Insurance Franchise: 300 vs 2500

Key Facts — Franchise & Models (2026)

• Adult franchise levels: CHF 300, 500, 1,000, 1,500, 2,000, 2,500
• Co-pay (Selbstbehalt): 10% after franchise, capped at CHF 700/year (CHF 350 for children)
• Maximum out-of-pocket: CHF 3,200/year (CHF 2,500 franchise + CHF 700 co-pay)
• Model savings vs Standard: GP ~10–15%, HMO ~15–25%, Telmed ~10–20%
• Deadline to switch: 30 November for 1 January start

The Real Math Behind Swiss Health Insurance Deductibles

Every expat in Switzerland faces the same question: should I pick the CHF 300 or CHF 2,500 franchise?

The common advice — “pick CHF 2,500 if you’re healthy” — is dangerously oversimplified. Whether a high franchise saves you money depends on three things: your actual premium difference, your expected medical costs, and your insurance model.

This guide calculates the exact break-even points so you can make a decision based on numbers, not guesswork.

Important: Your franchise (deductible) only applies to basic KVG/OKP insurance. Supplementary insurance has separate terms.

How the Swiss Franchise System Works

Every time you visit a doctor, the bill goes through three layers:

Layer 1 — Franchise (Deductible) You pay 100% of medical costs until you hit your chosen franchise amount. If you chose CHF 2,500, you pay the first CHF 2,500 of annual medical expenses yourself.

Layer 2 — Co-pay (Selbstbehalt) After your franchise is used up, you pay 10% of remaining costs, up to a maximum of CHF 700 per year (CHF 350 for children). For certain brand-name drugs where a generic exists, the co-pay rises to 20%.

Layer 3 — Full Coverage After franchise + CHF 700 co-pay, your insurer covers 100% of remaining eligible costs for the rest of the year.

Maximum annual out-of-pocket cost:

• With CHF 300 franchise: CHF 300 + CHF 700 = CHF 1,000
• With CHF 2,500 franchise: CHF 2,500 + CHF 700 = CHF 3,200

Note: Hospital stays add CHF 15/day (no cap). This applies to adults only — not children, students under 25, or maternity stays.

The Six Franchise Levels Compared

Here’s what each franchise level means for your total costs at different medical spending levels:

If You Spend CHF 0 on Healthcare (Healthy Year)

Franchise	You Pay	Insurer Pays	Total Out-of-Pocket
CHF 300	CHF 0	CHF 0	CHF 0 + higher premiums
CHF 2,500	CHF 0	CHF 0	CHF 0 + lower premiums

Winner: CHF 2,500 — you pocket the full premium savings.

If You Spend CHF 3,000 on Healthcare

Franchise	Franchise Paid	Co-pay (10%)	Total Out-of-Pocket
CHF 300	CHF 300	CHF 270	CHF 570
CHF 500	CHF 500	CHF 250	CHF 750
CHF 1,000	CHF 1,000	CHF 200	CHF 1,200
CHF 1,500	CHF 1,500	CHF 150	CHF 1,650
CHF 2,000	CHF 2,000	CHF 100	CHF 2,100
CHF 2,500	CHF 2,500	CHF 50	CHF 2,550

Difference: CHF 1,980 more out-of-pocket with CHF 2,500 vs CHF 300. That’s the premium savings you need to justify the higher franchise.

If You Spend CHF 10,000+ on Healthcare (Worst Case)

Franchise	Total Out-of-Pocket (capped)
CHF 300	CHF 1,000
CHF 2,500	CHF 3,200

Maximum exposure difference: CHF 2,200.

The Break-Even Calculation

The break-even point is simple: how much do you save in premiums vs how much more you risk paying out-of-pocket?

Typical 2026 Premium Savings (Zurich, Age 26+)

The premium difference between CHF 300 and CHF 2,500 franchise varies by insurer, but typically:

• Annual premium savings: CHF 1,200–2,400 (CHF 100–200/month)
• Additional risk: CHF 2,200 (difference in max out-of-pocket)

If your annual savings are CHF 1,800:

• You break even if medical costs stay below ~CHF 2,000
• You lose money if you have a bad year with CHF 5,000+ in costs
• Over 5 years, you need to stay healthy for 3+ years to come out ahead

The Decision Framework

Choose CHF 2,500 if ALL of these are true:

• You’re under 40 and generally healthy
• You can absorb CHF 3,200 in a bad year without financial stress
• You don’t take regular medication
• No planned surgeries or pregnancies
• Your premium savings exceed CHF 1,500/year

Choose CHF 300 if ANY of these are true:

• You have a chronic condition requiring regular treatment
• You’re planning a pregnancy (maternity = guaranteed high costs)
• You take regular prescription medication
• You can’t comfortably pay CHF 2,500 out of pocket
• Your premium savings are under CHF 1,000/year

Consider CHF 1,000 or CHF 1,500 as a middle ground if you want moderate savings without extreme risk.

Try our interactive deductible calculator to see exact costs for your situation.

Insurance Models: Your Second Savings Lever

The franchise isn’t your only tool. Choosing a different insurance model can cut premiums by 10–25% — and these savings stack with franchise savings.

Standard Model (Freie Arztwahl)

• How it works: See any doctor or specialist, anytime, no referral needed
• Premium impact: Baseline (most expensive)
• Best for: People who value maximum flexibility or have complex health needs
• Expat note: Easiest model — no gatekeeping, no language barriers with referral calls

Telmed Model (Telemedicine First)

• How it works: Call a medical hotline before seeing a doctor in person. The hotline triages your issue — most calls take 10–15 minutes
• Premium savings: 10–20% vs Standard
• Best for: Tech-comfortable expats who don’t mind a phone call before visits
• Expat note: Most hotlines offer English. Verify with your insurer before signing up
• Exceptions: Emergencies, annual gynecology checks, and ophthalmology are usually exempt

HMO Model (Health Maintenance Organization)

• How it works: You register with an HMO center. All care starts there — they refer you to network specialists when needed
• Premium savings: 15–25% vs Standard
• Best for: Expats near an HMO center who want coordinated care and maximum savings
• Expat note: Limited choice of doctors. Check if the HMO center has English-speaking physicians
• Limitation: Out-of-network specialists generally not covered except in emergencies

Family Doctor Model (Hausarzt)

• How it works: Choose a GP from your insurer’s list as your first point of contact. They coordinate all referrals
• Premium savings: 5–15% vs Standard
• Best for: Expats who want a consistent relationship with one doctor
• Expat note: Finding an English-speaking GP on the insurer’s approved list is essential — ask before committing

Stacking Savings: Model + Franchise Combined

The biggest savings come from combining a high franchise with a cost-saving model:

Combination	Estimated Annual Savings vs Standard + CHF 300
Standard + CHF 2,500	CHF 1,200–2,400
Telmed + CHF 300	CHF 400–900
Telmed + CHF 2,500	CHF 1,800–3,200
HMO + CHF 300	CHF 600–1,200
HMO + CHF 2,500	CHF 2,200–3,800

Maximum potential savings: CHF 3,000–4,000/year with HMO + CHF 2,500, compared to Standard + CHF 300.

But remember: those savings evaporate if you have a high-cost medical year.

Common Mistakes Expats Make

Mistake 1: Choosing CHF 2,500 Without a Cash Buffer

If you need medical care in January and haven’t saved the CHF 2,500, you still owe it. Some expats end up on payment plans with their insurer — not a great start.

Mistake 2: Forgetting About the Co-pay

The franchise isn’t your only out-of-pocket cost. After the franchise, you still pay 10% up to CHF 700. Many people budget for the franchise but forget this extra CHF 700.

Mistake 3: Not Switching Models When Moving

HMO availability varies by location. If you move from Zurich to a rural area, your HMO center might no longer be convenient. Review your model choice after every move.

Mistake 4: Keeping the Same Franchise After Life Changes

Had a baby? Diagnosed with something chronic? Your optimal franchise just changed. Review annually before the 30 November deadline.

Mistake 5: Comparing Premiums Without Total Cost

A plan with CHF 50/month lower premiums but CHF 2,200 higher deductible only saves you money if you stay very healthy. Always compare total annual cost (premiums + expected out-of-pocket).

When to Change Your Franchise

Deadline: 30 November for changes effective 1 January.

You can change your franchise every year — it’s one of the easiest insurance optimizations available. You can also switch your insurance model and even your insurer at the same time.

Review triggers:

• Significant change in health status
• Pregnancy planned for next year
• Starting or stopping regular medication
• Major age milestone (costs tend to rise after 40)
• Moving to a new canton (premiums vary significantly)

Pro tip: Even if you keep your insurer, compare premiums annually. Insurers adjust rates differently each year, and last year’s best deal might not be this year’s.

FAQ

Q: Can I change my franchise mid-year? No. Franchise changes only take effect on 1 January. You must notify your insurer by 30 November of the prior year.

Q: Does my franchise reset every year? Yes. Even if you didn’t use any of your franchise this year, it resets to the full amount on 1 January.

Q: What if I switch insurers — does my franchise carry over? No. Your franchise resets when you switch insurers, even mid-year. If you’ve already paid CHF 1,500 toward your franchise with Insurer A and switch to Insurer B, you start from zero with Insurer B.

Q: Which franchise is best for families with children? Children have different franchise options (CHF 0–600). For children, CHF 0 franchise is almost always the best choice — the premium savings for higher child franchises are minimal, and kids get sick frequently.

Q: Do accidents count toward my franchise? Only if you have basic accident coverage through your health insurer (typically non-employed persons). If you’re employed, your employer’s accident insurance (UVG) covers work and non-work accidents separately — these don’t touch your health insurance franchise.

Q: Is CHF 2,500 always the cheapest option for healthy people? Usually, but not always. Some insurers have relatively small premium differences between franchise levels, making the risk not worth it. Always calculate the actual numbers for your specific insurer and canton.

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Related Guides

• How to Choose the Right Health Insurance Deductible (Interactive Calculator)
• Best Health Insurance Switzerland 2026
• Cheapest Health Insurance Switzerland 2026
• Accident Insurance in Switzerland: The Weekend Gap

Make the Right Choice for Your Situation

The “best” franchise depends entirely on your personal situation. A 28-year-old marathon runner and a 45-year-old with diabetes need very different setups — yet both might be paying the wrong amount right now.

Our FINMA-certified advisors run personalized cost analyses across all franchise levels and insurance models, using your actual health profile and the latest 2026 premium data.