Co-payment: what you pay
Deductible, retention fee and contribution to hospital costs – this is how you participate in your healthcare costs.
Co-payment under basic insurance
Your health insurance premium depends on the chosen deductible, where you live and how old you are. Insured persons pay a share of their healthcare costs in the form of a deductible, retention fee and contribution to hospital costs. They are required to do so by law.
What is a deductible?
The deductible is the amount that you have to pay out of your own pocket whenever treatment costs arise under basic insurance. Adults must pay at least CHF 300 per year. There is no minimum deductible for children under 18. You have the option of choosing a higher deductible. That way, you take on more financial responsibility while enjoying a premium reduction.
Optional deductibles for adults
|
Optional annual deductible for adults |
Max. premium reduction per month |
Max. premium reduction per year |
|---|---|---|
| Deductibles CHF 500 | CHF 11.60 / month | CHF 139.20 / year |
| Deductibles CHF 1'000 | CHF 40.80 / month | CHF 489.60 / year |
| Deductibles CHF 1'500 | CHF 70.80 / month | CHF 840.00 / year |
| Deductibles CHF 2'000 | CHF 99.10 / month | CHF 1'189.20 / year |
| Deductibles CHF 2'500 | CHF 128.30 / month | CHF 1'539.60 / year |
Optional deductibles for children
|
Optional annual deductible for children |
Max. premium reduction per month |
Max. premium reduction per year |
|---|---|---|
| Deductible CHF 100 | CHF 5.80 / month | CHF 69.60 / year |
| Deductible CHF 200 | CHF 11.60 / month | CHF 139.20 / year |
| Deductible CHF 300 | CHF 17.50 / month | CHF 210.00 / year |
| Deductible CHF 400 | CHF 23.30 / month | CHF 279.60 / year |
| Deductible CHF 600 | CHF 35.00 / month | CHF 420.00 / year |
Choose the right deductible
Check how much you spend on healthcare each year: under CHF 1,800? Choose a deductible of CHF 2,500. Higher? Choose CHF 300.
You can change your deductible each year, regardless of your medical history. You have until 30 November to lower the deductible and until 31 December to increase it.
10% retention fee
Once the deductible has been used up, CSS pays most of your healthcare costs. You pay the 10% retention fee, which is capped at CHF 700 per calendar year. With Multimed, you benefit from a reduced retention fee of max. CHF 400. For children, the maximum amount is always CHF 350.
Good to know: CSS provides a transparent breakdown of the costs on each benefit statement. And in myCSS, you can see how high your retention fee is and view all your statements in your overview of the year.
Example of co-payment for outpatient treatment
|
Outpatient medical bill |
CHF 450 |
| ./. less standard deductible | - CHF 300 |
|
Remaining amount |
CHF 150 |
|
of which 10% is retention fee |
- CHF 15 |
|
Total co-payment charged to the insured person |
CHF 315 |
Hospital contribution – amount for each day spent in hospital
The contribution to hospital costs is the equivalent of a retention fee for a stay in hospital. It is CHF 15 per day spent in hospital. Children under 18 and adults under 25 who are still in education do not pay a contribution to hospital costs. There is no upper limit per stay or calendar year. The contribution to hospital costs is not set off against the deductible or retention fee.
Avoid high costs: choose a recognised hospital
You generally have a free choice of hospital. Basic insurance covers the cost of a stay in any hospital that features on the hospital list for the canton in which you live.
Exceptions to co-payments
Children and young adults in education do not pay a daily contribution if hospitalised.
Rules for pregnant women
When pregnant, there is no co-payment for maternity benefits. If a pregnant woman falls ill or complications set in, this counts as illness until the end of the 12th week of pregnancy. The deductible and retention fee then apply.
Higher retention fee for medication
The co-payment for medication is normally 10% if the deductible has already been paid. If several medicines with the same combination of active ingredients are included in the Specialties List compiled by the Federal Office of Public Health (FOPH), then the retention fee may amount to 40%. This does not apply if an originator product is prescribed for medical reasons. Special rules apply to the retention fee for medication under the family doctor and telemedicine models.
Co-payment under supplementary insurance
The retention fee for supplementary insurance is stated in the contract. You will find it on the policy or in the insurance conditions.
The retention fee for supplementary insurance is not offset against the co-payments for basic insurance.
