Selbstbehalt — Your 10% Co-insurance

What is the Selbstbehalt?

Selbstbehalt (also called co-insurance, retention, or participation) is the mandatory 10% contribution you make to each covered medical bill after your franchise has been fully used up for the year. It is set by federal law — every approved KVG insurer applies the same rate. Unlike the franchise (which you choose), the Selbstbehalt rate is always 10% and cannot be changed.

The annual caps

• Adults (26+): CHF 700 per year maximum
• Young adults (19–25): CHF 700 per year maximum
• Children (0–18): CHF 350 per year maximum

Once you have paid CHF 700 in Selbstbehalt within the calendar year, your insurer covers 100% of all further eligible costs for the rest of that year — no further co-payment from you.

The full cost-sharing picture

To reach the CHF 700 Selbstbehalt cap, you must have incurred CHF 7,000 in medical costs beyond your franchise. That means your total out-of-pocket exposure in a year is:

• Franchise (your chosen level: CHF 300–2,500) plus
• Selbstbehalt cap: CHF 700
• = Total maximum: CHF 1,000 to CHF 3,200

This maximum is reached only in years with very high medical expenses. Most healthy adults in Switzerland never exhaust their Selbstbehalt cap.

A full worked example

You have a CHF 500 franchise and face CHF 9,000 in medical costs during the year:

• First CHF 500: you pay entirely (franchise stage)
• Next CHF 7,000: you pay 10% = CHF 700 (Selbstbehalt stage — cap reached)
• Remaining CHF 1,500: insurer pays 100%

Your total out-of-pocket: CHF 500 + CHF 700 = CHF 1,200. The insurer covers CHF 7,800.

The hospital daily contribution

For inpatient hospital stays, there is an additional fixed daily contribution of CHF 15 per day (for adults living alone or families without children under 18). This is charged on top of the regular franchise and Selbstbehalt, and is not capped. It covers the "saved" household costs while you are in hospital. Exemptions apply for children and for long stays.

When does the Selbstbehalt NOT apply?

Just like the franchise, the Selbstbehalt is waived for:

• Maternity care (prenatal, birth, 8 weeks postnatal)
• Preventive mammography and colorectal cancer screening
• Certain national vaccination programme vaccines

How the Selbstbehalt appears on your bills

You do not pay the clinic directly for your Selbstbehalt share in most cases. The typical flow is:

1. Clinic sends the bill to your insurer (in the Tiers garant model) or to you (in the Tiers payant model).
2. Insurer calculates your share (franchise + Selbstbehalt) and sends you a detailed statement (Abrechnung).
3. You pay your share directly to the clinic or pharmacy, referencing the statement.
4. Your insurer tracks your annual totals and adjusts statements automatically as you approach the cap.

Learn more about how bills flow between clinics and insurers in Clinic & Insurance Contact.

Supplementary insurance cannot waive the Selbstbehalt

Some people ask whether supplementary insurance can cover their Selbstbehalt. Swiss law prohibits this — no VVG supplementary plan can reimburse your franchise or Selbstbehalt, because doing so would remove the cost-sharing incentive built into the mandatory KVG system.