Health insurance premium

Health insurers must have their health insurance premium for basic insurance for the following year approved by the Federal Office of Public Health (FOPH) by the summer. To do so, they have to make a forecast for the business year ahead and make assumptions, for example about their customer base and expected healthcare costs.

Health insurance premiums for basic insurance are affected by the following factors:

• Age group
• Place of residence/ premium region
• Chosen insurance model (family doctor model, HMO model, telemedicine)
• Deductible

With supplementary insurance plans, a person’s sex also influences the health insurance premium. When it comes to supplementary insurance, insurance companies are allowed to set risk-based premiums.

You can use the Sanitas premium calculator to calculate your premium directly for different deductibles and insurance models.

The main reason for this increase is investment in medical advances. Thanks to innovative research, cutting-edge technology and effective drugs and medicines, illnesses can be treated more successfully than ever. To ensure treatment methods are accessible to everyone, all doctors need to be familiar with the latest technologies. We in Switzerland have a highly advanced healthcare system. We believe it’s worth the investment. This way, all insureds can be sure of always getting top-quality treatment – promptly and regardless of their income.

Another positive benefit of this medical progress is that life expectancy in Switzerland is increasing by an average of six weeks a year. So you personally can expect to live much longer than the previous generation. However, this demographic change also means higher costs.

For every 100 francs you pay in premiums, around 95 are invested directly in medical treatments, hospitalisation, nursing costs, medicines and lab expenses. The remaining five francs go towards administration costs and are invested directly in improving the quality of service provided by Sanitas. This benefits you, for example, by ensuring that your claims are reimbursed as quickly as possible! Sanitas uses the premiums for the benefit of your health.

The premium earnings – including your premiums – must be used to pay all the benefit costs incurred by insureds under basic insurance. The premium depends on the insurance structure. The cost of claims within a premium region affects the premium you pay. This means that premiums are higher in premium regions where insureds frequently go to the doctor.

• Advances in medicine and technology.
• Ageing population and higher life expectancy.
• Increasing amount of outpatient treatment in hospitals. The costs of outpatient hospital treatment are borne entirely by health insurance companies i.e. insureds, while the cost of inpatient treatment is largely financed by taxpayers’ money.
• Reserve regulations of the Federal Office of Public Health (FOPH).

• By opting for an alternative insurance model (AIM) you benefit from generous premium discounts and save money on your premium.
• Check whether it makes sense for you to choose a higher deductible . The higher the deductible, the lower your premium.
• You can find more money-saving tips here.