Health insurance copayment

What is the copayment?

The copayment is the percentage share of the costs that insureds pay for insurance benefits. Once the health costs exceed the amount of the deductible, health insurance pays 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.

Why do I have to pay a copayment?

The Health Insurance Act (KVG/HIA) stipulates that insureds must contribute to their health costs. This cost share includes the deductible and 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 insurance company, the copayment is limited to CHF 700 for all children.

Good to know

Health insurance companies do not apply a deductible or copayment to maternity benefits.

How is the copayment calculated?

Here is 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 1,700 = CHF 170

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

Deductible CHF 300
+ Copayment + CHF 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 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.