Swiss health insurance franchise: the maths in four numbers
Swiss health insurance franchise explained simply: combine monthly premium, franchise, coinsurance and hospital contribution to choose the right level.
Editorial notice
This article is provided solely for general information. It does not constitute individual insurance advice, a personal recommendation or insurance intermediation. Current information from insurers and the competent authorities takes precedence.
Quick overview
What matters before you switch
Your franchise sets how much you pay first each year before mandatory health insurance takes over covered services. It is one of the biggest levers for balancing premium savings and financial risk.
- A low franchise gives more predictability but raises your monthly premium.
- A high franchise usually pays off when you expect only limited medical costs.
- Always choose it together with your insurance model and available cash buffer.
Swiss health insurance franchise: the maths in four numbers
Swiss health insurance franchise: the math behind it is simpler than it looks. You only need to track four numbers: your monthly premium, the franchise (CHF 300 or 2,500), the 10% coinsurance capped at CHF 700, and the CHF 15 per day hospital contribution. With those four numbers you can estimate almost any mandatory-insurance bill before it arrives.
This article walks through the formula, shows when each cost layer applies and breaks down a real hospital invoice so the mechanism becomes practical instead of abstract.
Mandatory health insurance works like a sequence of four cost layers:
- Monthly premium – your fixed membership fee. It depends on canton, age group, model and franchise, and for adults it usually lands in the mid three-figure range.
- Franchise – the first CHF 300 to 2,500 per year for covered services stays with you.
- 10% coinsurance – after that you keep paying 10% of costs until your share reaches CHF 700 (children: CHF 350).
- Hospital contribution – CHF 15 per inpatient day for meals and ancillary costs. Children, students up to 25 and pregnant women are exempt.
2. Franchise levels: CHF 300 vs 2,500
There are officially six options (CHF 300 | 500 | 1,000 | 1,500 | 2,000 | 2,500). In practice most households end up comparing the two extremes.
- CHF 300 – usually best when you expect more than roughly CHF 1,800 per year in healthcare costs.
- CHF 2,500 – usually best below that threshold, with premiums often around 25% lower.
| Option | Best for | Premium effect* |
|---|---|---|
| CHF 300 | Frequent doctor visits, medication, pregnancy | Baseline |
| CHF 2,500 | Rare doctor visits, solid emergency buffer | ≈ 25% lower |
*The exact percentage varies by canton and insurer, but the direction stays the same: a higher franchise lowers the premium.
Because coinsurance is capped at CHF 700, your worst year is fixed from the start. You never pay more than this towards covered treatment:
- Franchise CHF 300 – at most CHF 1,000 a year.
- Franchise CHF 2,500 – at most CHF 3,200 a year.
That turns the choice into a question you can answer yourself. If you expect medical costs above roughly CHF 1,800 to 2,000 — regular medication, physiotherapy, planned surgery — take CHF 300. If you are healthy, rarely see a doctor and can cover CHF 3,200 out of reserves, take CHF 2,500 and save on the premium every month. The levels in between raise the premium noticeably while barely lowering the risk.
3. A real hospital bill (CHF 2,600)
Maria, 31, lives in Zurich, has the standard model and a CHF 300 franchise. She has had no prior treatment in 2025. After a medical emergency she spends three nights in hospital.
| Cost item | Maria's share (CHF) | Running total |
|---|---|---|
| Hospital contribution (CHF 15 × 3 nights†) | 45 | 45 |
| Franchise | 300 | 345 |
| 10% coinsurance on the remaining CHF 2,255 | 225.5 | 570.5 |
† The discharge day is counted only partially, which is why only three nights are billed here.
4. Five proven savings levers
- Choose HMO or Telmed: Often 10% to 20% cheaper because you accept a first contact point.
- Raise the franchise deliberately: If you stay below roughly CHF 1,800 in yearly costs, CHF 2,500 is often the better deal.
- Pay annually: Some insurers grant 1% to 2% discount for upfront payment.
- Remove accident cover if applicable: Employees are usually already insured through their employer.
- Apply for premium subsidies: A significant share of residents qualifies, depending on canton and income.
FAQ
More questions on this topic
Is my franchise reset every year?
Yes. The count starts again from zero on January 1.
Can I change the franchise during the year?
No. Changes only take effect on the next January 1.
Does the 10% coinsurance also apply to medication?
Yes, for covered medication, but only after the franchise has been reached and only up to the annual cap.
Does pregnancy count towards the franchise?
No. Maternity benefits — check-ups, birth and aftercare — are covered without franchise and without coinsurance. The CHF 15 daily hospital contribution does not apply either.
What happens with a very large bill?
Your share is capped: you pay the franchise plus at most CHF 700 in coinsurance. Beyond that basic insurance covers the treatment in full — for an inpatient stay only the CHF 15 per day remains.