Premium subsidies reformed: what the counter-proposal changes from 2026

What has applied since 01.01.2026

As of 25.09.2026: the indirect counter-proposal to the Premium Relief Initiative has been in force since 01.01.2026. Parliament adopted it on 29.09.2023; the people and the cantons rejected the initiative itself on 09.06.2024 with 55.47 % voting no. The details are governed by the Ordinance on the Contributions of the Cantons and the Confederation to Premium Reduction (VPVK) of 12.09.2025.

Previously, only the federal contribution was fixed: 7.5 % of the gross costs of basic health insurance (Art. 66 para. 2 of the Federal Health Insurance Act, KVG). How much the cantons contributed themselves was up to them. The counter-proposal changes this. Since then, the premium subsidy has had two statutory minimums:

For you as an insured person, much stays the same: your canton of residence decides who is entitled, how much is paid and by when you have to apply. The reform affects the canton’s budget, not your premium invoice directly. The glossary explains the background to the vote under Premium Relief Initiative.

How the Confederation calculates the minimum share

The calculation is carried out every year in four steps, set out in Art. 65 KVG and in the VPVK:

1. Measuring the premium burden. The Federal Office of Public Health (FOPH) determines what share of income the premiums account for among the 40 % of insured persons in the canton with the lowest incomes. The basis is taxable income under direct federal tax and the premiums actually paid (Art. 65 para. 1sexies KVG). Premium subsidies already granted are deducted (Art. 6 VPVK).
2. Making households comparable. To rank incomes, the FOPH uses an equivalised income: the first adult counts as 1, each additional adult as 0.5, each child as 0.3 (Art. 10 VPVK).
3. Deriving the minimum share. Below a premium burden of 11 %, 3.5 % applies; from 18.5 %, 7.5 % applies; in between, the share rises linearly (Art. 65 para. 1quinquies KVG). The data from two years earlier is used.
4. Setting the minimum contribution. The share is multiplied by the estimated gross costs. The FOPH makes non-binding estimates of the values by the end of April and the end of July and publishes the minimum contributions by October of the previous year at the latest (Art. 4 VPVK).

Amounts that a canton pays for certificates of unpaid debt for unpaid premiums, and its share of the federal contribution, do not count towards the minimum contribution (Art. 65 para. 1septies KVG). After the year, the cantons account to the FOPH by 30 June (Art. 21 VPVK).

The 2026 figures

The FOPH published the minimum contributions for 2026 on 23.09.2025. Together, the cantons must spend at least around CHF 1,746 million on premium subsidies in 2026. The Confederation pays CHF 3,742.6 million in 2026, CHF 181.8 million or 5.1 % more than in 2025. For comparison: according to the same file, CHF 6,610 million in premium subsidies was paid in 2024, of which CHF 3,267 million came from the cantons. As of 25.09.2026, the FOPH had not yet published the values for 2027 on its website; under Art. 4 VPVK, they will follow in October at the latest.

Canton	Minimum contribution 2026 (3.5 %)	Federal contribution 2026	Premium burden of the 40 % with the lowest incomes	Minimum share after graduation, indicative
Zurich	CHF 305.6 million	CHF 662.9 million	14.68 %	5.46 %
Bern	CHF 208.6 million	CHF 436.6 million	20.72 %	7.5 %
Vaud	CHF 182.2 million	CHF 352.6 million	14.93 %	5.60 %
Aargau	CHF 136.5 million	CHF 303.2 million	15.43 %	5.86 %
Geneva	CHF 116.3 million	CHF 240.1 million	15.94 %	6.14 %
St. Gallen	CHF 91.7 million	CHF 220.1 million	16.59 %	6.48 %
Ticino	CHF 86.4 million	CHF 146.7 million	19.55 %	7.5 %
Lucerne	CHF 74.0 million	CHF 177.5 million	14.62 %	5.43 %
Zug	CHF 17.8 million	CHF 54.8 million	10.75 %	3.5 %
Switzerland	CHF 1,745.9 million	CHF 3,742.6 million	16.85 %	–

The last column shows which share would have applied under the graduated rule. The FOPH only shows it as an indication: in 2026 and 2027, 3.5 % applies everywhere, and from 2028 new data will be used. The premium burden in the fourth column is the value the FOPH used for the 2026 calculation.

Which cantons have to spend more money was shown by the FOPH in a calculation with 2023 data: 16 cantons would have had to increase their contributions, and Appenzell Innerrhoden, Glarus, Nidwalden and Schwyz were even below 3.5 %. Ten cantons already met the regular minimum requirements, including Geneva, Vaud and Zug. In 2023, 2.5 million insured persons received premium subsidies, 28 % of all insured persons (CHSS, 09.09.2025). For the counter-proposal as a whole, the FOPH estimated relief of around CHF 360 million, using 2020 data.

Sample calculation: the minimum contribution of the canton of Zurich

The FOPH estimates the gross costs of basic health insurance for insured persons resident in the canton of Zurich in 2026 at CHF 8,732.1 million.

Example with fictitious people.

What the reform means for you

• Check your entitlement every year. Cantons that have to spend more money can raise income limits, increase reference premiums or include more people. If you narrowly missed out on an entitlement so far, read your canton’s rules again every year. How the application works is explained in the article Applying for a premium subsidy.
• Know your canton’s social target. Which cantons name a percentage is shown in the article Premium caps: which cantons limit the premium burden.
• Lower your premium yourself. In many cantons, the subsidy does not depend on your actual premium. With your choice of insurer, model and deductible, you lower the rest. The premium calculator shows the offers for your municipality, and the article Deductible 300 or 2,500? shows how to choose your deductible.
• Keep an eye on the children. The minimum reduction of 80 % for children and 50 % for young adults in education still applies. You can work out children’s premiums without a subsidy in the children’s premium calculator.

Special cases

• Moving to another canton. For the current year, the canton in which you lived on 1 January remains responsible (Art. 5 VPVK). The rules of the new canton apply from the following year.
• What counts. All amounts that the canton spends on paying premiums count towards the minimum contribution, except the certificates of unpaid debt it takes over and its share of the federal contribution (Art. 65 para. 1septies KVG).
• Cantonal hospital costs. The minimum contribution only concerns premium subsidies. Separately, every canton pays at least 55 % of inpatient hospital costs, the cantonal share.
• Cantons with a high premium burden. Where the 40 % with the lowest incomes are particularly heavily burdened, for example in Bern or Ticino, the minimum share rises to 7.5 % from 2028 according to the indicative calculation.

Common mistakes

• Counting on the 10 % cap. The initiative was rejected. There is no nationwide cap on your premium burden.
• Waiting for an automatic increase. The reform obliges the canton, not the insurer. Whether you receive more only becomes clear from your canton’s decision, and in many cantons you have to apply for it.
• Overestimating the minimum share for 2026. In 2026 and 2027, 3.5 % applies everywhere. The graduation up to 7.5 % only takes effect from 2028.
• Confusing the premium subsidy with the tax deduction. The subsidy lowers the premium; in your tax return, you only deduct what you paid yourself.

You will find all articles about lowering costs in the section Saving money. Key figures for all insurers are under Health insurers.