Living with a Chronic Condition in Switzerland

Franchise strategy: CHF 300 is almost always best

When you have a chronic condition, you will use medical services regularly — GP visits, specialist appointments, lab work, medications. In most cases, you will exceed even the lowest franchise (CHF 300) within the first few months of the year.

Here is why CHF 300 is the smart choice:

• Maximum out-of-pocket: CHF 300 (franchise) + CHF 700 (Selbstbehalt cap) = CHF 1,000/year. After that, everything is 100% covered.
• With a CHF 2,500 franchise: You would pay CHF 2,500 + CHF 700 = CHF 3,200/year before full coverage kicks in.
• Premium savings do not compensate: The monthly premium difference between CHF 300 and CHF 2,500 franchise is typically CHF 100 -- 200/month (CHF 1,200 -- 2,400/year). But you save CHF 2,200 in out-of-pocket costs — which almost always exceeds the premium difference.

The January reset: plan ahead

Your franchise and Selbstbehalt reset to zero on January 1 every year. For people with chronic conditions, this means:

• Budget for January -- March: You will pay full costs again until you re-exhaust your franchise. With a CHF 300 franchise, this happens quickly, but plan for it.
• Stock up in December: If possible, fill prescriptions in December to have medication on hand for early January before you hit your new franchise.
• Schedule elective appointments wisely: If you have a non-urgent specialist visit or test, consider whether timing it in the same calendar year as your other costs is more efficient.

Repeat prescriptions and medication management

For chronic conditions, your GP or specialist can write Dauerrezepte (repeat prescriptions) that allow you to refill medications for up to one year without a new appointment:

• Your doctor specifies the medication, dosage, and number of permitted refills on the prescription.
• The pharmacy keeps the prescription on file and dispenses refills as needed.
• Most chronic condition medications (insulin, blood pressure medications, inhalers, etc.) are listed on the Spezialitätenliste (SL) and are covered by KVG.
• Generic substitution applies: request generics to pay 10% Selbstbehalt instead of 20% on brand-name drugs.

Ongoing specialist visits and the Selbstbehalt cap

Once your franchise is exhausted (quickly, with a chronic condition), you pay only 10% Selbstbehalt on all further medical costs. This 10% is capped at CHF 700 per year. After that:

• All covered medical costs are paid 100% by your insurer for the rest of the calendar year.
• The only remaining cost is CHF 15/day if you are hospitalized (Spitalbeitrag).
• Specialist visits, lab work, imaging, physiotherapy, and medications are all included in the cap calculation.

For many chronic condition patients, the franchise + Selbstbehalt cap is reached by March or April, meaning the rest of the year is effectively free (excluding monthly premiums).

Kostengutsprache: pre-approval for expensive treatments

If your condition requires expensive specialty medications — biologics for autoimmune diseases, cancer treatments, or specialty drugs — your insurer may require a Kostengutsprache (pre-approval):

• Your doctor submits a medical justification to the insurer explaining why the medication is necessary.
• The insurer reviews the request, typically within a few days to two weeks.
• Once approved, the medication is covered under normal cost-sharing rules (subject to franchise and Selbstbehalt).
• Approvals are typically valid for a defined period (e.g., 6 -- 12 months) and need renewal.
• If denied, you have the right to appeal through the cantonal arbitration board.

Disease management programs

Some Swiss insurers offer structured disease management programs for common chronic conditions:

• Diabetes programs: Regular monitoring, nutrition counseling, and coordinated care between GP, endocrinologist, and dietitian.
• COPD/asthma programs: Structured follow-up, inhalation technique training, and action plans for exacerbations.
• Cardiovascular risk management: Coordinated blood pressure and cholesterol management with lifestyle coaching.

These programs may offer premium discounts or reduced cost-sharing. Ask your insurer whether they have programs relevant to your condition.

Changing insurers with a chronic condition

This is one of the strongest protections in Swiss law:

However, there is an important distinction for supplementary insurance:

• Basic insurance (KVG): Guaranteed acceptance. No medical underwriting. All conditions covered from day one.
• Supplementary insurance (VVG): Insurers CAN and WILL exclude pre-existing conditions. They can also reject your application entirely. If you have a chronic condition, you are unlikely to get supplementary hospital insurance or other VVG products at standard terms.

This is why it is important to secure any supplementary insurance you might want before developing a chronic condition. If you already have supplementary insurance, keep it — even if you switch basic insurers. Supplementary insurance does not need to follow your basic insurance.