Understanding the Deductible (Franchise) in Swiss Health Insurance

What Is the Deductible (Franchise)?

The deductible (called Franchise in German, franchise in French) is the fixed annual amount you must pay out of your own pocket before your health insurer starts covering your medical costs. It resets every year on January 1.

When you visit a doctor, go to the hospital, or fill a prescription, you first pay the full cost yourself until you have reached your annual deductible. After that, your insurer covers the remaining costs — minus a 10% co-payment up to a yearly cap.

The key trade-off: a higher deductible means lower monthly premiums, but more financial risk if you need medical care. A lower deductible means higher monthly premiums, but more predictable costs if you get sick.

This mechanism exists to create cost awareness: if you have some "skin in the game," you are less likely to seek unnecessary medical care, which keeps overall system costs lower for everyone.

Swiss health insurance deductible calculation

All Deductible Levels for Adults (2026)

Swiss law defines exactly six deductible options for adults (age 19+). You choose one when you sign up or switch your insurance.

Franchise (CHF)	Monthly Premium Savings vs. 300	Annual Premium Savings vs. 300	Max. Out-of-Pocket	Break-Even Medical Costs
300 (minimum)	—	—	CHF 1,000	Always cheapest if costs > CHF 3,500
500	~ CHF 25	~ CHF 300	CHF 1,200	~ CHF 2,800
1,000	~ CHF 55	~ CHF 660	CHF 1,700	~ CHF 2,200
1,500	~ CHF 85	~ CHF 1,020	CHF 2,200	~ CHF 1,800
2,000	~ CHF 110	~ CHF 1,320	CHF 2,700	~ CHF 1,500
2,500 (maximum)	~ CHF 135	~ CHF 1,620	CHF 3,200	~ CHF 1,200

How to read "Break-Even Medical Costs": If your annual medical expenses are below this amount, the higher deductible saves you money overall (premiums + out-of-pocket). If your expenses exceed it, the lower deductible is cheaper. Premium savings shown are approximate averages and vary by canton and insurer.

The Co-Payment (Selbstbehalt) Explained

After you reach your deductible, you are not completely free from costs. Here is how the co-payment works.

10% Co-Payment, Capped at CHF 700

Once your annual deductible is exhausted, you continue to pay 10% of all subsequent medical costs. This 10% contribution is called the Selbstbehalt (co-payment). For adults, the co-payment is capped at CHF 700 per year. Once you have paid CHF 700 in co-payments (on top of your deductible), your insurer covers 100% of all further approved costs for the rest of the calendar year.

For children (under 18), the co-payment cap is CHF 350 per year. There is no co-payment for maternity-related costs — these are covered at 100% from the first franc once the pregnancy is confirmed.

Maximum Annual Out-of-Pocket Calculation

Your maximum possible annual out-of-pocket cost is: deductible + co-payment cap + monthly premiums. For an adult with a CHF 2,500 deductible, this means: CHF 2,500 (franchise) + CHF 700 (max co-payment) = CHF 3,200 in direct medical costs, plus your monthly premiums. After CHF 3,200, insurance covers everything at 100%.

With a CHF 300 deductible: CHF 300 + CHF 700 = CHF 1,000 maximum direct medical costs. The certainty of lower out-of-pocket costs comes at the price of higher monthly premiums — typically CHF 1,200–1,600 more per year compared to the CHF 2,500 deductible.

Example: You have a CHF 1,500 deductible. In March, you have medical costs of CHF 2,000. You pay the first CHF 1,500 (your deductible). The remaining CHF 500 is covered by insurance at 90%, meaning you pay 10% = CHF 50 (co-payment). Total out-of-pocket for this visit: CHF 1,550. If you later incur another CHF 5,000 in costs, you pay 10% co-payment on that = CHF 500. Your total co-payments for the year are now CHF 550, still below the CHF 700 cap. From this point, any additional costs have a 10% co-payment until you hit the CHF 700 cap.

When Does a High Deductible Make Sense?

The decision depends on your expected medical costs, risk tolerance, and financial situation.

CHF 2,500 Is Best If...

You are generally healthy and visit the doctor less than twice a year. Your annual medical expenses (excluding premiums) are consistently below CHF 1,200–1,500. You have the financial buffer to cover CHF 3,200 in a worst-case year. You are young (under 40) with no chronic conditions. You are comfortable accepting some financial risk in exchange for guaranteed monthly savings of CHF 100–135. You view health insurance as catastrophe protection rather than a daily-use product.

With the CHF 2,500 deductible, you save CHF 1,200–1,620 per year in premiums compared to the CHF 300 option. Even in a "bad year" where you use CHF 3,000+ in medical services, the premium savings still partially offset the higher out-of-pocket costs.

CHF 300 Is Best If...

You have a chronic condition requiring regular treatment (diabetes, asthma, ongoing physiotherapy). You take expensive medications regularly. You expect a planned surgery, pregnancy, or significant medical event this year. You have children who visit the pediatrician frequently. You prefer predictable monthly costs over potential out-of-pocket surprises.

With a CHF 300 deductible, your maximum out-of-pocket is CHF 1,000 per year (deductible + co-payment). If your annual medical costs regularly exceed CHF 2,500–3,500, the higher premium is offset by the lower direct costs. Essentially, you are pre-paying for certainty.

Children's Deductible Options

Children (under 18) have different deductible options and lower co-payment caps.

Children's Franchise (CHF)	Co-Payment Cap	Max. Out-of-Pocket	Recommendation
0	CHF 350	CHF 350	Frequent doctor visits, chronic conditions, ongoing treatments
100	CHF 350	CHF 450	Moderate usage, balanced approach
200	CHF 350	CHF 550	Moderate premium savings, lower risk
300	CHF 350	CHF 650	Healthy children, occasional visits
400	CHF 350	CHF 750	Healthy, rarely visit the doctor
500	CHF 350	CHF 850	Very healthy, maximum premium savings
600	CHF 350	CHF 950	Maximum savings, confident in child's health

For families: Children can be insured with a different insurer and at a different deductible level than their parents. There is no legal requirement to use the same insurer for the whole family. Compare separately for each child to maximize savings. A family with two children could easily save CHF 600–1,200 per year by optimizing each child's deductible and insurer independently.

Deductible Optimization Strategies

Practical approaches to choosing the right franchise for your situation.

Strategy 1: The "Healthy Year" Default

If you have been healthy for the past 2–3 years with annual medical costs below CHF 1,500 (excluding premiums), default to the CHF 2,500 deductible. The monthly premium savings of CHF 100–135 accumulate to CHF 1,200–1,620 per year. Even if you have one unexpected medical event, the premium savings from previous healthy years more than compensate. Over a 5-year horizon, this strategy typically saves CHF 4,000–6,000 compared to the CHF 300 deductible, assuming 1–2 "bad" years with significant medical costs.

Strategy 2: The "Emergency Fund" Approach

Set aside CHF 3,200 (the maximum out-of-pocket for a CHF 2,500 deductible) in a savings account at the beginning of each year. Choose the CHF 2,500 deductible and deposit the premium savings each month into this fund. If you need medical care, pay from the fund. If you stay healthy, the fund grows. After 2–3 healthy years, the fund covers a worst-case scenario entirely, and subsequent premium savings become pure profit. This strategy works because the expected value overwhelmingly favors the high deductible for anyone with average or below-average healthcare utilization.

Strategy 3: The "Life Stage" Review

Review your deductible at every major life change: turning 26 (adult premium bracket), getting married, having children, starting a new job, developing a chronic condition, or approaching retirement. Each of these events may shift the optimal deductible. For example, a 28-year-old with no health issues should almost certainly have a CHF 2,500 deductible. A 35-year-old planning a pregnancy should switch to CHF 300 for that year. A 50-year-old with controlled hypertension might find CHF 1,000 or 1,500 to be the sweet spot.

Strategy 4: Combine with Model Savings

The deductible and insurance model are two independent levers for reducing costs. Combining a high deductible (CHF 2,500) with a cost-saving model (Telmed or HMO) yields the maximum premium reduction. The combined savings can reach CHF 2,000–3,000 per year compared to a CHF 300 deductible with the standard model. If you are comfortable with both a phone-first triage system and a high out-of-pocket threshold, this combination delivers the lowest possible premium in any Swiss canton.

Common Misconceptions

Clearing up confusion about how the deductible works in practice.

No. The deductible resets to zero on January 1 every year. If you paid CHF 1,800 toward your CHF 2,500 deductible by December 31, that amount is lost. On January 1, you start over from zero. This is why timing of medical treatments can matter — if you have already met your deductible in November, it may be worth scheduling non-urgent procedures before December 31.

No. Your deductible is fixed for the calendar year. You can only change it during the annual switching period (for a change effective January 1) or, in some cases, mid-year if your insurer allows a July 1 change. The deductible you choose applies from January 1 to December 31 of the relevant year.

Partially. From the 13th week of pregnancy through 8 weeks after birth, maternity-related costs (prenatal checks, delivery, postnatal care) are fully exempt from both the deductible and the co-payment. However, non-maternity costs during pregnancy (e.g., treating a cold) are still subject to your deductible and co-payment as usual.

Per person. Each insured individual has their own deductible. A family of four has four separate deductibles. This is another reason why comparing and optimizing deductibles independently for each family member can yield significant savings. There is no shared family deductible in Swiss basic insurance.

It depends. If you have accident coverage through your employer (UVG), accident-related costs are handled separately and do not apply to your health insurance deductible. If you do not have employer UVG coverage (e.g., you work less than 8 hours/week or are self-employed), accident costs are covered by your basic health insurance and count toward the deductible.

Yes, prescribed medications on the official FOPH specialty list count toward your deductible. Over-the-counter medications and supplements generally do not. Some medications may have a surcharge (Selbstbehalt of 20% instead of 10%) if a cheaper generic alternative exists. Check with your pharmacist whether a generic option is available to save on co-payments.