Swiss Hospital Insurance Deductibles Explained

In Switzerland, insurance for treatment in semi-private and private hospital wards is provided by supplementary hospital insurance. This insurance extends the general ward coverage which you receive from your compulsory Swiss health insurance policy. You can find general information in the moneyland.ch guide to hospital insurance.

Deductible models vary widely between hospital insurance policies. Policies generally come without a deductible by default, but most insurance providers offer the option of using an annual deductible. Each policy has its own set of deductibles which you can choose from.

For example, Concordia lets you choose from six possible deductibles for its semi-private ward and private ward policies, with the lowest being CHF 0 and the highest being CHF 10,000. Visana offers 5 deductible options between CHF 0 and CHF 10,000. Helsana lets you select a deductible between CHF 0 and CHF 7000. Aquilana lets you choose between a CHF 0, CHF 2000 or CHF 5000 deductible. Groupe Mutuel offers CHF 0, CHF 1000 and CHF 3000 deductible options for its semi-private and private ward hospital insurance. Swica offers deductible of CHF 0, CHF 1000, CHF 2000 and CHF 5000.

The higher a deductible you choose, the lower your insurance premiums will be. Discounts vary between insurance providers. Helsana, for example, discounts premiums by 15% when you add a CHF 1000 annual deductible, and by 35% when you add the highest CHF 7000 annual deductible. Swica discounts premiums by 15% when you add a CHF 1000 deductible, and by 50% when you add the highest available deductible of CHF 5000. Groupe Mutuel offers discounts of either 25% (CHF 1000 deductible) or 45% (CHF 3000 deductible). Because hospital insurance premiums can be very high (as the moneyland.ch hospital insurance comparison shows), opting for a deductible can be a good financial move in many cases.

Some policies use a coinsurance model rather than a fixed annual deductible. This model is commonly used for flex hospital insurance policies which let policyholders choose between general, semi-private and private wards when they receive treatment at a hospital. Treatment in a general ward is normally fully covered with no coinsurance requirement. Coinsurance requirements for semi-private and private ward treatment may differ.

For example, CSS offers three different coinsurance options on its myFlex hospital insurance policies. Coinsurance options range from 40% (maximum CHF 8000) on the Economy policy to 0% on the Premium policy for semi-private ward treatment and between 70% (maximum CHF 14,000) and 35% (maximum CHF 2000) for private-ward treatment. The Concordia Libero flex hospital insurance policy has a coinsurance of 20% (maximum CHF 2000) for semi-private ward treatment and 35% (maximum CHF 4000) for private ward treatment.

Choosing the right deductible

As a general rule, a high deductible makes more financial sense if you rarely or never get treated at hospitals and spend little or no money on hospital stays. If your motive for taking out hospital insurance is to be better covered against the potentially high costs of treatment should an unexpected medical emergency occur, then choosing a high deductible and putting aside money towards paying deductibles works out cheaper, in many cases.

A low deductible makes sense if you expect to stay in hospitals regularly (every year, for example). In this case the higher premiums you pay for a low-deductible policy may be lower than the cumulative cost of deductibles.

Combined deductibles

A handful of insurance providers (Swica and Provita, for example), apply deductible payments towards costs covered by your compulsory health insurance policy with payments towards your hospital insurance deductible. This model only applies if both your compulsory and hospital insurance policies are issued by an insurer which uses it.

Example: You have a compulsory health insurance policy with a CHF 2500 deductible and a private-ward hospital insurance policy with a CHF 5000 deductible. You are hospitalized in a private ward for 15 days after an accident, at a cost of CHF 1700 per day or CHF 25,500 total. Your compulsory health insurance covers the cost of equivalent treatment in a private ward – which at the hospital in question is CHF 700 per day. So CHF 10,500 of your bill is covered by compulsory insurance. The remaining CHF 15,000 is covered by your private-ward hospital insurance. The CHF 2500 annual deductible and 10% (max. CHF 700) annual coinsurance payment towards costs covered by compulsory health insurance are applied towards your annual CHF 5000 hospital insurance deductible. So you only pay CHF 1800 out of your own pocket towards costs covered by hospital insurance, or a total of CHF 5000 out of your own pocket between both policies.

It is important to note that this model is the exception. The vast majority of Swiss hospital insurance providers do not apply compulsory health insurance out-of-pocket costs towards hospital insurance. This means that if, within one calendar year, you incur healthcare costs which are covered by compulsory health insurance and others which are covered by hospital insurance, you pay the full out-of-pocket costs for both policies.

Example: You have a compulsory health insurance policy with a CHF 2500 deductible and a private-ward hospital insurance policy with a CHF 5000 deductible. You receive treatment in a private ward for 15 days after an accident, at a cost of CHF 1700 per day or CHF 25,500 total. Your compulsory health insurance covers CHF 10,500 of your hospital bill (the cost of treatment in a general ward) and your hospital insurance policy covers the CHF 15,000 markup for treatment in a private ward. You must pay the CHF 2500 annual deductible and 10% (max. CHF 700) annual coinsurance payment towards costs covered by compulsory health insurance out of your own pocket. You must also cover the CHF 5000 hospital insurance deductible. So you pay a total of CHF 8200 in out-of-pocket costs between both policies.

Family deductibles

A handful of insurance policies (from Concordia and Krankenkasse Einsiedeln, for example) apply a single deductible to all policyholders who share the same household. This means that, should two or more people in the same household require hospital treatment, they would have to cover just one annual deductible.

The Concordia Libero flex hospital insurance policy applies a single coinsurance payment (maximum CHF 4000) to all policyholders in the same family and household. This is equivalent to the maximum annual coinsurance payment which applies to private ward treatment for an individual. The Krankenkasse Einsiedeln flex hospital insurance policy applies a maximum coinsurance payment of CHF 4500 to all covered members of one household. This is equivalent to the maximum annual coinsurance payment which applies to private ward treatment for an individual.

Example: A car accident leaves a couple and their three children in need of hospital care. Because their hospital insurance applies a single annual deductible of CHF 4000 to the entire insured household, they only pay a maximum of CHF 4000 in out-of-pocket costs towards covered hospital care.

The vast majority of hospital insurance providers in Switzerland apply deductibles individually per policy. In the scenario mentioned above, the CHF 4000 deductible would apply to each individual policy. The total out-of-pocket costs for the family would come to CHF 20,000.

Limitations on switching deductibles

Although policyholders can generally change their policy’s deductible every year, some hospital insurance providers do not let you change your deductible once you reach a certain age (60 years old, for example). Some insurance providers do not use age-based limitations, but require you as a policyholder to undergo a medical examination before changing your deductible. Some insurers only allow you to change your deductible after a predetermined qualification period (3 years, for example).

Verdict

There are many factors which determine which hospital insurance policy is best suited to your needs. These include premiums, available discounts, the hospitals you want to receive treatment at, the additional services which you would like coverage for, whether you want to get compulsory and hospital insurance from the same provider, and your family situation. You can compare most of these factors using the moneyland.ch hospital insurance comparison. If you feel you can benefit from the additional coverage provided by supplementary hospital insurance, make sure to carefully choose a policy with a deductible model which matches your specific situation.

More on this topic:
Hospital insurance comparison
Swiss private ward hospital insurance
Supplementary hospital insurance in Switzerland
Swiss general hospital ward insurance
Semi-private hospital insurance
Swiss flex hospital insurance