Cost contribution

The Federal Law on Sickness Insurance stipulates that  “policyholders contribute to the costs of the benefits provided for them.” The implications of this are that, if you are ill and visit the doctor, buy medications or have been in hospital, you pay some of the costs yourself. This applies to basic insurance >

However, a cost contribution may also be required for other insurance. The cost contribution in supplementary insurance explained >

Cost contribution in basic insurance

In basic insurance, the cost contribution comprises the franchise, the deductible and the hospital contribution. Sympany keeps you updated on the situation with regard to your cost contribution: it is indicated on every benefit statement and can be quickly and easily checked anytime in mySympany.

Good to know: you do not have to contribute to costs of benefits in the event of maternity.

Franchise

This is the amount that you have to pay from your own pocket for your health care every year. If these costs exceed your annual franchise, Sympany pays 90 percent of the additional costs (10 percent is your deductible).

You independently decide the amount of your franchise. The rule is: the higher the franchise, the lower the premium. The franchise can be altered as of 1 January of each year. The deadlines are:

  • Increasing your franchise: 31 December

  • Reducing your franchise: 30 November

 

Please note: Sympany must receive your notification no later than 5 pm on the last working day before these deadlines. The postmark does not count, so please allow for public holidays in December.

You have a choice of the following franchises (amounts in CHF):

Adults
300.– 500.– 1'000.– 1'500.– 2'000.– 2'500.–
Children*
0.– 200.– 400.– 600.–    

* Vivao Sympany AG, Kolping Krankenkasse AG

For basic insurance, the statutory minimum franchise for people aged 18 years and over is CHF 300. No franchise is charged for children. Adults can voluntarily increase their franchise to a maximum of CHF 2,500, children to CHF 600.

Deductible

Once you have reached your franchise, the compulsory basic insurance pays the costs of medical services and medications. However, you pay a legally stipulated but limited deductible of 10 percent. The maximum cost contribution arising from the deductible is as follows:

  • Children CHF 350 per calendar year.
  • Adults CHF 700 per calendar year.
  • Families CHF 1,000 per calendar year.


Once you have reached your maximum deductible, Sympany pays 100% of the further costs incurred in that calendar year as detailed on the basic insurance benefits list.

Hospital contribution

In the event of hospital admission, the compulsory basic insurance pays both the treatment costs and the costs of accommodation and food. However, the law stipulates that, if you are admitted to hospital as an inpatient, you must contribute CHF 15 per day to the costs.

The following are exempt from the hospital contribution:

  • Children aged up to 18
  • Young adults in training/education (aged up to 25)
  • Women, for benefits in the event of maternity

Cost contribution in supplementary insurance

A deductible also applies to some benefits provided under supplementary hospital, dental or outpatient insurance. However, the amount varies depending on the product and the chosen cover. You can check in mySympany which insurance policies you have taken out. The deductible is detailed in our benefit overviews >