Annual maximum retention fee

What is the annual maximum retention fee?

In basic health insurance you contribute to your healthcare costs in two ways: first with the deductible, then with the retention fee of 10% of further costs. The annual maximum retention fee is the upper limit for this second part. As soon as you have reached it in a calendar year, your insurer covers all further costs of basic health insurance in full.

For adults and young adults aged 19 and over, the maximum is CHF 700 per year, for children up to 18 it is CHF 350. The amount is the same with all insurers and in all cantons. It does not depend on the deductible you have chosen: whether your deductible is CHF 300 or CHF 2,500, the retention fee stops at CHF 700.

Together, the deductible and retention fee make up the statutory co-payment. The annual maximum retention fee only applies to basic health insurance under the Federal Health Insurance Act (KVG). Supplementary insurance has its own retention fees, which are set out in the contract.

How it works

Every basic health insurance bill is first credited towards your deductible. Once the deductible is used up, you pay 10% of every further bill. The insurer adds up these shares over the calendar year. When the total reaches CHF 700, that is the end: for the rest of the year you no longer pay a retention fee.

This leads to a simple calculation: the retention fee reaches CHF 700 when the costs after the deductible amount to CHF 7,000. With a deductible of CHF 300 this is the case at total costs of CHF 7,300, with a CHF 2,500 deductible at CHF 9,500.

Deductible	Maximum retention fee	Highest own share	Costs from which you pay nothing more
CHF 300	CHF 700	CHF 1,000	CHF 7,300
CHF 500	CHF 700	CHF 1,200	CHF 7,500
CHF 1,000	CHF 700	CHF 1,700	CHF 8,000
CHF 1,500	CHF 700	CHF 2,200	CHF 8,500
CHF 2,000	CHF 700	CHF 2,700	CHF 9,000
CHF 2,500	CHF 700	CHF 3,200	CHF 9,500

Some special rules change the calculation:

• Children: For children the maximum is CHF 350. If several children of one family are insured with the same insurer, together they pay at most the deductible and the maximum retention fee of one adult (Art. 64 para. 4 KVG).
• Medicines with a 40% retention fee: If you choose a medicine that is significantly more expensive than comparable generics, the retention fee is 40%. The part above the normal 10% only counts half towards the maximum. You can therefore effectively pay more than CHF 700 in retention fees in one year.
• Maternity: For services from the 13th week of pregnancy, during childbirth and up to 8 weeks afterwards, the insurer does not charge any co-payment.
• Hospital contribution: For inpatient stays, adults also pay CHF 15 per day. This contribution is not part of the retention fee and is not limited by the CHF 700. Children, young adults in education and women in connection with maternity are exempt.
• Alternative models: With insurance models that restrict the choice of doctor, the insurer may waive the deductible and retention fee in full or in part. Whether your insurer does so is stated in the conditions of your model.

Legal basis

Art. 64 para. 2 KVG states that the co-payment consists of the deductible and 10% of the costs exceeding the deductible. Under Art. 64 para. 3 KVG, the Federal Council sets an annual maximum amount for the retention fee. It has done so in Art. 103 para. 2 of the Health Insurance Ordinance (KVV): CHF 700 for adults, CHF 350 for children. Art. 103 para. 3 KVV states that the date of treatment is decisive, and para. 4 governs crediting when switching insurer during the year.

Art. 64 para. 4 KVG provides for half the maximum amount for children and limits the co-payment of several children of one family with the same insurer. The higher retention fee of 40% for certain medicines is governed by Art. 38a of the Health Care Benefits Ordinance (KLV); under Art. 104a para. 2 KVV the amount above the statutory rate only counts half towards the maximum. The exemption for maternity is set out in Art. 64 para. 7 KVG, the hospital contribution of CHF 15 per day in Art. 104 KVV. Under Art. 99 para. 2 KVV, insurers can waive the deductible and retention fee in models with a restricted choice of service provider. Art. 64 para. 8 KVG prohibits insuring the co-payment with an insurer or insurance policy.

Example: a year with high costs

Sandra, 45, has a deductible of CHF 1,500. After an operation and a longer period of outpatient follow-up treatment, her basic health insurance costs in 2026 add up to CHF 12,000. The calculation uses the statutory values; the premium is not included.

What this means for you

The annual maximum retention fee makes your risk in basic health insurance predictable. Use this for three decisions:

1. Choosing your deductible. Your worst year costs you your deductible plus CHF 700. Compare this amount with the premium discount for the higher deductible. The deductible calculator works this out using real premiums.
2. Building a reserve. Set aside your highest own share, especially with a high deductible. With a CHF 2,500 deductible that is CHF 3,200.
3. Planning treatment. If you have already reached the maximum in a year, further basic health insurance services in the same calendar year no longer cost you any co-payment. A treatment that can be planned may then be worth having before 31 December, if it makes medical sense.

Submit all bills, including small ones. Only then does your insurer add up your shares correctly. You can collect bills in your account. The premium calculator shows the premiums of all insurers for your deductible; the switching page explains whether switching for next year makes sense.

Common mistakes

• Confusing the deductible and the retention fee. You pay the deductible in full first; only then does the 10% retention fee begin.
• Forgetting the hospital contribution. The CHF 15 per day in hospital comes on top of the maximum.
• Paying a 40% retention fee without noticing. If you choose an expensive original product although cheaper generics are available, you pay more and reach the maximum later. Ask at the pharmacy.
• Counting supplementary insurance. Retention fees from supplementary insurance do not count towards the CHF 700.
• Leaving bills lying around. Bills you have not submitted are missing from the annual total.

We explain how we calculate the examples under How we calculate.