Why Do I Get Bills Despite Having Insurance?

Swiss insurance is not zero-cost insurance

Many people coming from countries with universal or employer-funded healthcare expect Swiss insurance to work the same way — you show your card, you get treated, nothing more is owed. This expectation leads to significant shock when the first bills arrive.

Swiss KVG insurance is a cost-sharing system. You pay a monthly premium that gives you access to healthcare and caps your risk — but you still contribute a portion of actual costs directly. There are three reasons you receive bills even with valid KVG insurance:

Reason 1: The Franchise (annual deductible)

Every KVG policy has an annual franchise — your chosen deductible, ranging from CHF 300 (minimum) to CHF 2,500 (maximum) for adults. You pay this amount yourself before your insurer contributes anything.

The franchise resets to zero on 1 January every year. So at the start of each year, you are again responsible for the first CHF 300–2,500 of healthcare costs. If your first visit of the year costs CHF 150, you pay CHF 150. If it costs CHF 500 and your franchise is CHF 300, you pay CHF 300 and your insurer covers the rest (minus Selbstbehalt — see below).

This is why you may receive an invoice for a consultation that "should have been covered" — if you have not yet met your franchise for the year, the cost comes to you.

Reason 2: The Selbstbehalt (co-insurance)

After your franchise is fully used up, you enter the Selbstbehalt phase. This is a 10% co-payment on all covered KVG costs, up to an annual maximum of CHF 700 for adults (CHF 350 for children). Once you have paid CHF 700 in Selbstbehalt for the year, KVG covers 100% of remaining costs.

So even after your franchise is met, you still receive bills — just smaller ones, representing 10% of each treatment.

Reason 3: Non-covered services

KVG only covers services on its official lists. The following are never reimbursed:

• Dental care (except narrow exceptions)
• Routine glasses and contact lenses
• Cosmetic procedures
• Non-approved medications
• Treatments by non-KVG-accredited providers
• Services you received without required prior authorisation
• Specialist visits in gated models without a referral

The billing maths — an example

Imagine it is March and you have a CHF 1,000 franchise. You have already paid CHF 400 toward this year's franchise. You visit a specialist whose invoice is CHF 300.

• You still have CHF 600 of franchise remaining
• The full CHF 300 invoice counts toward your franchise
• Your insurer pays CHF 0 (the entire amount is within your franchise)
• You owe CHF 300 directly to the specialist

Now in November, your franchise is fully met and your Selbstbehalt cap of CHF 700 is also reached. You visit your GP whose bill is CHF 150.

• You have met your franchise and Selbstbehalt
• KVG covers CHF 150 in full
• You owe CHF 0

Tracking your franchise and Selbstbehalt

Most insurer apps and online portals show a running total of your franchise usage and Selbstbehalt for the current year. Check this regularly — it helps you predict upcoming bills and plan accordingly. At the end of a year where you have used more than your franchise in healthcare, you may want to consider whether a higher franchise (and lower premium) would have been more economical.