Which Health Insurance Franchise Actually Saves

For most healthy adults the CHF 2,500 franchise costs the least, because the premium saving is bigger than any bill they are likely to face. It stops winning at roughly CHF 1,800 of medical care in the year. Above that, the CHF 300 franchise is cheaper. The whole decision is worth a few hundred francs a year, not thousands.

The number to compare is not the franchise on its own. It is the franchise plus CHF 700 plus twelve premiums — the most that level can cost you in a year. On Eini's own indicative working figures that worst case runs from about CHF 6,040 at the CHF 300 level to about CHF 6,860 at the CHF 2,500 level, a spread of roughly CHF 820.

How the franchise and the 10% retention actually work

Adults choose one of six levels: CHF 300, 500, 1,000, 1,500, 2,000 or 2,500. Below that amount you pay every invoice yourself. Once your bills for the year pass it, the insurer takes over — but not completely. You still pay a 10% retention on everything above the franchise, and that retention is capped at CHF 700 per year for adults.

That cap is what makes the decision calculable. Whatever the year brings, your medical bills stop at the franchise plus CHF 700. A CHF 2,500 franchise cannot cost you CHF 9,000 of care; it stops at CHF 3,200.

One thing newcomers miss: the premium is not deducted from your salary. Every adult pays it separately, by invoice — a fixed monthly cost in the same class as rent or the grocery share of your salary.

The most each franchise level can cost you in a year

Write down the worst case for every level and the choice becomes arithmetic instead of instinct.

The table runs the arithmetic across three honest scenarios: a year with almost no medical care, a year with about CHF 1,000 of care, and a year with CHF 3,000 or more.

Read the last column across: the break-even sits at roughly CHF 1,800 of care.

Which level wins in a quiet year, a CHF 1,000 year and a CHF 3,000 year

Almost no care. One check-up, one prescription, nothing else. You pay those bills yourself at every level, so the only difference is the premium: the highest franchise wins by about CHF 1,380.

About CHF 1,000 of care. A course of physiotherapy, a specialist referral, some imaging. At the CHF 300 level you pay CHF 370; at CHF 1,000 and above you pay the whole CHF 1,000, because you never cross the franchise. The high franchise still wins on total cost: the extra CHF 630 of bills is smaller than the CHF 1,380 of premium saved.

CHF 3,000 of care. A minor operation, a hospital night, a year of regular treatment. The CHF 300 franchise pays CHF 570, the CHF 2,500 franchise CHF 2,550. The premium saving no longer covers the gap and the low franchise comes out roughly CHF 600 ahead.

This is general information about how the Swiss system works, not individual advice — your canton, municipality and situation change the numbers.

Why CHF 2,500 is the default for healthy adults, and when it is not

The premium discount is certain; the medical bill is not. An adult who sees a doctor once or twice a year banks the full saving every year and loses it only when something goes wrong. Nine quiet years at CHF 1,380 saved outweigh one bad year at CHF 600 lost.

The condition is liquidity. Choosing CHF 2,500 means being able to produce CHF 3,200 if the year turns bad, without a loan. If that money does not exist yet, build it first: a monthly audit of what you actually spend shows where it can come from, and ten concrete steps on the grocery bill free up a meaningful amount within a month. A high franchise without a reserve behind it is not a saving, it is a bet.

Four situations flip the arithmetic, and they share one feature: the spending is foreseeable.

• A planned operation. Anything scheduled for next year will cross every franchise, so the low level is cheaper before you start.
• A pregnancy. A year of appointments and a hospital stay. The cost-sharing rules around maternity are a subject of their own and worth reading before you set your franchise.
• Ongoing therapy. Physiotherapy, psychotherapy or any treatment measured in sessions per month passes CHF 1,800 quickly.
• A chronic prescription. Medication you take every day is a predictable annual invoice. Add it up and hold it against the premium gap.

If two or more apply, the honest answer is usually the lowest franchise you can get. If none apply and the reserve exists, the highest one is usually cheaper.

Why the insurer matters less than the franchise and the model

Basic cover is identical by law at every Swiss insurer: the same treatments, the same medicines, the same hospital list in your canton. Only price and service differ, which leaves two real levers: the franchise and the model.

There are four model families. Standard gives free choice of doctor; the family-doctor model asks you to call your registered GP first; HMO routes you through a group practice; Telmed starts with a phone or video consultation. Each alternative trades some freedom of choice for a lower premium, at every franchise level.

Because the cover is the same everywhere, the only comparison worth doing is the price comparison. Run it at the Federal Office of Public Health premium comparison (Priminfo), which lists every approved premium for your postcode, age, franchise and model. Those are the numbers to decide on, not the indicative ones in the table above.

When you can actually change your franchise

Here is the practical trap. The franchise runs with the calendar year, and you normally change it with effect from 1 January. The decision is therefore taken months before the care happens, in the autumn, on a forecast of next year's health.

If you also want to switch insurer for 1 January, written notice must reach the insurer by the end of November. Reach, not be posted.

One consequence: if you learn in March that you need an operation, you cannot lower your franchise for that year, only for the following one. Set it around what you already know is coming, not around how you feel today.

How to decide your franchise in ten minutes

1. Add up last year's medical bills. The statements are in your insurer's portal; the total is the best single predictor you have.
2. Write down what you already know about next year. A scheduled operation, a pregnancy, a therapy still running, a daily medication.
3. Check whether you could produce CHF 3,200 tomorrow. If not, the highest franchise is off the table until the reserve exists.
4. Look up your real premiums. Enter postcode, year of birth and each franchise level in the official comparison, and note the annual figure for CHF 300 and CHF 2,500.
5. Subtract, then find the break-even. Divide the difference between those two annual premiums by 0.9 and add CHF 300. That is roughly the level of medical bills at which the two cost the same.
6. Compare with step 1. Expected care comfortably below the break-even points to the high franchise; above it points to the low one.
7. Decide the model separately. A family-doctor or Telmed model lowers the premium at every level.
8. Diarise the deadline. End of November, every year, and re-run the whole thing each autumn.

Insurance is Phase 5 of Eini's roadmap and it is being built now, not available yet. The insurance module will compare premiums for your canton, age, franchise and model, and store every policy you hold across the main Swiss insurance types with its renewal date and cancellation deadline. A dashboard will show what you pay in total, with alerts for approaching deadlines and gaps in cover. A franchise calculator will take your expected medical spend and return the level with the lowest total cost. Groceries and meal planning are what is live today.