FAQ

What is Helsana Business Salary?
Helsana Business Salary is the name of our daily sickness allowance insurance product for corporate customers.
What is Helsana Business Accident?
Helsana Business Accident is the name of our accident insurance product for corporate customers.
What is indemnity insurance?

Daily sickness allowance insurance policies can be either indemnity insurance or fixed-sum insurance. Indemnity insurance only reimburses the amount of the actual documented loss. An excess may be deducted in accordance with the contractual terms.

Daily sickness allowance insurance is always indemnity insurance unless another policy is specifically requested.

The alternative is a fixed-sum insurance policy in which the sum payable in the event of a claim is agreed in advance. The actual loss amount is irrelevant and there is no need to provide documentary evidence.

What is fixed-sum insurance?

Fixed-sum insurance defines the amount to be paid in the event of a claim. The actual loss amount is irrelevant: the payment is determined solely by the sum defined in the contract. Fixed-sum insurance is available for self-employed persons or people named in the policy.

The alternative is indemnity insurance, which only reimburses the amount of the actual documented loss, minus the contractual excess.

What is a profit share?
The benefits and administrative costs in a given period may be less than the premiums paid by the policyholder over the same period. This creates a surplus. If the contract includes a profit share clause, the policyholder will receive a share in the profit (surplus) at the end of the period.
Who pays the premium?

As the policyholder, the employer is liable to pay the premium to the insurer.

However, in the case of daily sickness allowance insurance, up to 50% of the premium costs can be passed on to employees, provided that the daily allowance covers at least 80% of their salary.

For statutory accident insurance, the employer can pass on up to 100% of the non-occupational accident premium to employees. However, this does not apply to occupational accidents, where the employer is liable to pay the full amount.

If the employer takes out supplementary accident insurance cover, the cost of the premiums for accidents at work and outside work can be passed on to employees. Employers usually define the arrangements for passing on insurance costs in the staff regulations.

What is the level of benefit?

The level of benefit defines the percentage of the AHV salary to be paid as daily allowance benefits (daily sickness or accident allowance) or pension benefits (accident insurance).

The employer is exempt from any further obligations if the daily sickness allowance is 80% or above. In practice, this means that most policyholders opt for daily sickness allowance of 80% or above.

What is a group of persons?
An employer can divide all employees into groups at their discretion and define different levels of cover for each group. The groups are used solely to distinguish between the insurance cover required.
What salary total can I insure?

Clients can insure the actual salary total. However, the maximum for any individual is CHF 300,000. Higher individual salaries can be insured, subject to a medical examination.

The insurance can cover a standard salary amount for everyone. Alternatively, different salary totals can be defined for specific groups of persons on request.

Daily sickness allowance insurance

What is a waiting period?

The waiting period defers the point at which the insurer begins paying benefits. During the waiting period, the employee is entitled to continue receiving salary payments. The waiting period is therefore part of the period for which benefits are payable. However, during the waiting period, it is the employer who continues the salary payments, not the insurer.

The employer is able to define the waiting period when the daily sickness allowance insurance is taken out. Waiting periods are usually set at between 0 and 90 days, but can be up to 365 days.

The waiting period has a similar effect to the deductible in compulsory health insurance. If the policyholder opts for a longer waiting period, they effectively increase their own risk exposure, which reduces the premium. By contrast, a short waiting period means a higher premium, because the risk is higher for the insurer.

To optimise the waiting period, policyholders should consider the realities of their company and financial resources. Companies should only opt for a longer waiting period if they have adequate financial reserves to cope with an emergency.

What is the duration of benefits?

The duration of benefits is the maximum period for which the insured person is entitled to receive insurance benefits.

There are two possible legal bases for daily sickness allowance insurance: the Federal Health Insurance Act (KVG) and the Federal Act on Insurance Contracts (VVG). The duration of benefits varies according to the legal basis chosen.

For VVG insurance, you can choose a duration of 365 or 730 days.

For KVG insurance, a maximum of 720 daily allowances are payable over a 900-day period.

The waiting period is always included in the duration of benefits, even though the insurer does not pay any benefits during the waiting period.

What legal requirements apply to daily sickness allowance insurance?

All daily sickness allowance insurance is voluntary. The insurance allows companies to cover the financial risks associated with the obligation to continue salary payments as defined in Article 324a of the Swiss Code of Obligations.

The company is released from the obligations set out in Article 324a (4) if it takes out insurance to cover at least 80% of the employees' loss of income.

The insurance can be taken out under either the Federal Health Insurance Act (KVG) or the Federal Act on Insurance Contracts (VVG).

The main difference is in the amount of flexibility. The KVG imposes a compulsory scope of benefits, but the insurer is free to adapt the benefits to reflect the client's requirements under a VVG policy.

Collective agreements are used to define the scope of benefits. If the collective agreement permits a VVG insurance policy, the VVG insurance can have exactly the same content as a KVG policy.

What are the KVG and VVG?

KVG is the acronym used for the Swiss Federal Health Insurance Act.

The legislation defines the compulsory scope of benefits for daily sickness allowances in daily sickness allowance insurance under KVG. No variations are permitted because the Federal Health Insurance Act contains binding legal requirements.

However, daily sickness allowance insurance can be taken out using a different legal basis: the Federal Act on Insurance Contracts (VVG). This legislation contains very few compulsory requirements for daily sickness allowance insurance, which leaves insurers greater freedom to define the scope of benefits.

From the client's perspective, there is no material difference. Some collective agreements impose the compulsory scope of benefits defined in the KVG. Insurance companies currently replicate the KVG scope of benefits in VVG-based solutions, which can also cover the requirements.

Why take out daily sickness allowance insurance?

The statutory duty to continue salary payments means that companies are exposed to significant financial risks if employees are absent for long periods on grounds of sickness, pregnancy or maternity leave.

The risks are particularly hard to estimate for small companies and in extreme cases may actually threaten the company's existence.

Daily sickness allowance insurance allows companies to insure against this risk. If something happens, the insurer bears the cost of the continued salary payments. This kind of insurance is an established feature of pension provisions for most companies in Switzerland.

However, daily sickness allowance insurance is not just good for companies: employees have the advantage of knowing that their income is guaranteed in most cases until any pension benefits become due. This kind of seamless cover is often not provided by the statutory continuation of salary payments.

How can I reduce my costs?

The two main factors in reducing absence costs are the waiting period and your employees' health.

Waiting period

Direct absence costs in your company are made up of two elements: the premiums that you pay for daily allowance insurance and the cost of continuing salary payments during the contractual waiting period. The insurance benefits only kick in at the end of the waiting period.

You can reduce your premium costs by opting for a longer waiting period, which increases the amount of continued salary payments made by you. Don't forget that you will be liable for all the costs associated with an emergency during the waiting period. The waiting period can be used to optimise and leverage costs, but you need to consider your company's situation when defining the waiting period. Our advisors and your broker can help you to assess the company's situation and choose a waiting period that is right for you. You can find some advice on how to assess your company's situation here.

Employee health

The second factor is your employees' health: fewer absences mean lower absence costs. So healthy employees are a key factor in keeping the cost of continued salary payments and premiums down. Our health experts will be happy to help you keep your employees healthy.

Extra savings

Helsana offers attractive package discounts in conjunction with our partner, Swiss Life. In addition to saving money, you also benefit from having a one-stop-shop for harmonised insurance solutions: accident, sickness and occupational pensions.

What insurance do other companies go for?

Most SMEs choose the following insurance cover:

  • Daily sickness allowance insurance under VVG
  • 80% cover for absence from work
  • 30-day waiting period
  • Duration of benefits 730 days

This combination means that most of your employees have the best possible sickness and/or accident insurance cover, while you and your company benefit from a healthy balance between direct responsibility, insurance benefits and premium costs.

The maximum duration of benefits – 730 days – provides full cover until any disability pension takes effect. The duration also allows you to defer occupational pension insurance benefits (BVG) for a maximum of 24 months, which reduces the burden on your pension fund and saves on BVG risk premiums.

If you opt for the standard 30-day waiting period, then the company is liable for continuing to pay the employee's salary during that time. A shorter waiting period will reduce that cost, but will hike up your premium. More information about waiting periods can be found here.

How can I extend the statutory maternity insurance?

Under the Federal Ordinance on allowances for loss of earnings, statutory maternity insurance covers mothers for a period of 14 weeks after the birth at 80% of their current salary, up to a maximum of CHF 196 per day.

Daily sickness allowance insurance allows you to increase the compensation to up to 100% of the salary and to extend the duration of benefits to a maximum of 16 weeks.

What does accident insurance cover when it is included in daily sickness allowance insurance?

Including accident insurance in your daily sickness allowance insurance covers loss of income due to an accident. If you want the same scope of benefits as for compulsory accident insurance, including pension benefits, then you need to opt for voluntary accident insurance based on the UVG instead. The insured person then enjoys the same protection as someone with compulsory accident insurance.

By law, anyone who does not have compulsory accident insurance is insured for accidents in accordance with the provisions of the KVG through their compulsory health insurance. The compulsory health insurance only covers treatment costs such as medical expenses, hospital costs and medication.

What risks are covered by daily sickness allowance insurance?

Mainly the risk of falling ill. Being declared medically unfit for work during pregnancy also qualifies as an illness.

The statutory maternity insurance benefits under the Federal Ordinance on allowances for loss of earnings can be extended by opting to include maternity.

Accident insurance

What is a waiting period?

The waiting period defers the point at which the insurer begins paying benefits. During the waiting period, the employee is entitled to continue receiving salary payments. The waiting period is therefore part of the period for which benefits are payable. However, during the waiting period, it is the employer who continues the salary payments, not the insurer.

The Swiss Federal Act on Accident Insurance imposes a waiting period of two days after the accident date.

For supplementary accident insurance, the policyholder can define any waiting period for the supplementary daily allowance as the compulsory accident insurance meets all the legal requirements.

What is the duration of benefits?

The duration of benefits is the maximum period for which the insured person is entitled to receive insurance benefits.

In the event of an accident, there is no time limit for benefits: the duration is determined by certain conditions or changes in circumstances.

The insured party will receive daily accident allowances throughout the entire recovery process. Once the individual's health stops improving – and with it their ability to work – they are no longer eligible for daily allowances and the treatment is deemed to have been completed. At the latest, the treatment is deemed complete when the individual begins receiving disability pension payments linked to the same accident.

If the insured person's health deteriorates or new complaints emerge that are the result of the insured accident, this is classified as a relapse. In the event of a relapse, the insurer will also cover the costs of treatment and daily allowance benefits. Daily allowance benefits will only be paid if the insured person was working up until the time of the relapse.

What legal requirements apply to accident insurance?

Employee accident insurance is compulsory and is governed by the Federal Act on Accident Insurance (UVG).

Anyone who is not an employee can include accident cover in their compulsory health insurance. Health insurance with accident cover only insures treatment costs such as medical expenses, hospital costs and medication.

Self-employed persons can take out voluntary accident insurance and have two options to choose from. One option is a daily sickness allowance insurance policy that includes absences from work due to an accident. Alternatively, self-employed persons can voluntarily take out statutory accident insurance (UVG). This solution gives the policyholder the same protection and benefits as an employee.

What are UVG, UVG-O, UVG-Z and UVG-F?

UVG is the acronym for the Federal Act on Accident Insurance. The legislation requires all employers in Switzerland to insure their employees against the consequences of accidents and occupational illness. When we talk about this requirement, we often call it UVG-O (obligatory UVG cover).

Compulsory accident insurance only provides limited cover for certain elements, such as the need to insure salaries in excess of CHF 148,200. So supplementary UVG insurance is also available, which is referred to as UVG-Z.

Self-employed persons can opt to take out insurance that is equivalent to compulsory accident insurance. This is known as UVG-F (freelance UVG). As the scope of benefits for this insurance policy cannot be customised, Helsana provides alternative personalised insurance products for self-employed persons.

Is accident insurance only valid in Switzerland?

Your accident insurance and supplementary insurance are valid worldwide.

If you are involved in an accident while abroad, the compulsory insurance will cover up to a maximum of twice the cost of the same benefit in Switzerland. Even better terms apply to EU and EFTA countries.

If you are insured for treatment in a semi-private or private ward, the insurance will cover those costs when you're abroad too.

Whatever happens, if you have an accident while abroad, you are entitled to medical care and treatment until you can be repatriated to Switzerland. All subsequent medical treatment will then be provided in Switzerland.

What benefits am I entitled to under my statutory accident insurance?

If you have statutory accident insurance, then you are eligible for the following minimum benefits:

Treatment, care and reimbursement of the associated costs

  • Medical and hospital invoices for outpatient treatment and inpatient treatment in a general hospital ward
  • Medical aids such as canes, wheelchairs, special devices and other equipment
  • Travel and transport costs
  • Rescue
  • Recovery, transport and burial of body

Compensation for loss of income

  • Daily allowance while you are unable to work after an accident: 80% of salary, up to a maximum of CHF 148,200

Disability and death benefits

  • Disability pension at 80% of salary, up to a maximum of CHF 148,200
  • Integrity compensation for full or partial loss of physical, mental and emotional integrity, calculated in accordance with the degree of injury using this table
  • Helplessness allowance as a contribution towards the costs of caring for someone who is unable to care for themselves
  • Survivor's pension of up to 70% of salary, up to a maximum of CHF 148,200
What is a minor accident?
If the injured person is able to return to work within three days of the accident, the accident is classified as a minor accident. We recommend that you also report minor accidents to your insurer in case you need to claim for any subsequent complications and consequential damage.
Which part of my income is covered by UVG insurance (UVG salary)?

Under the Federal Act on Accident Insurance (UVG), salaries can be insured up to a maximum of CHF 148,200. This part of the salary is known as the UVG salary. The salary component above the threshold is not insured under compulsory accident insurance. However, you can take out supplementary insurance to cover the remainder (surplus salary).

Here are a couple of examples:

  • The salary of someone who earns CHF 120,000 per annum is fully covered by compulsory accident insurance, because their salary is below the ceiling. Daily allowance benefits are calculated based on the salary: 80% of CHF 120,000 = CHF 96,000 (payable in the event of complete incapacity for work).
  • Only the first CHF 148,200 is insured for someone who earns CHF 160,000 per year. The daily allowance benefits are calculated using the maximum amount: 80% of CHF 148,200 = CHF 118,560 (payable in the event of complete incapacity for work).

The provisions of Article 15 (3) of the Federal Act on Accident Insurance (UVG) on the maximum insured salary ensure that between 92% and 96% of the population of Switzerland will not suffer any significant financial loss in the event of an accident.

What is the surplus salary?
The surplus salary refers to the part of a salary that exceeds the CHF 148,200 ceiling for statutory insurance. The surplus salary is not covered by compulsory accident insurance, but can be insured under a supplementary accident policy.
How do you define medical treatment?
For the purpose of accident insurance, all necessary treatment prescribed by a doctor for the insured person to treat the consequences of an accident qualifies as medical treatment. The legal definitions can be found in Article 10 of the Federal Act on Accident Insurance (UVG) and Articles 17 to 21 inclusive of the Accident Insurance Ordinance (UVV).
What is a medical aid?
Any object that is used to compensate for physical injuries or loss of bodily functions. The Federal Office of Public Health publishes a list of aids and equipment.
How much is the daily allowance?

If the insured person is completely unable to work, they will receive 80% of the insured salary. In cases of partial incapacity for work, the amount is reduced pro rata.

With compulsory accident insurance, the maximum insured annual salary is CHF 148,200. The maximum possible daily allowance is therefore CHF 324.80: 80% of the maximum UVG salary divided by 365.

Supplementary accident insurance can be taken out to cover the salary component that exceeds the CHF 148,200 ceiling. For more information, see the section on UVG salaries.

What is disability?
For the purposes of accident and health insurance, disability means a proven incapacity for work as certified by a doctor.
When is an insured person eligible for a disability pension?

Someone who is injured in an accident and has completed the treatment and rehabilitation but is still at least 10% disabled, which limits their ability to work, is entitled to a disability pension.

If the individual is completely unable to work (total disability), the pension is 80% of the insured salary, subject to the UVG ceiling of CHF 148,200. If the person is only partially incapacitated for work, the pension is reduced accordingly.

What is integrity compensation? When does someone qualify?

Individuals who have suffered a significant and permanent loss of physical, mental and emotional integrity as a result of an accident are entitled to receive integrity compensation.

The following are examples of a significant loss of integrity:

  • Loss of one or more limbs or the use thereof
  • Organ failure
  • Mental and emotional capacities are diminished, which affects everyday living

Integrity compensation is not dependent on full or partial incapacity for work.

The level of compensation is determined using the table published in the Accident Insurance Ordinance.

What is a helplessness allowance? When does someone qualify?
Someone who has been disabled in an accident and needs help or personal supervision to cope with everyday living is entitled to receive a helplessness allowance. The amount is determined according to the degree of helplessness on a case-by-case basis.
Who is eligible to receive a survivor's pension?

When an insured person dies as the result of an accident, the surviving spouse and children are entitled to receive a survivors' pension.

For the spouse, the pension can be up to 40% of the insured income; each child is entitled to receive up to 15% of the insured income. However, the total pension payments cannot exceed 70% of the insured income.

The figures given here are guidelines: the exact amount will be calculated on a case-by-case basis.

Where can I find full details of the benefits provided by compulsory accident insurance?
The benefits provided under compulsory accident insurance are defined in the Federal Act on Accident Insurance (UVG) and the accompanying Ordinance. The full text of the UVG is available online here.