A lower health-insurance premium does not always mean a lower annual bill. Compare the premiums and your share of treatment costs together, then check whether your savings could cover an unexpected bill.
The Swiss term franchise means your annual deductible: the amount of eligible treatment costs you pay first. The co-payment is the additional share you usually pay after that. We will compare CHF 300 and CHF 2,500 deductibles using the same person and two hypothetical quotes, so you can repeat the calculation with your own figures.
The rules behind the calculation
For an adult under ordinary basic-insurance cost sharing, the standard deductible is CHF 300. After the deductible, the usual retention fee is 10%, capped at CHF 700 annually. Hospital contributions and special cost-sharing rules can apply separately, and some care is exempt. The FOPH explains these boundaries in FOPH: deductible, retention fee and cost-sharing exceptions.
Use the calculation below for ordinary eligible treatment subject to those rules. It excludes hospital daily contributions, non-covered care, supplementary benefits, maternity exemptions and medicines subject to increased retention. Those exclusions matter when matching the worksheet to your own situation.
A transparent comparison with hypothetical premiums
Suppose the same adult, postcode and care model produce these illustrative quotes: CHF 420 a month with a CHF 300 deductible, or CHF 300 with a CHF 2,500 deductible. The high-deductible option saves CHF 1,440 in annual premiums. These are example figures, not insurer offers.
For each row, add the annual premium to the treatment costs you pay up to the deductible, then add the usual 10% share above it, capped at CHF 700. The table uses ordinary adult cost sharing and the exclusions explained above.
| Annual eligible costs | Total with CHF 300 deductible | Total with CHF 2,500 deductible |
|---|---|---|
| CHF 0 | CHF 5,040 | CHF 3,600 |
| CHF 1,000 | CHF 5,410 | CHF 4,600 |
| CHF 2,000 | CHF 5,510 | CHF 5,600 |
| CHF 5,000 | CHF 5,810 | CHF 6,350 |
| CHF 10,000 | CHF 6,040 | CHF 6,800 |
Where the cheaper option changes in this example
At CHF 1,900 of ordinary eligible treatment costs, both options total CHF 5,500 for the year:
- CHF 300 deductible: CHF 5,040 premiums + CHF 300 deductible + CHF 160 co-payment.
- CHF 2,500 deductible: CHF 3,600 premiums + CHF 1,900 treatment spending.
With these example premiums, the higher deductible is cheaper below that point and the lower deductible is cheaper above it. CHF 1,900 is not a universal threshold. Recalculate with your actual quotes, including intermediate deductibles, and the treatment rules relevant to you.
Run a cash-reserve test as well
Under ordinary adult cost sharing, a CHF 2,500 deductible plus the usual CHF 700 retention cap creates CHF 3,200 of potential personal treatment spending, before separate charges and exclusions. With CHF 300, the comparable amount is CHF 1,000.
Ask whether you can meet a large bill without borrowing or missing essential payments. A household with several high deductibles should test a year in which more than one person needs treatment. Compare the cash demand with liquid savings, not your investment account’s hoped-for future return.
Use your treatment plan carefully
List known medication, regular appointments and planned treatment. Ask providers for estimates of eligible costs rather than using the amount you paid after reimbursement last year. An unusually healthy year is not proof that next year will be the same.
If pregnancy, a hospital stay or unusual medication rules affect the calculation, ask the insurer how those costs are treated. Do not delay medically necessary care to make the spreadsheet work.
Repeat the comparison with your own bills
- Choose quotes for the same person, postcode, care model and accident setting.
- Multiply each monthly premium by 12.
- List three treatment scenarios: a quiet year, your known treatment needs and an unexpectedly expensive year.
- Add the applicable deductible and co-payment to each premium total.
- Check whether the necessary cash reserve is available without borrowing.
Use the insurer’s total eligible treatment costs from previous statements, not only the net amount you personally paid. A CHF 400 bill after insurance reimbursement does not mean the underlying treatment cost was CHF 400.
Keep the scenario you chose and the reserve you need on one page. If the cheapest annual option would leave you struggling to pay a large bill, include that practical cost in your decision.
Timing and common questions
Deductible changes take effect at the start of a calendar year. A request to reduce the deductible must reach the insurer by 30 November; increasing it has different timing. Check the official FOPH: changing basic insurance — explanation and deadline table table and your insurer’s process.
Is the highest deductible always best for healthy people?
No. It depends on the premium saving, expected eligible costs and ability to absorb an unexpected bill.
Should everyone in my family select the same deductible?
No. Compare each person using their applicable rules and then test the combined household cash demand.
What should I save from the comparison?
The actual premiums, assumptions, cost scenarios and chosen reserve. That record explains your decision more clearly than a generic recommendation.
Related reading
Discuss your own position
Bring your current policies, relevant employer benefits and the questions raised by this checklist. Contact Swiss Prime International to discuss the next steps for your circumstances.
