Choosing Your Swiss Health Insurance Franchise

How the franchise works under compulsory health insurance

The franchise is the portion of your annual healthcare costs that you pay out of your own pocket before your compulsory insurance (LAMal/KVG) starts reimbursing. It resets every calendar year on 1 January, regardless of when you joined your insurer or when you last used the deductible.

Costs that count towards the franchise include most medical consultations, prescribed medication, hospital stays in the general ward, and laboratory tests billed under compulsory insurance. A small number of preventive services, such as certain vaccinations and screenings defined by federal ordinance, are exempt and reimbursed from the first franc.

• •The franchise applies per insured person, not per household
• •It is set once a year when you choose or confirm your policy
• •Unused franchise does not carry over or reduce future years

The franchise levels available to adults and children

For adults, Swiss insurers must offer a standard franchise and a set of optional, higher franchises. Choosing a higher franchise reduces your monthly premium, because you are agreeing to cover more of your own costs before the insurer contributes.

For children, the range starts at zero, since a child can be insured with no annual deductible at all, which many families choose given how unpredictable paediatric costs can be.

The co-payment on top of the franchise

Once you have paid your franchise for the year, you do not move to full reimbursement immediately. Compulsory insurance then applies a co-payment, generally 10 percent of costs above the franchise, until an annual ceiling is reached.

This ceiling is capped by law, separately for adults and children, so your maximum out-of-pocket exposure in a given year is the franchise you chose plus this capped co-payment. Hospital stays also carry a separate daily contribution towards accommodation and meals, which is not affected by the franchise you select.

Deciding which franchise to choose

There is no single correct answer, because the right franchise depends on how often you expect to see a doctor, whether you take regular medication, whether you are planning a pregnancy or surgery, and how much monthly premium relief actually matters to your budget.

As a general principle, a low franchise suits people who expect regular medical costs during the year, including families with young children, people managing a chronic condition, or anyone planning a procedure they know is coming. A higher franchise suits people in good health who rarely consult a doctor and who would rather pay a lower premium every month and accept the risk of a larger bill in an exceptional year.

This is also one of the areas where new arrivals in Switzerland make avoidable mistakes, often because they choose an insurer and franchise under time pressure in their first weeks, without comparing what their actual usage is likely to be.

When and how you can change your franchise

You can change your franchise once a year, with the change taking effect on 1 January of the following year. Insurers generally require notice by a set deadline in the preceding autumn, so this is a decision to revisit annually rather than something fixed forever.

If your circumstances change significantly during the year, such as a new pregnancy or diagnosis, it is worth reviewing your franchise ahead of the next renewal date rather than waiting until costs have already accumulated.