# Deductible and co-payment: the difference explained simply

> Deductible vs. co-payment: the difference explained simply – 10% co-payment, maximum amounts for adults and children, with a worked example.

Source: https://easyall.ch/en/ratgeber/selbstbehalt-franchise-unterschied
Updated: 2026-11-06

The deductible (franchise) and the co-payment (Selbstbehalt) are often confused in everyday life — yet these two parts of cost sharing work quite differently. This guide explains what is due when, which maximum amounts apply to adults and children and how to calculate your own cost sharing.

## Two terms, one form of cost sharing

Anyone who receives medical services in Switzerland pays part of the costs themselves — the so-called cost sharing of basic insurance. It consists of two elements that apply one after the other: first the deductible, then the co-payment.

The deductible is the fixed amount you pay in full yourself each calendar year before your insurer starts paying. The co-payment only comes into play after that: you bear 10% of the costs above the deductible — up to an annual cap.

## The deductible: a fixed annual amount of your choice

Adults choose between the ordinary deductible of CHF 300 and the [optional deductibles](https://easyall.ch/en/ratgeber/franchise-waehlen) of 500, 1'000, 1'500, 2'000 and 2'500. Children have no ordinary deductible (CHF 0); levels up to CHF 600 can be chosen.

The deductible does not change the benefits — in basic insurance these are identical by law at every insurer. It only shifts who pays how much: a low deductible means a higher premium and little personal risk, a high deductible a lower premium and more personal risk. As a rule of thumb: if you rarely see a doctor, a high deductible often works out cheaper; if you have regular costs, a low deductible does.

## The co-payment: 10% with a cap

Once the deductible has been used up, your insurer covers further costs — minus a 10% co-payment. The co-payment is capped: adults pay at most CHF 700 in co-payments per year, children at most CHF 350. Mathematically, the maximum is reached as soon as treatment costs of CHF 7'000 (CHF 3'500 for children) have accumulated after the deductible — beyond that, no further co-payment is due.

Two special cases: for original medicines for which a generic is available, the co-payment can be higher. And in hospital, adults additionally pay a contribution of CHF 15 per day towards the costs of the stay — this does not apply to children or to [young adults](https://easyall.ch/en/ratgeber/junge-erwachsene-praemien) in education.

## Worked example: from doctor's visit to statement

Suppose your treatment costs covered by basic insurance total CHF 2'500 in one calendar year — outpatient, without a hospital stay.

For context, the maximum annual risk: with a CHF 300 deductible, cost sharing is at most CHF 1'000 per year (deductible plus the full co-payment), with a CHF 2'500 deductible at most CHF 3'200 — in each case excluding the hospital contribution of CHF 15 per day. This is how the calculation looks for an adult:

- With a CHF 300 deductible: you pay the first CHF 300 in full yourself. On the remaining CHF 2'200 you bear a 10% co-payment, i.e. CHF 220. Your cost sharing: CHF 520 — the insurer covers CHF 1'980.
- With a CHF 2'500 deductible: the entire costs fall within the deductible. You pay the full CHF 2'500 yourself; no co-payment is due.

## When cost sharing does not apply or is credited

An important exception applies to maternity: from the 13th week of pregnancy until 8 weeks after the [birth](https://easyall.ch/en/ratgeber/neugeborene-versichern), neither deductible nor co-payment is charged for general benefits and nursing care in the event of illness (Art. 64 para. 7 KVG).

If you [switch insurer](https://easyall.ch/en/ratgeber/krankenkasse-wechseln) during the year (for example as of 1 July), cost sharing does not start again from scratch: the new insurer credits the deductible and co-payment already invoiced in the same calendar year (KVV Art. 103 para. 4). Keep your previous insurer's cost-sharing statement as proof.

## Conclusion: submit your invoices, review your deductible every year

Submit all invoices to your insurer — including those below the deductible. This is the only way your deductible balance is recorded correctly and your annual statement is accurate. For outpatient treatment, you usually pay the invoice yourself first and submit it to your insurer (“[tiers garant](https://easyall.ch/en/ratgeber/tiers-garant-tiers-payant)”); in hospitals and pharmacies, the provider usually bills the insurer directly (“tiers payant”). Reimbursement is usually made within 2 to 4 weeks, minus cost sharing.

If your deductible no longer suits your situation, you can change it with your own insurer as of 1 January each year: report a lower deductible by the end of November; most insurers accept a higher one until the end of December. In the [easyall calculator](https://easyall.ch/en/calculator) you can work through different deductibles and models directly — and easy, our AI guide, answers detailed questions about cost sharing right in the comparison.

## FAQ

### What is the difference between the deductible and the co-payment?

The deductible is the fixed annual amount you pay in full yourself before your insurer takes over (adults CHF 300–2'500, children CHF 0–600). The co-payment applies after that: you bear 10% of further costs — at most CHF 700 per year for adults or CHF 350 for children.

### What is the maximum cost sharing per year?

For adults with a CHF 300 deductible at most CHF 1'000, with a CHF 2'500 deductible at most CHF 3'200 — in each case excluding the hospital contribution of CHF 15 per day that adults also pay for hospital stays (it does not apply to children and young adults in education).

### Why is the co-payment higher than 10% for some medicines?

For original medicines for which a generic is available, the co-payment can be higher than the usual 10%.

### Do I pay the deductible and co-payment during pregnancy?

From the 13th week of pregnancy until 8 weeks after the birth, neither deductible nor co-payment is charged for general benefits and nursing care in the event of illness (Art. 64 para. 7 KVG); treatment after an accident and dental treatment are not included. Costs before the 13th week of pregnancy count as normal, however, except for maternity benefits such as check-ups, which are never subject to cost sharing.

### Do I have to submit invoices below the deductible?

Yes, ideally always: this is the only way your deductible balance is recorded correctly and your annual statement is accurate. Reimbursement is usually made within 2 to 4 weeks, minus cost sharing.

## Sources

- [Federal Health Insurance Act (KVG), SR 832.10 – official text in German](https://www.fedlex.admin.ch/eli/cc/1995/1328_1328_1328/de) – Fedlex, Classified Compilation of Federal Legislation
- [Health Insurance Ordinance (KVV), SR 832.102 – official text in German](https://www.fedlex.admin.ch/eli/cc/1995/3867_3867_3867/de) – Fedlex, Classified Compilation of Federal Legislation
- [Health insurance costs and premium reductions](https://www.ch.ch/en/health/health-insurance/health-insurance-costs/) – ch.ch, Confederation, cantons and communes