The Deductible in the LAMal Obligatory Plan

For the obligatory LAMal coverage the client is free to choose a deductible (franchise in French) ranging from CHF 300 to 2,500 per calendar year.

1) A deductible or “franchise” means that you pay a chosen amount out-of-pocket before the insurance coverage kicks in. For adults the choices are CHF 300, 500, 1500, 2000, or 2500 CHF and for children CHF 0, 100, 200, 300, 400, 500 or 600. A quick analysis reveals that the 0 deductible is best for children, but the choice is more complicated for adults.

2) To illustrate, if you choose a low deductible (for example CHF 300), the insurance coverage will “kick in” faster than if you choose a high deductible (for example CHF 2500). This means that you are considered a better “risk” for the insurance company if you choose a high deductible, because their coverage kicks in later and they know that you are healthy customer (because if you were not you would have chosen the small deductible!!). Who says “better risk” in insurance jargon, says “cheaper monthly premium”. This is where choosing your annual deductible becomes complicated, because you have to make an educated advanced calculation of your medical expenses in the year to come, which is obviously a hazardous task!

To help you, on average a client will pay between CHF 120 to 140 per month more for a low deductible (which means approximately CHF 1450 CHF per year). That is why CHF 1500 of medical expenses per year is a key figure for helping you to choose your deductible (“franchise”). If you anticipate a high need for medical care during the year (above CHF 1,500), it would be advisable to take a plan with a low deductible (300).

3) Health insurance deductibles are cumulative over the year and valid from 1 January to 31 December. They are not applied per invoice and are not valid a year from the subscription date, as is the case for most other types of insurance (for example if you subscribe in September your deductible is not calculated from 1 September to 31 August).

4) On top of this deductible all clients must also pay 10% of their medical bills out-of-pocket and this until a maximum of CHF 7000 per year for adults and 3500 for children. The maximum a person with a 300 deductible could therefore pay per year (on top of their monthly premiums) would be CHF 1000 (deductible plus 10% of 7000); or CHF 3200 for a 2500 deductible.

How to choose your Deductible:

If you have high annual medical costs (over CHF 1500 per year), choose a low deductible or “franchise” of CHF 300.

If you have low medical costs per year (less than CHF 1500 per year), you may wish to choose a higher deductible or “franchise” of say, CHF 1500 to 2500. If you are not employed or are independent or self-employed, the maximum recommended deductible is CHF 1500.

Some additional information to help you choose:

  • The average cost of a doctor consultancy (General Practitioner) ranges from CHF 150 to 300 per visit.
  • The average gynecologist’s fees range from CHF 200 to 400 depending on lab tests.
  • Average health costs per year for a man in good health in Switzerland: CHF 800
  • Average health costs per year for a woman in good health in Switzerland: CHF 1200