What Swiss basic health insurance covers, and what you pay

WEWritten byWorkacross Editorial

Editorially checked byTobias KernFounder · 6 September 2026

Swiss basic insurance has one legal benefit catalogue, but a covered treatment can still leave part of the bill with you. The useful distinction is between what the policy covers, how the invoice moves and how deductible and co-payment are applied.

One compulsory catalogue, wherever you live

If Switzerland insures you under compulsory basic health insurance, the statutory catalogue covers illness, maternity and accidents when no separate accident insurance is responsible. Authorised basic insurers must provide the same compulsory benefits. That shared Swiss catalogue is the anchor for insured people living in France and Germany.

Coverage is still tied to conditions: a provider must be authorised, a treatment must meet the legal effectiveness, usefulness and cost-effectiveness tests, and some items need a prescription or appear on a statutory list. Ask the insurer about an uncertain treatment before relying on reimbursement.

The deductible comes first, then 10%

The standard adult deductible is CHF 300 per calendar year. A deductible is the amount you pay before the insurer begins sharing ordinary covered costs. After that, you pay 10% of the remaining covered bill until your annual co-payment reaches CHF 700. With the standard deductible, the usual adult maximum is therefore CHF 1,000, before any hospital daily contribution.

Example: covered treatment totals CHF 2,000 in one year. You pay CHF 300, leaving CHF 1,700. Ten per cent of CHF 1,700 is CHF 170, so you pay CHF 470 and the insurer reimburses CHF 1,530. An optional deductible changes that arithmetic, and special exemptions or medicine rates can also apply.

The invoice can reach you in two ways

Under tiers garant, the provider bills you and you send the invoice to the insurer, which reimburses the covered amount minus your cost share. Under tiers payant, the provider bills the insurer directly and the insurer later charges your share. These French terms name who pays the provider first; they do not change the benefit catalogue.

Keep the original invoice, reimbursement statement and payment proof together. If you receive treatment in your EU country of residence rather than Switzerland, local cost-sharing rules may apply, so check the insurer's route for planned treatment before the appointment.

Accident cover and route choice are separate questions

Swiss basic insurance covers accidents only when another accident insurer is not responsible. For many Swiss employees, employer accident insurance handles the claim instead; the responsible insurer changes the invoice path and cost sharing.

Use these cost-sharing rules after the competent authority has confirmed that Swiss basic insurance applies. If you live in France and still need the earlier route decision, compare the reviewed France routes and confirm the result with that authority.