The franchise decision, explained for your arrival year.

In short: The franchise is the annual deductible on Swiss compulsory health insurance (KVG). The standard level is 300 francs, with optional levels up to 2,500, and the premium falls as the franchise rises. Above it you still pay a 10% retention capped at 700 francs a year, plus 15 francs a day for inpatient stays, which sits outside the cap. The choice is annual.

Swiss basic insurance leaves you exactly one pricing lever, and every new arrival pulls it half-blind. The compulsory benefits are identical at every insurer by law; what you choose is the franchise — your annual deductible, from 300 to an optional 2,500 francs — and the premium falls as the franchise rises. It is the largest controllable number in your Swiss insurance year, it is chosen inside the first ninety days, and it is chosen precisely when you know least about your Swiss life. Here is the arithmetic, and the arrival-year version of it.

The machine, verified

Three parts, all confirmed against the BAG. The franchise: you pay the first 300–2,500 francs of the year’s costs yourself, at the level you selected. The standard level is 300; the optional levels climb from 500 to the 2,500 ceiling, with rungs in between, though the decision in practice is nearly always top-versus-bottom. The retention: above the franchise you still pay 10% of costs, capped at 700 francs a year — so even the worst year has a known ceiling. The hospital contribution: 15 francs a day for inpatient stays, and it sits outside the cap. Total worst-case exposure at the top franchise: roughly 2,500 + 700 plus hospital days — call it 3,300-plus francs. At the bottom: 300 + 700 and the same days — about 1,000.

Against that, the premium saving between bottom and top franchise is substantial and annual. The whole decision is those two numbers side by side: guaranteed premium saving versus contingent extra exposure of roughly two thousand francs.

One thing the franchise does not touch: your supplementary insurance, if you hold any. Supplementary cover is a separate contract with separate terms and its own settlement rules, and it is underwritten on your health at application. The franchise is a dial on the compulsory layer only.

What the franchise actually feels like across one year

Stated as a rule it is abstract. Stated as a year it is obvious.

January, you see a doctor about a persistent cough. The consultation and the prescription settle against your franchise: you carry the full cost, because the franchise is the part of the year you fund yourself. March, physiotherapy after a running injury. Still the franchise, still your money. Somewhere in the spring, if the costs keep coming, the franchise is exhausted — and the mechanism changes rather than stopping. From that point you pay 10% of everything, until that retention reaches 700 francs for the year, after which the compulsory layer carries the rest. If any of it involved an inpatient stay, add 15 francs for each day, and note that those days keep charging after the 700-franc cap is reached, because they sit outside it.

Two practical implications fall out of that sequence. First, the franchise is front-loaded, so a high franchise chosen in a year that turns out to be expensive hurts early and visibly, in the first months, which is exactly when a new arrival’s cash flow is already carrying deposits and furniture. Second, you should not be tracking this in your head. Your Krankenkasse settles each claim and reports what counted toward the franchise and what counted toward the retention; those statements are the running total, and reading the first few properly is how the system stops being a mystery.

The arithmetic, without the folklore

Swiss dinner-party wisdom assigns franchises to personality types — cautious people at 300, optimists at 2,500. Ignore it; this is a sum. If your realistic year holds routine care only — a GP visit, a prescription or two — the high franchise wins: you pocket the premium difference and pay the small bills yourself. If your year predictably holds volume — pregnancy, a managed condition, a planned procedure, children’s orthodontic years — the low franchise wins before it starts. The break-even sits at moderate usage, and the honest question is which side of it your actual next year likely lands.

Three refinements sharpen it. Liquidity is a real input: the 2,500 franchise is only cheap if a surprise 3,000-franc quarter is an annoyance, not a crisis — the premium saving is not worth financing stress. The choice is annual: you can reset the level for a new year, and the market resets around you at the same time, since premiums are re-set annually and the switching windows open towards the end of the year. And the insurer choice sits underneath all of it: premiums for the legally identical basic package differ between funds, so the franchise is a percentage adjustment to a number you also chose. A low franchise at a competitively priced fund can cost less than a high franchise at an expensive one. Compare the two decisions together, not in sequence.

The arrival-year version

Your first Swiss year is the worst year to model, and it is the year you must choose in. No Swiss GP yet, no sense of local costs, possibly no sense of your own family’s rhythm in a new country. Four arrival-specific notes:

The year may be short. Arrive in September and your franchise still spans the calendar year — three months of exposure against a full year’s franchise choice. A high franchise in a short, healthy stub of a year is nearly free premium saving; the calculation resets properly in January.

The premium underneath is not only about age and canton. It is set per person by age, insurer and premium region — a federal designation finer than the canton, so the address you register at moves the number the franchise is adjusting. Two arrivals in the same canton, same age, same fund and same franchise can pay differently.

Accident cover changes the flow. If you work eight or more hours a week for one employer, accidents are the employer’s insurance, not yours — exclude accident cover from the health policy (leaving it in is the classic arrival double-payment) and note that your franchise then only ever meets illness costs. Under eight hours, accidents run through your policy and the same franchise.

The model choice compounds it. Family-doctor, telemedicine and HMO models discount the premium at every franchise level in exchange for a gatekeeping rule. The frugal-and-healthy arrival stacking top franchise on a restricted model reaches the cheapest legal version of Swiss insurance — a defensible position, provided the gatekeeping suits how you actually seek care.

Choosing for a family means choosing four times

Swiss cover is per person. Four people means four policies, four premiums and four franchises, each set independently — and the household’s worst case is the sum of four ceilings, not one. That is the number to plan around, and it is the number a single adult’s quote hides completely.

The useful consequence is that a family does not need one answer. The adult with a managed condition can sit low while the healthy adult sits high; the arithmetic is run per person because the exposure is held per person. Treating the franchise as one household setting gets it wrong in both directions at once.

Children are a genuine exception and we will not guess at it: the adult ladder described above is the adult ladder, and children’s franchises work on their own terms. Confirm the levels available for each child with the fund before you sign the family’s applications — it is a two-minute question and the wrong assumption is expensive across four policies.

When the high franchise is the wrong answer

Three cases, stated plainly, because the default advice in expat circles runs one direction only.

If a three-thousand-franc year would force a decision about something else — a flight home, a rent buffer, a course you had planned — the low franchise is correct regardless of the expected-value arithmetic. Buying predictability is a legitimate use of money.

If your year holds known volume, the high franchise is not a bet, it is a cost. Pregnancy, a condition already under management, an operation you have been putting off since before the move: these do not make the high franchise a gamble that might pay off, they make it the more expensive option before the year starts.

And if you are exempt, none of this applies to you at all. Cross-border commuters and pensioners insured where they live, temporary students with equivalent cover, diplomatic staff, EU/EFTA workers and pensioners can be released from the compulsory system entirely — formally, through the cantonal authority, inside the first three months. Establish that before you optimise a franchise you may not owe.

Decide, then re-decide with data

The arrival-year answer for most healthy, liquid newcomers: high franchise, restricted model if the gatekeeping suits you, accident cover matched to your employment hours — then run one real Swiss year and reset the level with twelve months of actual receipts.

Two longer horizons are worth holding while you do it. The premium the franchise adjusts is set by age, and age moves one way: our own fifty-country data shows the shape of that climb clearly, with comparable international cover in Switzerland running about $6,392 for the 24-year-old profile in the SIP Health Cost Index 2025, $8,017 at 35 and $12,328 at 50 — a multiple of 1.54 across fifteen years, and a steep curve by the standards of the index. The franchise saving is a slice of a number that grows underneath you. And the decision that deserves your caution is the neighbouring one: supplementary insurance, which underwrites your health at application and does not offer next-January resets. The franchise forgives; supplementary remembers.

Before you file anything away, read one document: the policy certificate your fund sends after enrolment. Three lines on it decide your year — the franchise level, the model, and whether accident cover is included or excluded. If any of the three does not match what you believed you chose, that is a phone call this week, not next January.

The deep Swiss versions of all of this — model comparisons, worked franchise tables, fund service records — live on expat-savvy.ch, our Swiss practice. The arrival-shaped summary is on our Switzerland page.