Premiums

premiums 

Health insurance is funded through contributions from both insured individuals and employers, cost-sharing by the insured, and government subsidies.

Premium health insurance

Every insured adult is required to pay a "capitation premium." Children are exempt from premiums in mandatory health care insurance. Health insurers are obligated to establish different premiums for individuals aged 16 to 20 and for adults. The premiums for young people must not exceed half of the adult premiums.

Employed individuals receive a contribution from their employer, which corresponds to half of the national average of premiums in mandatory health insurance. Effective January 1, 2024, the employer contribution will be CHF 166.00 (compared to CHF 156.50 in 2023) per month for adults and CHF 83.00 (compared to CHF 78.25 in 2023) for young people. For part-time employees, the employer contribution is reduced proportionally based on the degree of employment.

Premium Overview 2024

Cost-sharing effective Jan. 1, 2023

For children and adolescents up to the age of 20, there is no cost-sharing requirement. However, for adult insured individuals (excluding maternity, preventive examinations, and certain chronic illnesses), there is a cost-sharing structure in place.

Adults are required to contribute to the costs through a fixed amount of CHF 500 and a deductible of 20% of the costs that exceed this initial amount, up to the high-cost limit of CHF 5,000. Once the high-cost limit is reached, no further cost-sharing is applied.

From the time an insured person reaches the standard retirement age, the fixed amount will no longer be applicable starting in 2023. Instead, a percentage deductible of 10% is introduced. This percentage deductible is applicable to the annual costs incurred between the fixed amount and the high-cost limit of CHF 5,000

Example:

Let's consider annual treatment costs (including doctor visits, medication, ambulance transport, etc.) amounting to CHF 3,000 in one year.

For non-pensioners:

The insured individual pays a fixed amount of CHF 500.

Additionally, 20% of the remaining costs up to the high-cost limit (CHF 2,500) is applied.

Therefore, the total cost-sharing for non-pensioners in this example is CHF 500 (fixed amount) + CHF 500 (20% of CHF 2,500) = CHF 1,000.

For pensioners:

Pensioners, who have reached the standard retirement age, follow a different cost-sharing structure.

They do not pay the fixed amount but instead have a percentage deductible of 10% applied to the annual costs between the fixed amount and the high-cost limit.

In this example, the cost-sharing for pensioners is CHF 0 (fixed amount) + CHF 500 (10% of CHF 5,000) = CHF 500.

Insurers are required to provide insured individuals with at least three options for higher voluntary cost-sharing if the premium is appropriately reduced. The maximum fixed amount allowable is CHF 4,000.

Premium daily sickness benefits insurance

Premiums for daily sickness benefits insurance can be either fixed amounts or calculated as a percentage of the insured salary. It is mandated that half of the premium for mandatory daily sickness benefits insurance is to be covered by the employer.

Premium reduction