Franchise in Swiss Health Insurance

How the franchise fits into compulsory health insurance

Every person residing in Switzerland must take out compulsory basic health insurance, known as LAMal in French or KVG in German, generally within three months of arrival. The franchise is one of two cost elements you pay directly, alongside the cost-sharing percentage that applies once the franchise is used up.

For adults, the ordinary franchise levels are set by the Federal Office of Public Health and run from a minimum of CHF 300 up to a maximum of CHF 2,500 per calendar year, in fixed steps. Children up to age 18 are covered under their own, lower scale, with a minimum franchise of CHF 0.

The cost-sharing rule that applies above your franchise

Once your medical costs for the year pass your franchise, you do not move to full coverage immediately. A cost-sharing percentage, generally 10 percent of further costs, still applies until you reach an annual cap of CHF 700 for adults and CHF 350 for children, after which basic insurance covers the rest for the remainder of that calendar year.

This two-step structure, franchise first and then cost-sharing up to a cap, is why two people with the same franchise can still end up paying different amounts out of pocket in a given year, depending on how much care they actually use.

Choosing a franchise as a newcomer to Switzerland

There is no single correct franchise for everyone. If you expect few medical visits and want the lowest possible monthly outlay, a higher franchise can make sense, provided you could comfortably cover that amount if an unexpected treatment arose. If you have young children, ongoing treatment, or simply prefer predictable monthly costs, a lower franchise usually suits you better.

Your choice is normally fixed for the calendar year, with a change only possible at the next renewal date, so it is worth thinking through your household's likely needs, not just the premium quoted on day one.

• •Compare the premium difference between franchise levels, not just the headline monthly figure
• •Factor in dental, maternity, or ongoing treatment needs that compulsory insurance may only partly cover
• •Remember that each family member, including children, needs their own franchise decision
• •Check the renewal deadline so you are not locked into an unsuitable level for another year

Common pitfalls for expats and families

New arrivals sometimes confuse the franchise with the total amount they could ever pay in a year, overlooking the cost-sharing percentage and cap that still apply above it. Others select their franchise based on price comparison sites alone, without checking that the insurer and the specific product cover their situation, such as cross-border work or an existing treatment plan.

Coordinating health insurance with the rest of your relocation, alongside your permit, employer's requirements, and family situation, is where a specialist adds the most value.