractive premium discounts.

Children 0 100 200 300 400 500 600
Adult
 300 500 1,000 1,500 2,000 2,500  

Children and adult deductibles (in CHF)

Which deductible should I choose?

You are free to choose your deductible. Both a high and a low deductible can be financially worthwhile.

  • Example of a high deductible

    Person A has basic insurance with Sanitas with a deductible of CHF 2,500. They receive a medical bill for CHF 2,000.

    Medical bill
    		 CHF 2000  
    - Deductible (remaining deductible CHF 500) - CHF 2000 To be paid by person A
    Interim result CHF 0  
    - Copayment - CHF 0 To be paid by person A
    Final result
    		 CHF 0 To be paid by Sanitas

    Person A also receives a physiotherapy bill for CHF 600.

    Physiotherapy bill CHF 600  
    - Deductible (deductible has been exhausted.) - CHF 500 To be paid by person A
    Interim result
    		 CHF 100  
    - Copayment (10% of CHF 100, up to max. CHF 700) - CHF 10 To be paid by person A
    Final result
    		 CHF 90 To be paid by Sanitas

    Person A pays CHF 2,510 for both bills. Sanitas covers the remaining amount of CHF 90.

    It makes sense to choose a high deductible for health insurance when your health costs tend to be low. You benefit from an attractive discount on your basic insurance premium.

  • Example of a low deductible

    Person B has basic insurance with Sanitas with a deductible of CHF 300. They receive a medical bill for CHF 2,000.

    Medical bill
    		 CHF 2,000  
    - Deductible (deductible has been exhausted.) - CHF 300 To be paid by person B
    Interim result
    		 CHF 1,700  
    - Copayment (10% of CHF 1,700, up to max. CHF 700) - CHF 170 To be paid by person B
    Final result CHF 1,530 To be paid by Sanitas

    Person B also receives a physiotherapy bill for CHF 600.

    Physiotherapy bill
    		 CHF 600  
    - Deductible (deductible has been exhausted.) - CHF 0 To be paid by person B
    Interim result
    		 CHF 600  
    - Copayment (10% of CHF 600, up to max. CHF 700) - CHF 60 To be paid by person B
    Final result CHF 540 To be paid by Sanitas

    Person B pays CHF 530 (CHF 300 + CHF 170 + CHF 60) for both bills. Sanitas covers the remaining CHF 2,070.

    It makes sense to choose a low deductible for health insurance when your health costs tend to be high. This means that basic insurance contributes more to your health costs. In case of a claim, the costs you have to pay will be lower.

How can I change my deductible?

You can choose a new deductible for basic insurance each year. You can change your deductible for basic insurance without a health check and regardless of your state of health and ongoing medical treatments.

If you want to reduce your deductible, your notification must reach Sanitas by 30 November. Requests to increase your deductible must reach Sanitas by 31 December. Your deductible can only be changed with effect 1 January of the following year.

You can change the deductible for your basic insurance quickly and easily yourself in the Sanitas Portal. Interested? Sign up now to get started straight away. Or you can change your deductible on our website.

What is the difference between the deductible and copayment?

The deductible is the insured person’s contribution to healthcare costs. Once this amount has been exhausted, the health insurance company covers 90% of the costs under basic insurance. Insureds have to pay the remaining 10% of the costs. This cost share is known as the copayment.

What is the copayment?

You pay a copayment as soon as your chosen deductible is exhausted. From this point, insured persons pay 10% of their treatment costs, up to a maximum of CHF 700 per year (children up to CHF 350). This cost share is known as the copayment.

How high is the copayment?

The copayment is 10%. For original drugs for which a generic is available, the copayment is 40%.

The maximum copayment per year is CHF 700 for adults and CHF 350 for children. Once more than two children in a family are insured with the same company, the copayment is limited to CHF 700 for all children.

  • How the copayment is calculated: an example

    An insured has health costs of CHF 2,000 in one year. He has chosen the minimum deductible of CHF 300.

    Total health costs CHF 2,000
    Minus deductible (e.g. CHF 300) - CHF 300
    Remaining costs CHF 1,700

    Of the remaining costs, the insured has to pay a copayment of 10% (up to a maximum of CHF 700 per year).

    10% copayment of CHF 1700 = CHF 170

    In this case, the insured’s healthcare costs amount to:

    Deductible CHF 300
    + Copayment + 170
    Insured’s total costs CHF 470

For which medicines do I not have to pay a higher copayment?

The copayment for generic drugs is usually 10%, compared to 40% for original drugs.

The higher copayment for original drugs does not apply:

  • If no generic drug is available
  • If an original drug cannot be replaced by a generic drug for medical reasons. In this case, a special prescription is required from the doctor.
  • If the price difference between the original drug and the generic is less than 30%.

You can use the Sanitas Generic drug finder to find out whether you have to pay an increased copayment for your medication.

What is the hospital copayment?

The hospital copayment is an additional cost share incurred during a hospital stay. Adults aged 18 and over who are not in education and aren’t receiving maternity benefits pay CHF 15 per day towards the cost of their stay. More information about the hospital copayment.

What cost share is applied for maternity benefits?

Health insurers do not apply a deductible or copayment to maternity benefits. This means that during pregnancy, no deductible is applied to maternity-related benefits. For health insurance purposes, maternity begins at the 13th week of pregnancy and ends eight weeks after the birth. This also applies to illnesses and complications related to pregnancy and the birth.

Important: Let Sanitas know in good time if you are pregnant so that you are not charged the deductible and copayment. You will find a wealth of information on maternity topics here.