Swiss Health Insurance Deductible 2027: How to Choose Your Franchise

The 2027 premium letters are arriving, the average premium is rising by 5.0%, and somewhere in that letter sits a choice most newcomers make on autopilot: your deductible, called the Franchise in German and French. Pick well and you can save well over a thousand francs a year. Pick badly and a single hospital stay or an unlucky winter of physio appointments can cost you more than you ever saved.

This guide is written the way an experienced expat would explain it over coffee: what the franchise actually is, how the maths works, who should choose which level, and what to do before the 30 November 2026 deadline. It complements our complete guide to moving to Switzerland; here we zoom in on one decision only.

Disclaimer: This article is for general guidance only. It is not legal, financial or insurance advice. Rules and tariffs differ by insurer and canton, so confirm the details with your insurer before you decide.

What the Franchise Is (and What It Is Not)

Swiss basic insurance (KVG/LAMal) is mandatory for everyone resident in Switzerland. It is not "free at the point of use" like a tax-funded system. Instead you share costs in three layers:

1. Franchise (deductible): the amount of medical costs you pay yourself each calendar year before the insurer starts paying. You choose it.
2. Selbstbehalt (co-payment): once the franchise is used up, you pay 10% of further costs, capped at CHF 700 per year for adults and CHF 350 for children. You cannot choose or change this.
3. Hospital contribution: CHF 15 per day of hospital stay in Switzerland. Children, young adults in training and maternity stays are exempt.

So your worst-case yearly bill for covered care is: franchise + CHF 700 (+ CHF 15 per hospital day). The higher the franchise you choose, the lower your monthly premium, because you carry more of the risk yourself.

Two things the franchise does not touch: your supplementary insurance (a separate contract), and accident care for employees working more than eight hours a week for one employer, which is covered by mandatory accident insurance (UVG) without franchise or co-payment. Dental care is mostly not part of basic insurance at all.

The Available Levels

Adults (18 and over) can choose from six levels. Children can have a franchise between CHF 0 and CHF 600 in CHF 100 steps.

The discount column deserves an explanation. Federal rules cap the discount an insurer may give at 70% of the additional risk you take on compared with the CHF 300 level (for example, CHF 2,200 more risk × 70% = CHF 1,540). Insurers may offer less than the cap, and many do, especially for the middle levels. The real discount is on your insurer's tariff sheet, so always check your own letter or a comparison tool rather than assuming the maximum.

The Break-Even Maths in Plain English

For each level, ask: "How much would I save in premiums, and how much more would I pay out of pocket if I use care?"

Using the maximum legal discounts above, here is your net yearly cost (out-of-pocket health costs minus premium savings, compared with the premium you would pay at CHF 300). A negative number means you come out ahead. These figures use the maximum discount, so your real result will usually be somewhat less favourable.

Method: net cost = what you pay yourself (franchise portion plus 10% co-payment up to CHF 700) minus the maximum premium discount. Our own calculation from the federal rules; real discounts vary by insurer.

What the table tells you:

• At the maximum discount, CHF 2,500 beats CHF 300 as long as your yearly medical costs stay below roughly CHF 2,000. Above that, CHF 300 wins, and the gap widens to roughly CHF 500 to 660 in a bad year.
• The lopsidedness is the key insight. In a healthy year, the high franchise saves you up to about CHF 1,500. In a heavy year, it costs you at most about CHF 660 more than the low one (the CHF 700 co-payment cap applies to both). You are being paid a premium to take on a risk that is capped.
• Middle levels (CHF 500 to 1,500) rarely come out clearly ahead, because insurers often discount them less generously. They matter mainly if your expected costs are modest but not tiny.

Which Franchise for Which Person?

Use your last twelve months of actual spending, not your hopes. Your insurer's app or annual statement lists everything billed under basic insurance.

Rarely see a doctor, under about CHF 1,000 a year in covered costs. CHF 2,500 is usually the sensible default. Make sure you can cover a CHF 3,200 worst case from savings without stress. If a surprise bill of that size would hurt, step down a level.

An occasional visit, costs around CHF 1,000 to 2,000. You are near the break-even zone. Compare the real tariffs of CHF 1,500 or 2,000 against 2,500 and 300. Often the answer is "whichever the insurer discounts best for you."

Regular care: chronic conditions, regular medication, therapy, physio, planned treatment, or expected pregnancy. CHF 300 is typically right, because you will exceed the franchise anyway and the discount is not worth it. Pregnancy is a special case: from week 13 until eight weeks after birth you pay no franchise or co-payment for covered care (prevention and dental excepted). Even so, many expecting parents still prefer CHF 300 in the year around the birth for the other costs that surround it. Ask your insurer how it applies in your case.

Children. Children's franchises are chosen separately. Most families keep them at CHF 0 or low levels because children visit doctors often and their maximum co-payment is only CHF 350 each. Children of the same family insured with the same insurer also have a combined co-payment cap of CHF 1,000.

Newcomers and nervous first-year expats. Not knowing the system is a reason for a low franchise in your first year: you will probably also use the system more as you find a GP, get checkups, and handle small issues. You can raise it for the next year once you see your real costs.

Do Not Forget the Other Levers

The franchise is only one of several decisions that move your monthly premium:

• Insurance model: Standard (free choice of doctor), Family doctor (Hausarzt), HMO, and Telmed (call a hotline first). The managed-care models typically cut premiums against Standard, by an amount that varies by insurer and canton, in exchange for a restricted path to specialists. Combine this with the franchise decision.
• Insurer: the same basic cover from the same canton can differ by hundreds of francs a year between insurers. Comparison tools show the whole market.
• Premium subsidies (IPV): depending on canton and income, you may be entitled to a premium reduction. Many people who qualify never apply. Check your cantonal authority's website for the rules and application deadline.
• Premium level: for 2027 the federal office (BAG) reports an average premium of CHF 412 per month (+5.0%), with adults at about CHF 487.60, young adults (19 to 25) at CHF 338.80, and children at CHF 128.10. The rise ranges from about +3.0% in Glarus to +6.6% in Jura, so your canton matters.

The Rules and the Deadline

• Choose by 30 November 2026 for a change to take effect on 1 January 2027. Your insurer must have your written notice by that date, so do not wait until the last evening. Many insurers accept an online request; if you send a letter, use a trackable method.
• Raising your franchise (for example CHF 300 to 2,500) is only possible at the end of a calendar year, with that notice. Lowering it is also tied to the year-end cycle, and insurers may handle the timing and any confirmation differently. Check your insurer's terms and do not leave it to the last day.
• Changing insurers also requires notice by 30 November, but remember the replacement insurer must accept you. Basic insurance must be offered to everyone without health screening.
• Special cases: a franchise can be adjusted outside the cycle only in specific life events, for example starting or stopping self-employment or moving abroad. These are exceptions, not an escape route.
• New arrivals: if you just registered with your commune, you have three months from arrival to take out basic insurance, and cover is retroactive to your arrival date. Do not assume you can postpone indefinitely; unpaid premiums can lead to enforcement action. Your first franchise choice then runs until the next year-end.

Also worth knowing: the franchise applies to costs billed under basic insurance only. Costs under supplementary contracts are separate. And franchise payments are generally not deductible as insurance premiums; some cantons allow a deduction for medical expenses above a share of income. Ask your tax adviser.

A Four-Step Process for Your 2027 Decision

1. Look up your actual 2026 spending in your insurer's online account (franchise used so far this year, co-payments paid).
2. Estimate 2027: planned treatments, new medication, pregnancy, dental or orthodontic needs (mostly not covered), age and family changes.
3. Check the real discounts in your 2027 letter or on a comparison site for the franchise levels you are considering, and run the numbers with the table above.
4. Stress-test: could you pay the worst-case amount (franchise + CHF 700 + hospital days) from savings in one year? If not, go one level lower. Then send your notice before 30 November.

Common Mistakes

• Choosing the highest franchise because it has the lowest premium. You are not saving money, you are buying a risk. Make sure you can carry it.
• Staying on autopilot for years. Your health, family and income change; review every autumn.
• Not accounting for planned treatment. If you know about a procedure, scan, or long course of therapy next year, a low franchise is usually cheaper.
• Ignoring the CHF 700 co-payment cap in the maths. It is exactly what makes the high franchise a capped risk.
• Missing the deadline by a day. A request that arrives on 1 December will, in practice, only take effect for 2028.

Frequently Asked Questions

Can I change my franchise during the year?

Generally not. Franchise changes follow the calendar-year cycle with notice by 30 November, apart from specific life events (for example starting self-employment or leaving Switzerland). Treat the choice as binding for the full year.

What is the maximum I can pay for medical care in a year?

For an adult, the franchise you chose plus CHF 700 co-payment, plus CHF 15 per hospital day. With CHF 300 that is CHF 1,000; with CHF 2,500 it is CHF 3,200 (before hospital days). Supplementary, uncovered and dental costs come on top.

Does the franchise apply to accidents?

If you work more than eight hours a week for one employer, accidents are covered by your employer's accident insurance without franchise or co-payment. If you are not covered through work (for example if you are not employed), accident cover is part of your basic insurance and the franchise applies.

Is the CHF 2,500 franchise a good idea for a healthy 30-year-old?

Often yes, as long as you have savings to cover up to CHF 3,200 in a bad year and expect low usage. Check the actual discount your insurer gives, since the maximum is rarely offered at every level.

Do pregnancy and birth cost franchise and co-payment?

For covered pregnancy care from week 13 until eight weeks after birth, no franchise or co-payment applies (with exceptions such as prevention and dental treatment). Ask your insurer about the details.

Key Takeaways

• The franchise is the amount you pay yourself each year before insurance pays; adults choose between CHF 300 and CHF 2,500, and a 10% co-payment of up to CHF 700 applies on top.
• A higher franchise lowers your premium, but the real discount is set by each insurer, not by law. Check your own tariff.
• At maximum discounts, CHF 2,500 beats CHF 300 if your yearly medical costs stay under roughly CHF 2,000; above that, CHF 300 wins.
• Because the co-payment is capped, a high franchise is a capped risk. Make sure the worst case is affordable.
• Chronic conditions, planned treatment, and regular medication usually point to CHF 300.
• Combine the franchise decision with model choice, insurer comparison, and premium subsidies for the biggest saving.
• Give notice by 30 November 2026 for 1 January 2027.

Sources

• ch.ch: Health insurance costs and premiums
• Comparis: Selbstbehalt in der Grundversicherung
• BAG / Federal Office of Public Health: Krankenkassenprämien steigen durchschnittlich um 5,0 Prozent
• expat-savvy.ch: How to choose a health insurance deductible
• Swisslife: Switching basic insurance
• Concordia: Deductible and retention fee

Information is for general guidance only and does not constitute legal or financial advice.