Income-based premiums: initiatives, votes and what applies today

Per-capita premium and premium subsidies: the current system

In Switzerland, basic health insurance is financed through the per-capita premium: each insurer charges its insured persons the same premiums, unless the law provides for an exception (Art. 61 para. 1 of the Federal Health Insurance Act, KVG). There are exceptions by canton and premium region, for children and young adults, and by deductible, model and accident cover (Art. 61 para. 2–3 KVG). Income is not one of them.

The social balance comes from the premium subsidy. The cantons reduce the premiums of insured persons of modest means and pay the contribution directly to the insurer (Art. 65 para. 1 KVG). For lower and middle incomes, they reduce the premiums of children by at least 80 % and those of young adults in education by at least 50 % (Art. 65 para. 1bis KVG). Each canton decides for itself who is entitled, usually on the basis of a relevant income taken from the tax assessment.

“Income-based premiums” can mean different things. The proposals of the last two decades fall into three models:

The proposals and their results

Date	Proposal	Core	Yes	No	Yes share	Cantons
18.05.2003	“Health must remain affordable”	contributions based on income and assets, plus VAT	625,073	1,682,694	27.1 %	no canton in favour
11.03.2007	“For a social single health insurance fund”	one insurer, premiums based on economic capacity	641,917	1,590,213	28.8 %	2 in favour, 18 6/2 against
09.06.2024	“Maximum 10 % of income for health insurance premiums”	premium burden at most 10 % of disposable income	1,117,095	1,391,645	44.5 %	7 1/2 in favour, 13 5/2 against

2003: the health initiative

The popular initiative “Health must remain affordable” sought to finance basic health insurance in a new way: from additional, earmarked federal VAT revenue and, to at least the same extent, from contributions by insured persons set in proportion to their income and real assets and taking family responsibilities into account. The Federal Council wanted to keep the system of per-capita premiums and premium subsidies in principle (dispatch, Curia Vista 00.046). No canton voted in favour.

2007: single health insurance fund with premiums based on economic capacity

The initiative “For a social single health insurance fund” combined two demands: a single insurer for basic health insurance and premiums based on the economic capacity of insured persons. In its dispatch, the Federal Council stated that abolishing the per-capita premium, which is independent of income and assets, would amount to creating a new income and wealth tax (Curia Vista 05.089). Neuchâtel and Jura voted in favour. The single fund part is covered in more depth in the article Single health insurance fund and public health insurer.

2024: the Premium Relief Initiative

The Premium Relief Initiative did not seek to scale the premium according to income, but to cap the burden: insured persons were to pay at most 10 % of their disposable income for premiums, and the Confederation and the cantons would have covered the rest through premium subsidies, with the Confederation paying at least two thirds. The Federal Council and Parliament recommended rejecting it; according to the FOPH, they considered the initiative too expensive and lacking any incentive to curb the rise in costs. On 09.06.2024, the people and the cantons rejected it. The cantons of Fribourg, Valais, Ticino, Vaud, Neuchâtel, Geneva and Jura and the half-canton of Basel-Stadt voted in favour.

In Parliament: parliamentary initiative 23.451

On 13.09.2023, the Green Group submitted the parliamentary initiative “Financing health insurance in the same way as accident insurance”. It called for a KVG bill with premiums based on income and assets. On 04.06.2024, the National Council decided by 126 votes to 59 not to proceed with it; the matter is closed.

Status 25.09.2026: an announced initiative

SP Switzerland decided at its party congress on 25.10.2025 to launch a popular initiative for income-based premiums. According to its press release, households are to receive income-based premium discounts and children and young people up to 18 are to pay no basic health insurance premiums, financed through surcharges on high incomes. A preliminary review by the Federal Chancellery, with which the collection of signatures formally begins, had not been published in the Federal Gazette by 25.09.2026. The wording is therefore not yet officially fixed; the Federal Council and Parliament have not commented on it. We report on how it develops, without forecasting the outcome.

What has applied since 01.01.2026: the counter-proposal

After the Premium Relief Initiative was rejected, the indirect counter-proposal came into force, an amendment to the KVG of 29.09.2023. It does not cap your personal premium burden, but places obligations on the cantons:

1. Social target: Each canton sets the maximum share of the disposable income of insured persons in the canton that the premium may account for (Art. 65 para. 1ter KVG). If it does not do so within four years, the Federal Council sets the share (transitional provision).
2. Minimum budget: The canton’s premium subsidy per calendar year must correspond to a minimum share of the gross costs of basic health insurance for its residents (Art. 65 para. 1quater KVG).
3. Graduated by burden: The minimum share is 3.5 % if premiums account for less than 11 % of the income of the 40 % of insured persons with the lowest incomes, and 7.5 % from 18.5 %; in between it rises in a straight line (Art. 65 para. 1quinquies KVG). In 2026 and 2027, 3.5 % applies in all cantons.
4. Federal contribution: As before, the Confederation pays 7.5 % of the gross costs of basic health insurance towards premium subsidies (Art. 66 KVG).

The details are set out in the Ordinance on the Contributions of the Cantons and the Confederation to Premium Reductions (VPVK). How a canton distributes the additional funds, whether through higher contributions or higher income limits, is up to the canton. On request, the cantons must take into account the most recent income and family circumstances (Art. 65 para. 3 KVG), for example after a job loss.

Sample calculation: how the per-capita premium weighs on different incomes

Example with fictitious people. Two families live in the city of Bern, each with two adults and one child. Both choose the middle offer (median) with accident cover: adults with a CHF 300 deductible, child with a CHF 0 deductible. Premiums 2026, municipality of Bern (region 1); source FOPH. The disposable incomes are assumed.

Today, family A might be entitled to a premium subsidy, depending on the rules of the canton of Bern; for the child, the subsidy for lower and middle incomes must be at least 80 % (Art. 65 para. 1bis KVG). Whether and how much depends on the relevant income and assets under cantonal law. You can find the rules of your canton under Premium subsidy.

In a system with contributions based on income, as proposed in 2003 and 2007, it would not be the subsidy but the premium itself that rose with income. How high the contributions would be for each income would depend entirely on the design; as of 25.09.2026, there is no official text on this.

Special cases

• Children and young adults: They already pay lower premiums than adults today (Art. 61 para. 3 KVG), and for lower and middle incomes the minimum subsidy under Art. 65 para. 1bis KVG applies.
• Moving to another canton: The premium and premium subsidy depend on where you live. If you move, you get a new premium and must check the subsidy in the new canton under its rules. More on this in the article Moving and premium region.
• Supplementary benefits: If you receive supplementary benefits, they pay an amount for basic health insurance directly to your insurer (Art. 21a ELG). The cantonal supplementary benefits office is responsible.

What does this mean for you?

Today you do not reduce your premium through your income, but through your choice of insurer, deductible and model. Between offers in the same municipality, there is often a difference of several hundred francs a year: in Bern, basic health insurance in 2026 for adults with a CHF 300 deductible and accident cover costs between CHF 545.90 and CHF 758.90 a month (source FOPH). The premium calculator shows all offers, and the health insurer profiles show key figures for the insurers.

Also check your entitlement to a premium subsidy every year. Cantons that have to spend more money because of the counter-proposal may adjust their limits.

Common mistakes

• Believing the 10 % cap applies. The initiative was rejected. Since 2026, each canton has set its own social target; there is no nationwide cap.
• Taking an announcement for current law. An initiative only applies once the people and the cantons have adopted it and it has been implemented.
• Not applying for a premium subsidy. In many cantons you have to apply yourself, often by a deadline.
• Confusing the income in your tax return with the relevant income. The cantons add assets and certain deductions back in.
• Staying with your insurer because of the subsidy. You receive the subsidy with any insurer; it goes directly to the insurer of your choice.

You can find all the basics of basic health insurance in the topic area Understanding basic insurance. If you want to switch, the deadlines under Switching health insurer apply.