English Forum Switzerland

English Forum Switzerland (https://www.englishforum.ch/forum.php)
-   Insurance (https://www.englishforum.ch/insurance/)
-   -   Deductible / Excess / Franchise [health insurance] - which is the best one to choose? (https://www.englishforum.ch/insurance/49126-deductible-excess-franchise-health-insurance-best-one-choose.html)

jenny 17.04.2009 15:53

Deductible / Excess / Franchise [health insurance] - which is the best one to choose?
 
I have noticed quite a few posts on here recently about which deductible is the best one to choose so I thought it might be helpful to start a proper thread dealing only with this issue.

If you read through all the threads and agree with everyone, then every single deductible seems to be the best one to choose!

You have to be careful how you calculate which deductible is the best one for you. Taking into consideration the 10% quota ("quote-part") and how often you need to see a doctor/take medication etc.

This is the best way I've found to work out so get yer calculators out!

Let's take 3 different deductibles : 300.-, 1'500.- and 2'500.-

Let's take premiums for Vaud zone 1 with the company Vivacare without accident, for adults (26+).

Monthly premiums :

300.- = 333.50
1'500.- = 257.30
2'500.- = 193.90


Example 1.

You have to visit the doctor a couple of times a year and take regular medication. Your annual bills come to 1'000.-.

1. You have a 300.- deductible. You will have to pay :

- premiums = 333.50 x 12 = 4'002.-
- your deductible = 300.-
- 10% of what is remaining = 70.- (1'000 - 300 = 700 x 10% = 70.-)

Total = 4'372.-

2. You have a 1'500.- deductible. You will have to pay :

- premiums = 257.30 x 12 = 3'087.60
- you have not gone over your deductible so you'll have to pay the full 1'000.- medical bills = 1'000.-
- no 10% (haven't gone over deductible)

Total = 4'087.60

3. You have a 2'500.- deductible. You will have to pay :

- premiums = 193.90 x 12 = 2'326.80
- as above, = 1'000.-
- no 10%

Total = 3'326.80

------

In this case, you would be better off with a 2'500.- deductible.
Despite your 1'000.- worth of bills, you are still saving 1'045.20 p.a.

------

Example 2.

You have a catastrophic year with bills coming left, right and centre totalling 100'000.-

1. You have a 300.- deductible. You will have to pay :

- premiums = 333.50 x 12 = 4'002.-
- your deductible = 300.-
- 10% of what is remaining = 700.-
(fortunately, this is maxed out at 700.-)

Total = 5'002.-

2. You have a 1'500.- deductible. You will have to pay :

- premiums = 257.30 x 12 = 3'087.60
- your deductible = 1'500.-
- 10% of what is remaining = 700.-

Total = 5'287.60

3. You have a 2'500.- deductible. You will have to pay :

- premiums = 193.90 x 12 = 2'326.80
- your deductible = 2'500.-
- 10% of what is remaining = 700.-

Total = 5'526.80

-----

In this example, you would be better off having a 300.- deductible.

---------

If example 1 is a typical year for you but you know that example 2 could happen one day, you have to think, "is it worth it for me to save over 1'000.- p.a. to lose 526.- the year that something major happens?"
If example 2 happens in your 5th year of insurance, you will have saved over 4'000.- in the first 4 years to then lose 526.-. You are still saving money over all.

You can take any company and any deductible and work it out for yourself. Why not try other examples? "What would happen if I have 2'000.- worth of bills?" etc.

If you have just arrived in Switzerland and are on regular medication, ask a local pharmacy how much your medication costs and for how many. Work out how much this would cost you annually and do your sums. It doesn't take long and it could save you money so I think it's worth it.

Ideally, if you go for a big deductible, you should put that amount in a second bank account in your name and keep it there for emergencies. The financial risk of having taken a bigger deductible is therefore covered rather than giving it to your insurance company every month.


Remember, you can change your deductible each year if you wish. So, you can use this to your advantage.
Say you find out in September 09 that you have to go in to hospital for an operation in February 10, you should lower your deductible to 300.- for 2010.
If you have a low deductible and the chances of you having to visit doctors etc. the following year is slight, increase it.

You have to let your health insurance provider know by November 30th with a registered letter that you wish to change your deductible for the following year.

N.B. There is no deductible on supplementary cover with most companies so osteopaths for example, do not count towards your deductible. This is only for basic cover.

-------

Hope this clarifies things and hasn't given you too much of a headache!

If you have any questions, as always, just let me know :)

CH_Me 17.04.2009 16:34

Re: Deductible / Excess / Franchise - which is the best one to choose?
 
One thing worth mentioning, is that for pregnancy you don't pay the 10%, since 100% is covered by health insurance (excluding some meds here you still pay the 10%).

Can't you only cancel by November 30th if your premium increases? With no increase I though you must give notice by end of Sept. Supplementary insurance needs notice by end of Sept.

bill_door 17.04.2009 16:38

Re: Deductible / Excess / Franchise - which is the best one to choose?
 
[MOD: this thread should be made sticky!]

thanks jenny for putting my own calculations so eloquently and a fantastic post! (c; it might be worth adding that: if you are making a tax return in CH then medical costs greater than 5% of salary are deductible in some cantons.

as you seem to have a great depth of knowledge and experience in this field, can you clarify this:

take an individual like in example 2. they are struck down with cancer/brain tumor/ something equally as medically expensive: the maximum they would pay is 700CHF + monthly premium + deductible.

I guessed that there was some upper limit after which someone (state?) would pay. this is the first time i have actually seen a number. can you confirm that?

TIA, bill

jenny 17.04.2009 16:42

Re: Deductible / Excess / Franchise - which is the best one to choose?
 
Quote:

Originally Posted by MarieZug (Post 439700)
One thing worth mentioning, is that for pregnancy you don't pay the 10%, since 100% is covered by health insurance (excluding some meds here you still pay the 10%).

Yes, good point.

There is no deductible or 10% on anything relating to maternity (birth included).

That means that even if you are pregnant when you arrive here, you will be covered 100% for the birth as long as it's in a local, public hospital.

jenny 17.04.2009 16:44

Re: Deductible / Excess / Franchise - which is the best one to choose?
 
Quote:

Originally Posted by bill_door (Post 439704)

take an individual like in example 2. they are struck down with cancer/brain tumor/ something equally as medically expensive: the maximum they would pay is 700CHF + monthly premium + deductible.

That is absolutely correct.

One thing I forgot to point out is that the 10% is maxed out at 350.- for children. So if the above example was for a child, the maximum they would have to pay is 350.- + monthly premium + deductible.

Mel07 17.04.2009 16:46

Re: Deductible / Excess / Franchise - which is the best one to choose?
 
Quote:

Originally Posted by jenny (Post 439713)
That is absolutely correct.

One thing I forgot to point out is that the 10% is maxed out at 350.- for children. So if the above example was for a child, the maximum they would have to pay is 350.- + monthly premium + deductible.

Children don't have a deductible. Just the 10%. I didn't know it maxed out at 350Chf though. That is good to know.

jenny 17.04.2009 16:58

Re: Deductible / Excess / Franchise - which is the best one to choose?
 
Quote:

Originally Posted by Mel07 (Post 439718)
Children don't have a deductible. Just the 10%. I didn't know it maxed out at 350Chf though. That is good to know.

You can choose to have a 0.- (or no) deductible for children but deductibles do exist for them.

They go from 100.- to 600.- in 100.- increments though usually the difference in premium isn't worth it and a 0.- deductible is recommended for children, especially if they're still little.

jenny 17.04.2009 17:25

Re: Deductible / Excess / Franchise - which is the best one to choose?
 
Quote:

Originally Posted by MarieZug (Post 439700)
Can't you only cancel by November 30th if your premium increases? With no increase I though you must give notice by end of Sept. Supplementary insurance needs notice by end of Sept.

Remember, the deductible only applies to basic insurance.
When you receive your new policy sometime in October, you have 1 month i.e. until the end of November to change providers should you wish to.
You can change providers if your premium has gone up, down or is still the same.

For supplementary insurance, it depends who you're with as to when you can cancel it.
For most companies, contracts are 1 year and you have to give them 3 months notice.
Some are 3 years (e.g. CSS), some are 5 years (Groupe Mutuel, Assura) and with some you have to give 6 months notice - i.e. before the 30th of June.

mabramovich 26.05.2009 05:31

Re: Deductible / Excess / Franchise - which is the best one to choose?
 
Hi,

One question I have which would assist in choosing an appropriate deductible is the cost of health care: for example, a common-enough illness is strep throat. If someone comes down with strep throat, s/he must go to the doctor who must take a throat swab. This then goes to the lab and antibiotics must be prescribed upon a positive swab.

How much would this whole procedure cost? If seeing a doctor is like 300 CHF a pop, picking a high deductible makes little sense. Can someone thus estimate the cost of getting sick a couple of times a year?

Thank you.

CH_Me 26.05.2009 08:46

Re: Deductible / Excess / Franchise - which is the best one to choose?
 
Quote:

Originally Posted by mabramovich (Post 463765)
Hi,

One question I have which would assist in choosing an appropriate deductible is the cost of health care: for example, a common-enough illness is strep throat. If someone comes down with strep throat, s/he must go to the doctor who must take a throat swab. This then goes to the lab and antibiotics must be prescribed upon a positive swab.

How much would this whole procedure cost? If seeing a doctor is like 300 CHF a pop, picking a high deductible makes little sense. Can someone thus estimate the cost of getting sick a couple of times a year?

Thank you.

Seeing a doctor for me is usually around CHF 80-120 CHF. Test for strep throat < CHF 20 with results on the spot and antibiotics < CHF 20.

I have only reduced my premium when I wanted to get my knee seen to and for pregnancy.

jenny 26.05.2009 12:27

Re: Deductible / Excess / Franchise - which is the best one to choose?
 
Quote:

Originally Posted by mabramovich (Post 463765)
If seeing a doctor is like 300 CHF a pop, picking a high deductible makes little sense. Can someone thus estimate the cost of getting sick a couple of times a year?


I would agree with Marie. A standard doctors visit would be around that price.

If you get strep-throat twice a year for example, have blood tests done, have to take antibiotics etc. let's say it all comes to 400.-. (I think it would actually be less than that).

Example

You have a 300.- deductible.

Of the 400.-, you have to pay the first 300.-.

That leaves 100.-.

You have to pay 10%. 10% x 100.- = 10.-

The insurance company will reimburse you 90.- of the total amount.

Personally, I don't think it's worth paying 1'700.- extra in premiums p.a. to get 90.- back from them.
(using the figures from the example in the first post)

BenderRules 29.05.2009 15:15

Re: Deductible / Excess / Franchise - which is the best one to choose?
 
1 Attachment(s)
Jenny has already answered so many things in other posts and given a comprehensive situation analysis in this sticky. If I may, perhaps a plot of different possible situations would help 'the more analytical' in us.

The attached plot is for calculation based on:
26+ male
staying in Adliswil
EGK Basic Health Insurance, without accident coverage, without extra insurances. (ohne zusatliche versicherung)

On X Axis you will find: Hypothetical Yearly expense, i.e. how much are your total medical bills for a specific year. (e.g. medicines, doctors etc)

On Y Axis you will find: Yearly Total expense, i.e. all that you might have to pay, which includes the premiums, the Franchise and also the 10% of the amount exceeding Franchise.

Disclaimer: This graph is only to give you an idea about differences in total expenditures for possible scenarios. If you want to be "exact" for your specific case right till the last Rappen, I would suggest that you do the same calculation for yourself. This is not difficult to plot!:msnnerd: If you find mistakes in the plot, please get in touch with me ASAP, since it means I have to redo all my personal expenses!!:D

If you are NOT inclined technically to learn more:
  • Yes, sometimes I get that crazy to plot such graphs for fun! :msntongue:
If you are inclined technically to learn more:
  • So, when you have a really healthy year, with zero medical bills, you would end up paying ~1500CHF more for the "least Franchise" than what you would pay for the "maximum Franchise".
  • If you happen to cross 2500CHF worth of medical bills, the absolute difference in CHF remains the same. Thus no matter what your bill is
    • for Franchise 500 - you pay 27.6 CHF more than if you've Franchise 300
    • for Franchise 1000 - you pay 98.4 CHF more than if you've Franchise 300
    • for Franchise 1500 - you pay 168 CHF more than if you've Franchise 300
    • for Franchise 2000 - you pay 237.6 CHF more than if you've Franchise 300
    • for Franchise 2500 - you pay 471.6 CHF more than if you've Franchise 300

Jase 29.05.2009 15:27

Re: Deductible / Excess / Franchise - which is the best one to choose?
 
WOW! this is an eye opener this thread - i've just stumbled on it

thanks for the great info!!!

CH_Me 29.05.2009 15:37

Re: Deductible / Excess / Franchise - which is the best one to choose?
 
Quote:

Originally Posted by BenderRules (Post 466045)
Yes, sometimes I get that crazy to plot such graphs for fun! :msntongue:


I did this too a few years back when deciding on my franchaise. I have been on the CHF 300 franchaise even since and go straight to the doctor when I am ill. I try to get all my meds through the doctor too - even paracetamol :)

BenderRules 29.05.2009 16:29

Re: Deductible / Excess / Franchise - which is the best one to choose?
 
Quote:

Originally Posted by MarieZug (Post 466061)
I did this too a few years back when deciding on my franchaise. I have been on the CHF 300 franchaise even since and go straight to the doctor when I am ill. I try to get all my meds through the doctor too - even paracetamol :)

To each his/her own, I think thats the beauty of graphs. I actually came to the conclusion after studying the graph that I would surely keep the Franchise to 2500CHF.

Reason being, it is only somewhere after ~1900CHF yearly bill, I would start paying 'more' in total, due to higher Franchise. That too the 'more' reaches maximum of 471CHF! Which anyhow ceases to be an issue (of course comparatively) if you have a mega 'touch luck' bill of 100'000 as in the example!!

I hardly reach 1000CHF a year, averaging somewhere around 300CHF for the last 5years. Thus, it is thus MUCH better for me to save the extra, that I would have otherwise paid as premium, in my bank account as Jenny suggested.

rachelryan1978 31.05.2009 21:20

Re: Deductible / Excess / Franchise - which is the best one to choose?
 
This is an excellent thread, Folks; very helpful.

I do have a questions though: I noticed "maternity" listed as an extra over and above the standard cover. Reading the thread above it seems like maternity is covered at least in part by the basic insurance.

If anyone can shed shome light on the difference between the two I would be grateful.

Secondly, if I get half way through an insurance year but find I am pregnant, can I "upgrade" to the maternity extras part way through?

Been here a year and not brilliant at reading the German fine print yet :msngrin:

Thank you, All

Rachel

Goldtop 31.05.2009 21:40

Re: Deductible / Excess / Franchise - which is the best one to choose?
 
The Swiss Parliament is actively discussing this topic and the Swiss government intends to modify the rules. The optimum could be different in 2010.

Among the proposals are CHF 30 charge per visit, diminished premium rebates for higher deductibles, etc

eireann 22.06.2009 00:40

Re: Deductible / Excess / Franchise - which is the best one to choose?
 
Sorry if not the right place for this question, but I'm wondering if you have a treatment/doctor's visit at the end of the year (e.g. 2008) and receive the bill at the start of the new year (e.g. 2009), which year's franchise does the bill come out of?

bill_door 22.06.2009 01:13

Re: Deductible / Excess / Franchise - which is the best one to choose?
 
Quote:

Originally Posted by eireann (Post 479432)
Sorry if not the right place for this question, but I'm wondering if you have a treatment/doctor's visit at the end of the year (e.g. 2008) and receive the bill at the start of the new year (e.g. 2009), which year's franchise does the bill come out of?

2008. you have a few months in 2009 to gather all your 2008 bills together and submit them to your insurance provider. it is the date of treatment that is important. not the date of the bill!

jenny 24.06.2009 00:46

Re: Deductible / Excess / Franchise - which is the best one to choose?
 
Quote:

Originally Posted by bill_door (Post 479442)
2008. you have a few months in 2009 to gather all your 2008 bills together and submit them to your insurance provider. it is the date of treatment that is important. not the date of the bill!

Correct :)


All times are GMT +2. The time now is 05:00.

Powered by vBulletin® Version 3.8.4
Copyright ©2000 - 2019, Jelsoft Enterprises Ltd.
LinkBacks Enabled by vBSEO 3.1.0