Cost contribution
The Federal Law on Sickness Insurance stipulates that “policyholders contribute to the costs of the benefits provided for them.” The implications of this are that, if you are ill and visit the doctor, buy medications or have been in hospital, you pay some of the costs yourself. This applies to basic insurance >
However, a cost contribution may also be required for other insurance. The cost contribution in supplementary insurance explained >
Cost contribution in basic insurance
In basic insurance, the cost contribution comprises the franchise, the deductible and the hospital contribution. Sympany keeps you updated on the situation with regard to your cost contribution: it is indicated on every benefit statement and can be quickly and easily checked anytime in mySympany.
Good to know:
- You don’t have to pay a cost contribution for special benefits during pregnancy. From the 13th week of pregnancy up to eight weeks after the birth, you won’t have to pay a cost contribution for treatments relating to illnesses or accidents either. More information about pregnancy >
- If you have included accident cover in your basic insurance, you must contribute to the costs of medical treatment following an accident. This cost contribution doesn’t apply if you have accident insurance through your employer. More information on accident insurance >
This is the amount that you have to pay from your own pocket for your health care every year. If these costs exceed your annual franchise, Sympany pays 90 percent of the additional costs (10 percent is your deductible).
Insured persons residing in Switzerland:
You independently decide the amount of your franchise. The rule is: the higher the franchise, the lower the premium. The franchise can be altered as of 1 January of each year. The deadlines are:
-
Reducing your franchise: 30 November
-
Increasing your franchise: 31 December
Please note: The notification by telephone or post must be received by Sympany by no later than 5 pm on the last working day before these deadlines.
You have a choice of the following franchises (amounts in CHF):
| Adults | |||||
|---|---|---|---|---|---|
| 300 | 500 | 1,000 | 1,500 | 2,000 | 2,500 |
| Children | |||||
| 0 | 200 | 400 | 600 | ||
For basic insurance, the statutory minimum franchise for people aged 18 years and over is CHF 300. No franchise is charged for children. Adults can voluntarily increase their franchise to a maximum of CHF 2,500, children to CHF 600.
Reaching the age of majority: at the age of 18, an excess must be chosen for the first time. In order to keep your premiums low, we will suggest an excess of CHF 2,500 in the next policy. This will become valid on 1 January of the year in which you turn 19.
Once you have reached your franchise, the compulsory basic insurance pays the costs of medical services and medications. However, you pay a legally stipulated but limited deductible of 10 percent (40 percent for original preparations for which a generic or biosimilar is available. The maximum cost contribution arising from the deductible is as follows:
- Children CHF 350 per calendar year,
- Adults CHF 700 per calendar year.
Once you have reached your maximum deductible, Sympany pays 100% of the further costs incurred in that calendar year as detailed on the basic insurance benefits list.
The following applies for branded medicines with available generic or biosimilar:
The increased deductible of 40% is applied. Of this, only 25% can be credited towards the maximum cost contribution of CHF 350/700. You have to pay 15% yourself. Example:
- Price of branded medicine: CHF 700
- 40% deductible: CHF 280
- 25% creditable deductible: CHF 175
- 15% non-insurable cost contribution: CHF 105
► Basic insurance pays: CHF 420
When the maximum contribution is reached, basic insurance covers 100% of the costs, including for branded medicines.
In the event of hospital admission, the compulsory basic insurance pays both the treatment costs and the costs of accommodation and food. However, the law stipulates that, if you are admitted to hospital as an inpatient, you must contribute CHF 15 per day to the costs.
The following are exempt from the hospital contribution:
- Children aged up to 18
- Young adults in training/education (aged up to 25)
- Women, for benefits in the event of maternity
Cost contribution in supplementary insurance
A deductible also applies to some benefits provided under supplementary hospital, dental or outpatient insurance. However, the amount varies depending on the product and the chosen cover. You can check in mySympany which insurance policies you have taken out. The deductible is detailed in our benefit overviews >