The basic insurance premium does not depend on income: it is the same for every person insured with the same insurer, in the same region and in the same age band. It is to correct this effect that the law obliges the cantons to reduce the premiums of insured people of modest economic means.
What federal law guarantees everywhere
The cantons grant a premium reduction to insured people of modest economic means, and pay the corresponding amount directly to the insurer. The insured person therefore receives no money: it is their premium bill that goes down.
The law sets a floor for families. For low and middle incomes, the cantons reduce children's premiums by at least 80 per cent, and those of young adults in education by at least 50 per cent. This floor applies in every canton; what each canton defines is what it means by low and middle incomes.
Two further obligations protect the insured. The cantons must take account of the most recent economic and family circumstances, in particular at the insured person's request: a change in situation, a job loss or a birth can therefore be reported without waiting for the next tax assessment. And the cantons must regularly inform insured people of their right to the reduction.
The reduction appears directly on the premium bill: the law requires the canton to send the insurer the beneficiaries' data and the amount of the reduction in good time. The Federal Council may also extend the reduction to people required to be insured who have no domicile in Switzerland but stay here for a prolonged period. Finally, what a canton spends on taking over unpaid premiums does not count towards the minimum it must spend on premium reductions: the law treats the two separately.
What has changed since 1 January 2026
The premium-relief initiative was rejected at the ballot box, but its indirect counter-proposal came into force on 1 January 2026. It adds two rules to the law. Each canton now defines the maximum percentage that premiums may represent of the disposable income of the insured people who live there.
Each canton must also spend a minimum amount on premium reductions, expressed as a percentage of the gross costs of basic insurance in the canton. This minimum ranges from 3.5 to 7.5 per cent, depending on the share of income that premiums represent for the 40 per cent of insured people with the lowest incomes: the heavier that burden, the more the canton must spend on reductions.
The Confederation pays, the canton decides
The Confederation grants the cantons annual subsidies equal to 7.5 per cent of the gross costs of compulsory health insurance, allocated according to population. But it is the canton that determines, within the federal framework, who can claim a reduction and to what extent: income thresholds, amounts, the procedure and the payment arrangements vary from one canton to another.
Automatic or on request: it depends on the canton
The Federal Office of Public Health puts it bluntly: some cantons reduce premiums automatically, while in others an application must be submitted to the competent authority. You always apply to your canton of residence, never to the insurer.
Two neighbouring cantons show the difference. In Geneva, the health insurance service states that the subsidy is in principle granted automatically according to income, although certain categories of people must submit an application. In the canton of Vaud, the application is made online or at the social insurance agency for your region of residence.
Cross-border workers and insured people living in the EU
The law also provides a reduction for certain insured people of modest means who live in a European Union state, Iceland, Norway or the United Kingdom: cross-border workers and their family members, family members of holders of a settlement permit, and people receiving a benefit from Swiss unemployment insurance.
What is worth checking
- In your canton of residence: is the reduction automatic or must you apply for it, and by what deadline?
- If your income or family situation has changed recently: report it to the canton, which must take it into account at the insured person's request.
- For children and young people in education: the federal floor of 80 per cent and 50 per cent applies to low and middle incomes.
- If premiums are unpaid: the reduction, paid directly to the insurer, lowers future debt, not arrears already in debt collection.
The reduction does not depend on the insurer chosen: it follows the insured person if they change insurer, since it is the canton that pays it to whichever insurer they have at the time.