Retention fee

What is the retention fee?

The retention fee is the part of your healthcare costs that you keep paying yourself in basic health insurance after the deductible. In German it is called the Selbstbehalt. It amounts to 10% of every bill that goes beyond your deductible. Together with the deductible and the hospital contribution, it forms the statutory co-payment.

The law aims to do two things with it: insured persons should feel part of the costs and use benefits consciously, while nobody should pay without limit in an expensive year. That is why the retention fee has a fixed cap per calendar year. This limit is also called the annual maximum retention fee.

The German term is used in two senses. In basic health insurance under the Health Insurance Act (KVG/LAMal) it is set by law and the same at every insurer: 10%, at most CHF 700 for adults and CHF 350 for children. Supplementary insurance under the Insurance Contract Act (ICA) also has retention fees, for example as a percentage of supplementary outpatient benefits or as a fixed amount in flexible hospital insurance. These are set out in each insurer’s policy conditions and have nothing to do with the statutory retention fee. This page is about the retention fee in basic health insurance.

How it works

Order: first the deductible, then the retention fee

Every bill is first counted towards the deductible. Once the deductible for the calendar year has been used up, the insurer covers 90% of further costs and you pay 10%. This continues until your retention fee for the year reaches CHF 700. After that, the insurer covers the insured benefits in full until the end of the year. On 1 January the count starts again.

What matters is the date of treatment, not the date of the invoice. A treatment on 20 December counts towards the previous year’s retention fee, even if the bill only arrives in January.

The cap

The maximum retention fee does not depend on your deductible. It is CHF 700 at every deductible level. Your maximum co-payment per year is therefore the deductible plus CHF 700: with a CHF 300 deductible at most CHF 1,000, with a CHF 2,500 deductible at most CHF 3,200. You can work out the healthcare costs at which you reach this limit: the costs must exceed the deductible by CHF 7,000, because 10% of CHF 7,000 is exactly CHF 700.

Children and families

Children up to 18 pay at most CHF 350 in retention fees per year. Children have no standard deductible; if the parents choose an optional deductible for the child, the retention fee applies above that amount. If several children in one family are insured with the same insurer, together they pay no more than the deductible and the maximum retention fee of one adult.

40% for expensive medicines

A special rule applies to medicines. If a product costs at least 10% more than the average of the cheapest third of all products with the same active ingredient on the List of Pharmaceutical Specialties (SL), the retention fee is 40% instead of 10%. The rule affects original products, but also expensive generics and biosimilars. If your doctor explicitly prescribes the original for medical reasons, the rate goes back to 10%. Your doctor and pharmacy must inform you if the retention fee for your medicine is higher than 10%.

Only half of the higher share counts towards the CHF 700 cap. If you pay CHF 30 more for a medicine than the usual 10%, only CHF 15 of that is credited towards the maximum retention fee. In an expensive year you can therefore end up paying more than CHF 700 in retention fees if you take expensive products.

Changing insurer during the year

If you change insurer during the year, for example because a move takes you out of your insurer’s area of operation, the new insurer credits the retention fee you have already paid. If the old insurer has not yet billed anything, you have to provide proof of the amounts.

Legal basis

Art. 64 para. 2 KVG provides that the co-payment consists of a fixed annual amount, the deductible, and 10% of the costs exceeding the deductible, the retention fee. Under Art. 64 para. 3 KVG, the Federal Council sets an annual maximum amount for the retention fee. Art. 64 para. 4 KVG halves this maximum for children and limits the co-payment of several children of one family insured with the same insurer.

The amounts are set out in Art. 103 of the Health Insurance Ordinance (KVV): para. 2 sets CHF 700 for adults and CHF 350 for children, para. 3 makes the date of treatment decisive, and para. 4 governs crediting when you change insurer during the year. Art. 104a para. 2 KVV provides that a higher retention fee counts only half towards the maximum amount.

The 40% retention fee for medicines is governed by Art. 38a of the Health Care Benefits Ordinance (KLV), with para. 7 covering the exception for medical reasons and para. 8 the duty to inform. Art. 64 para. 7 KVG exempts maternity benefits from the co-payment, and Art. 64 para. 8 KVG prohibits insuring co-payments. The hospital contribution of CHF 15 per day is governed by Art. 64 para. 5 KVG and Art. 104 KVV.

Example: three years, three retention fees

Marco is 45 and has a deductible of CHF 1,000. The examples use the statutory values (10% retention fee, at most CHF 700) and leave out the premium.

Variant: medicine with a 40% retention fee

Marco has reached his deductible and takes an original product costing CHF 200, although a much cheaper generic exists. He pays 40%, i.e. CHF 80, instead of CHF 20 at 10%. Only half of the extra CHF 60, i.e. CHF 30, counts towards his cap. If he takes the generic, he pays 10% of a lower price. The deductible calculator shows which deductible works out cheapest for your costs.

What this means for you

The retention fee is the same at all insurers. You cannot choose it and you cannot insure it. But you can influence how hard it hits you:

1. Plan for the maximum. Set aside the deductible plus CHF 700 for a bad year. With a CHF 2,500 deductible that is CHF 3,200.
2. Ask for the generic. For medicines with a 40% retention fee, a cheaper product saves you twice: a lower price and a lower share. Ask at the pharmacy before taking an expensive original.
3. Submit all bills. Only submitted bills count towards the deductible and retention fee. If you have reached the cap by December, you receive further benefits without any co-payment until the end of the year.
4. Choose the right deductible. Because the retention fee is the same for everyone, your deductible determines your maximum co-payment. You can compare premiums for each deductible in the premium calculator.
5. Watch the deadlines. You must request a lower deductible by 30 November and a higher one by 31 December. All dates are listed under deadlines; how to switch insurer is explained under switch insurer.

Common mistakes

• Confusing the deductible and the retention fee. You pay the deductible in full first and the retention fee as a share afterwards. If you only count the deductible, you underestimate your costs by up to CHF 700.
• Believing everything is paid after the deductible. The insurer only covers insured benefits in full once you have paid the deductible and CHF 700 in retention fees.
• Overlooking the 40% retention fee. It is shown on the statement and can quickly add up to three-digit amounts for expensive products.
• Counting a retention fee from supplementary insurance. Retention fees from supplementary insurance do not count towards the statutory cap of CHF 700.
• Leaving bills lying around. Bills you have not submitted are missing from the annual count. You may then pay retention fees later even though you would already have reached the limit.

We explain how we calculate co-payments and premiums in our examples under How we calculate.