What Healthcare Actually Costs You

How cost-sharing works in practice

Every time you receive medical care, three layers determine what you pay:

• Franchise (deductible): You pay 100% of all costs until you reach your chosen annual franchise (CHF 300 to CHF 2,500 for adults).
• Selbstbehalt (co-insurance): After the franchise is used up, you pay 10% of further costs up to a cap of CHF 700 per year.
• Full coverage: Once you have paid franchise + CHF 700 Selbstbehalt, insurance covers 100% for the rest of the calendar year.

Additionally, for each day you spend in a hospital, you pay CHF 15 as a Spitalbeitrag (hospital contribution). This applies regardless of whether your franchise is exhausted. See Franchise explained for more details.

Common medical costs at a glance

These are approximate ranges you can expect to see on your bills. Actual amounts vary by canton, provider, and complexity.

• GP visit (standard consultation): CHF 150 -- 250
• Blood test (basic panel): CHF 50 -- 150
• Specialist consultation: CHF 200 -- 400
• Walk-in clinic / Permanence visit: CHF 100 -- 300
• Hospital emergency room: CHF 500 -- 1,500+ (depending on tests and treatment)
• Hospital stay per day: CHF 800 -- 1,200 (you pay CHF 15/day Spitalbeitrag)
• Physiotherapy session: CHF 50 -- 100
• Psychotherapy session (50 min): CHF 150 -- 200

Worked example: CHF 300 franchise (low deductible)

Imagine you have a CHF 300 franchise and visit your GP in February for a consultation plus blood work. The bill is CHF 280.

• You have not used any franchise yet this year, so you pay the full CHF 280.
• Your remaining franchise for the year: CHF 20.

In April you see a specialist. The bill is CHF 350.

• First CHF 20 goes toward your remaining franchise. Now your franchise is exhausted.
• Remaining CHF 330: you pay 10% Selbstbehalt = CHF 33.
• Insurance pays the other CHF 297.

Your total out of pocket so far: CHF 280 + CHF 20 + CHF 33 = CHF 333.

Worked example: CHF 2,500 franchise (high deductible)

Same scenario but with a CHF 2,500 franchise. You had the GP visit (CHF 280) and the specialist visit (CHF 350).

• Both bills are fully under your franchise. You pay CHF 630 out of pocket.
• Remaining franchise: CHF 1,870.

If you stay healthy the rest of the year, you have paid CHF 630 total. But your monthly premiums were significantly lower — often CHF 100 -- 200/month less than the CHF 300 franchise plan, depending on your canton. This is why the high franchise makes financial sense for healthy people who rarely see a doctor.

Worst-case annual costs

In a year with heavy medical use (surgery, chronic illness flare-up, accident), you will hit the maximum out-of-pocket:

• CHF 300 franchise: CHF 300 + CHF 700 = CHF 1,000 maximum
• CHF 500 franchise: CHF 500 + CHF 700 = CHF 1,200 maximum
• CHF 1,000 franchise: CHF 1,000 + CHF 700 = CHF 1,700 maximum
• CHF 1,500 franchise: CHF 1,500 + CHF 700 = CHF 2,200 maximum
• CHF 2,000 franchise: CHF 2,000 + CHF 700 = CHF 2,700 maximum
• CHF 2,500 franchise: CHF 2,500 + CHF 700 = CHF 3,200 maximum

Once you hit these amounts, you pay zero for covered services for the rest of the calendar year (except CHF 15/day hospital contribution).

Costs that bypass the franchise

Some costs exist outside the franchise/Selbstbehalt system entirely:

• Maternity: All prenatal, birth, and 8-week postnatal care is free of franchise and Selbstbehalt. See Maternity coverage.
• Certain preventive screenings: Some cancer screenings and vaccinations are exempt. See Preventive care.
• Dental, glasses, OTC medication: These are not covered by KVG at all, so they are 100% out of pocket (no insurance involvement). See Dental & vision.

How to keep your costs down

• Choose the right franchise: If you are healthy and rarely visit doctors, a higher franchise saves on monthly premiums.
• Use your insurance model correctly: In HMO or Telmed models, always start with your designated first contact point to avoid claim rejections.
• Ask for generics: When your doctor prescribes medication, ask the pharmacy for the generic version. You pay 10% Selbstbehalt on generics versus 20% on brand-name drugs when a generic exists.
• Avoid the ER for non-emergencies: A GP visit costs CHF 150 -- 250; the ER can cost CHF 500 -- 1,500+ for the same issue. Walk-in clinics (Permanence) are a good middle ground.
• Check your bills: Billing errors happen. Review every statement (Rechnungskopie) your insurer sends.