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Notices to customers

Premium increases

Premiums are increasing every year. We explain the correlation between costs and premiums – and show you how Helsana is handling premium increases and what you yourself can do about high premiums. In this way, we can work together to ensure that our high-quality healthcare system continues to remain affordable in the future.

  1. The benefit costs that premiums cover
  2. What drives up costs
  3. How costs are developing
  4. How we are negotiating more favourable conditions
  5. How we are campaigning for lower premiums at political level
  6. How we are dealing with fraudsters and profiteers to keep premiums low
  7. How we assist you free of charge after a serious accident or in the event of long-term illness
  8. How you save with alternative insurance models under basic insurance
  9. How you can obtain medications at a lower price from our mail-order pharmacies
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The benefit costs that premiums cover

All benefit costs incurred must be covered by premiums. There are no gains under basic insurance – any surpluses are transferred to the reserves. The following diagram shows where different types of costs are incurred and how high they are.

Premium increases

In 2013, compulsory health insurance (OKP) paid out almost CHF 27.9 billion in healthcare benefits. Policyholders paid CHF 3.9 billion towards these costs. This amount is made up of the excess and deductible.

OKP spending is financed mainly via policyholders' premium payments. Premium income amounted to CHF 24.8 billion, of which CHF 4 billion was financed by the individual premium subsidy. Other income also contributed towards financing the costs, namely investment income of CHF 373 million.

"Premiums - costs - explanations" (in German, by our Curafutura association)

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What drives up costs

Competition among health insurers is strictly regulated. Insurers are obliged to reimburse all benefits under basic insurance. There are practically no incentives to offer cost-effective treatments. Medical advances and technological progress, as well as the steady expansion of the benefits catalogue, are also driving up costs. Scientific breakthroughs have their price, with new medications often costing several times more than their predecessors.

A further factor is policyholders' entitlement attitudes in combination with a high degree of health consciousness: even healthy people are increasingly accessing medical services. Furthermore, the steadily ageing population means that there is a prolonged demand for healthcare benefits.

The result is that costs and therefore premiums will continue to increase considerably in 2015, despite Helsana's strong commitment to a financially sustainable healthcare system .

"Need for reform in health insurance and the healthcare system" (in German, by our Curafutura association)

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How costs are developing

In 2011, the costs of compulsory health insurance came to around CHF 25 billion per year, corresponding to CHF 3,171 per person. In the last ten years, there has been an above-average increase in the outpatient hospital segment, with growth of 7.1%. This is more than double the average growth in all other segments. Over the same period, above-average cost increases have also been recorded in the Spitex segment (7.2 %). Costs in the inpatient hospital segment rose by 3.4%; at 22.8%, they account for the largest share of the total costs of the healthcare system.

Helsana Group reporting
"Health insurance in brief" (in German, by our Curafutura association)

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How we are negotiating more favourable conditions

Helsana is strongly committed to premiums remaining affordable in the long term, as well as to offering the highest quality and best possible price. Helsana has therefore set up the HSK Purchasing Cooperative, together with two other health insurers. This legally independent organisation enables its members to obtain services at more favourable conditions and pass them on to policyholders.

HSK Purchasing Cooperative (in German, Helsana, Sanitas und KPT)

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How we are campaigning for lower premiums at political level

Helsana is also active at political level for its customers and is in regular contact with authorities and politicians. As Switzerland's leading health insurer with over 1.9 million policyholders, Helsana has an important say.

Helsana's political stance

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How we are dealing with fraudsters and profiteers to keep premiums low

Falsified doctor's bills, both in Switzerland and from abroad, fiddled or incorrectly filled out receipts from service providers, unjustified salary payments owing to a delayed return to work: the list of insurance benefit scams is long. Helsana has consistently stepped up its efforts to fight fraud in recent years, and has saved millions in the process. This commitment means we can contribute to keeping costs and premiums low.

"Beware of fraudsters" article (Senso customer magazine)

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How we assist you free of charge after a serious accident or in the event of long-term illness

For those who are unable to work for a prolonged period due to illness or accident, it's often not just their health that is affected. In addition to medical issues, there are also professional, legal, social and financial matters to consider. A multitude of agencies, such as doctors, employees, insurers and administrative offices, are often involved, and things can quickly become complicated. You need someone to maintain an overview and who is familiar with the Swiss social system. What offers are available and where can you apply for them? Who pays what? Helsana Case Management helps you with such questions. Case managers provide patients with comprehensive assistance. They coordinate treatments and all the steps required for a quick return to work, thus avoiding redundancies and relieving pressure on both patients and employers. This is a voluntary service free of charge.

Four patients recall how Helsana case managers helped them
Overview of Helsana Case Management

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How you save with alternative insurance models under basic insurance

Under basic insurance you have the option of selecting the standard model or a cheaper alternative insurance model. Under the latter, you always turn to the same point of contact if you have a health problem, whether a medical advice hotline, a general practitioner or group practice. They coordinate your treatments with doctors, specialists and hospitals. As a result, your treatments are more reliable and there are fewer redundancies, allowing you to save on healthcare costs. You benefit in the form of a lower basic insurance premium. Alternative insurance models are becoming more and more popular: around 61% of all Helsana policyholders have already opted for such a model.

Alternative insurance models

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How you can obtain medications at a lower price from our mail-order pharmacies

Medications are expensive. But thanks to our partnership with four Swiss mail-order pharmacies, you can now obtain your medications at a lower price. As result, you not only contribute to lowering healthcare costs, but also save money and benefit. The medications are sent quickly and simply by post directly to your home – without a prescription and without shipping costs. Ordering is simple. Upon request you can also obtain advice discreetly from competent specialists by phone. Please also ask about possible generic medications, which contain the same active ingredient as the original medication, but cost far less.

Mail-order pharmacies