Franchise and co-payment
A year of doctor's bills: who pays what?
- Franchise
- You pay the first CHF 300 out of pocket.You pay the first CHF 2'500 out of pocket.
- Co-payment
- 10% on all further costs, capped at CHF 700 per year (adults).
- Then
- Your insurer covers 100% for the rest of the year.
- Max out-of-pocket
- CHF 1'000 + premiumsCHF 3'200 + premiums
The Short Answer
If you are healthy, rarely visit the doctor, and can afford to pay CHF 2’500 out of pocket in an emergency, choose the highest franchise (deductible) of CHF 2’500. You will save CHF 1’200 to CHF 2’100 per year in premiums. If you have chronic conditions, take regular medication, or cannot absorb a surprise CHF 2’500 bill, choose CHF 300. For everyone in between, CHF 1’500 is the sweet spot.
The franchise (called “Franchise” in German, functioning as your annual deductible) is the single biggest lever you have to control your health insurance costs in Switzerland. Choosing the right level can save you over a thousand francs per year — or cost you that much if you choose wrong.
Important
The franchise is the amount you pay out of pocket each calendar year before your insurer covers any costs. After reaching your franchise, you still pay a Selbstbehalt (co-payment) of 10% on all further costs, capped at CHF 700 per year. Your total maximum out-of-pocket cost: franchise + CHF 700 + annual premiums.
The Six Franchise Levels for Adults
Swiss law defines exactly six franchise levels for adults (age 19+). You cannot choose an amount in between.
| Franchise | Monthly Premium (approx.)* | Annual Premium | Max Out-of-Pocket |
|---|---|---|---|
| CHF 300 | CHF 420 | CHF 5’040 | CHF 1’000 + premiums |
| CHF 500 | CHF 398 | CHF 4’776 | CHF 1’200 + premiums |
| CHF 1’000 | CHF 370 | CHF 4’440 | CHF 1’700 + premiums |
| CHF 1’500 | CHF 348 | CHF 4’176 | CHF 2’200 + premiums |
| CHF 2’000 | CHF 322 | CHF 3’864 | CHF 2’700 + premiums |
| CHF 2’500 | CHF 285 | CHF 3’420 | CHF 3’200 + premiums |
*Approximate premiums for an adult 26+, Zurich, Telmed model, including accident coverage. Actual premiums vary by insurer and canton.
The premium difference between CHF 300 and CHF 2’500 franchise is approximately CHF 135 per month, or CHF 1’620 per year. That is the maximum you can save by choosing the highest franchise.
The Break-Even Calculation
The core question: At what level of annual health costs does a lower franchise become cheaper than a higher one?
Let’s compare the two extremes: CHF 300 vs. CHF 2’500.
Scenario A: You spend CHF 0 on healthcare
- CHF 300 franchise: You pay CHF 5’040 in premiums. Total cost: CHF 5’040.
- CHF 2’500 franchise: You pay CHF 3’420 in premiums. Total cost: CHF 3’420.
- Savings with CHF 2’500: CHF 1’620 per year.
Scenario B: You spend CHF 2’000 on healthcare
- CHF 300 franchise: You pay CHF 5’040 in premiums + CHF 300 franchise + CHF 170 co-payment (10% of CHF 1’700). Total cost: CHF 5’510.
- CHF 2’500 franchise: You pay CHF 3’420 in premiums + CHF 2’000 (all out of pocket, under franchise). Total cost: CHF 5’420.
- Savings with CHF 2’500: CHF 90 per year. Barely worth it.
Scenario C: You spend CHF 5’000 on healthcare
- CHF 300 franchise: You pay CHF 5’040 in premiums + CHF 300 franchise + CHF 470 co-payment (10% of CHF 4’700). Total cost: CHF 5’810.
- CHF 2’500 franchise: You pay CHF 3’420 in premiums + CHF 2’500 franchise + CHF 250 co-payment (10% of CHF 2’500). Total cost: CHF 6’170.
- CHF 300 franchise is cheaper by: CHF 360 per year.
The Break-Even Point
Key Finding
The break-even point between a CHF 300 and CHF 2’500 franchise sits at approximately CHF 1’500 to CHF 2’200 in annual health costs (depending on your specific insurer and canton). Below this amount, the high franchise saves money. Above it, the low franchise saves money.
In practical terms: if you visit the doctor once or twice a year and take no regular medication, the high franchise is almost certainly better. If you have any chronic condition, take daily medication, or are planning a surgery or pregnancy, the low franchise wins.
Decision Framework: Which Franchise Is Right for You?
| Your Situation | Recommended Franchise | Why |
|---|---|---|
| Healthy, rarely see doctor, have savings | CHF 2’500 | Maximum premium savings of CHF 1’200–2’100/year |
| Healthy, but no savings buffer | CHF 1’500 | Good savings, manageable risk |
| Occasional doctor visits (2–4/year) | CHF 1’500 | Best balance of savings vs. risk |
| Regular medication or ongoing treatment | CHF 300 | You will hit the franchise anyway — pay less total |
| Planned surgery or pregnancy | CHF 300 | Certain high costs make low franchise optimal |
| Chronic condition (diabetes, etc.) | CHF 300 | Annual costs always exceed break-even |
| Young couple planning family | CHF 300 (for the expectant partner) | Pregnancy/birth costs easily exceed CHF 5’000 |
Franchise for Children
Children (under 19) have different franchise options: CHF 0, 100, 200, 300, 400, 500, and 600. Most parents choose CHF 0 — the premium savings from a children’s franchise are minimal (CHF 5 to CHF 15 per month), while children tend to visit the doctor more frequently than adults.
How and When to Change Your Franchise
You can change your franchise once per year, effective January 1. The deadlines differ depending on the direction:
- Lowering your franchise (e.g., from CHF 2’500 to CHF 300): Deadline is November 30 of the prior year.
- Raising your franchise (e.g., from CHF 300 to CHF 2’500): Deadline is December 31 of the prior year.
- Changing franchise when switching insurer: Any direction, deadline November 30.
Pro Tip
Want a lower franchise but missed November 30? Then your current franchise stays for another year. If you switch insurer anyway, you can choose any franchise level with the new one; the cancellation must also reach your old insurer by November 30. See our Best Health Insurance 2026 ranking for options.
Common Mistakes to Avoid
Mistake 1: Choosing CHF 2’500 without reserves
The high franchise saves money — but only if you can actually pay it when needed. An unexpected hospitalization or accident could happen at any time. If you cannot cover CHF 2’500 from savings within a month, the high franchise is too risky. Consider CHF 1’500 or CHF 1’000 instead.
Mistake 2: Forgetting about the Selbstbehalt (co-payment)
Many people focus only on the franchise and forget that after reaching it, they still pay 10% of all costs up to CHF 700 per year. This means even with a CHF 300 franchise, your maximum annual out-of-pocket expense is CHF 1’000 — not CHF 300.
Mistake 3: Thinking only one year ahead
Over five healthy years, a CHF 2’500 franchise saves approximately CHF 8’100 compared to CHF 300. One year with major health costs might cost you CHF 2’200 extra. The math strongly favors the high franchise over time if you are generally healthy.
Mistake 4: Not lowering before pregnancy
Pregnancy and childbirth in Switzerland typically cost CHF 5’000 to CHF 10’000 or more. If you are planning a pregnancy, switch to the CHF 300 franchise by November 30 of the year before delivery. This single decision can save you over CHF 2’000.
Franchise vs. Insurance Model: Which Saves More?
Both the franchise level and the insurance model affect your premium. From 2027 the FOPH groups the managed-care models as «Praxis» (family doctor and HMO), «Telmed/digital» and «Flex». Here is what each change is worth in Zurich in 2027:
| Change | Monthly saving | Annual saving | Trade-off |
|---|---|---|---|
| CHF 300 to CHF 2’500 franchise | up to CHF 128 | at most CHF 1’540 (legal cap for adults) | Higher financial risk if sick |
| Standard to Telmed | about CHF 75 (median −14.7 %) | about CHF 900 | Call the telemedicine service before seeing a doctor |
| Standard to Praxis (family doctor/HMO) | about CHF 77 (median −15.5 %) | about CHF 925 | First visit always at your chosen practice |
| Both: CHF 2’500 + Telmed or Praxis | about CHF 200 | about CHF 2’400 | Maximum savings, most restrictions |
Source: FOPH premiums 2027, city of Zurich (premium region 1), adults; model rows compare each insurer’s cheapest Telmed or Praxis tariff with its own standard tariff (deductible CHF 2,500, no accident cover), median across the insurers offering both. The franchise cap follows from KVV Art. 95 para. 2bis. Your own figures: premium calculator.
The franchise change typically saves more than the model change. But combining both — choosing the highest franchise with an HMO or Telmed model — delivers maximum savings. For a comparison of top insurers offering these models, see SWICA vs Helsana.
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Frequently Asked Questions
What is a franchise in Swiss health insurance?
The franchise is your annual deductible — the amount you pay out of pocket each calendar year before your insurer starts covering costs. It resets to zero on January 1. Adults can choose from six levels: CHF 300, 500, 1’000, 1’500, 2’000, or 2’500.
Does the franchise reset every year?
Yes. On January 1, your franchise resets to zero regardless of how much you used the previous year. This means if you hit your CHF 2’500 franchise in December, you start again at zero in January.
What is the Selbstbehalt (co-payment)?
After you reach your franchise, you pay 10% of all further medical costs up to a maximum of CHF 700 per year (for adults). After that, your insurer covers 100% of covered services for the rest of the year.
Can I change my franchise mid-year?
No. Franchise changes only take effect on January 1 of the following year. The deadline to lower your franchise is November 30, and the deadline to raise it is December 31. Moving to another canton does not change this: it is not a reason for an extraordinary cancellation.
Should I choose the highest franchise to save money?
Only if you are healthy and have at least CHF 2’500 in accessible savings. If you cannot absorb an unexpected medical bill of CHF 2’500, the risk outweighs the premium savings. A middle franchise like CHF 1’500 may be a better fit.
Does the franchise apply to maternity care?
Starting from the 13th week of pregnancy, certain prenatal exams are exempt from the franchise and Selbstbehalt. The birth itself and postnatal care are also exempt. However, costs before week 13 and certain non-standard treatments may still count toward your franchise.
What is the best franchise for a couple?
Each person has their own franchise — there is no joint option. Assess each person individually. Often, one partner (the healthier one) chooses CHF 2’500, while the other (if they have ongoing medical needs) chooses CHF 300. This optimizes total household costs.
Are prescription medications counted toward the franchise?
Yes. Prescription medications on the official Spezialitaetenliste (medication list) count toward your franchise and, once the franchise is met, toward your 10% co-payment. Over-the-counter medications are generally not covered.
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Nicole Bohne
Pension & Relocation Advisor
Nicole Bohne has worked in insurance and pensions for 10 years, including at Basler and Zurich. She specialises in pensions (pillar 3a, risk cover, tax) and in the insurance questions that come with moving to Switzerland. FINMA-registered intermediary (F01536402); she advises in German, English and French.
