What to do in the event of a claim

Congenital defects

In the event of hereditary diseases ("congenital defects"), your disability insurance (Invalidenversicherung, IV) will bear the costs of any medical treatment up to the age of 20.

IV bears the costs of congenital defects

In the event of hereditary diseases ("congenital defects"), your disability insurance (Invalidenversicherung, IV) will take care of any medical treatment until you reach the age of 20. Unlike health insurance policies, IV does not involve co-payment. In other words, it bears the full cost of any treatment.

As of the age of 20, your basic insurance (compulsory healthcare insurance) will bear the treatment costs, as long as they are related to a compulsory KVG benefit. In this case, the insured person bears their share of the costs.

Processes between IV and Helsana

For invoices indicating a congenital defect, Helsana will contact the physician treating the child. During this process, it will examine whether the child is suffering from a hereditary disease. If so, Helsana will request that the parents register the child with the IV. If the parents do not comply with this request, Helsana is entitled to submit the notification itself. Helsana shall continue to bear the costs and the parents their share of the costs until the IV recognises the congenital defect. If the IV takes the case on, the parents will subsequently be reimbursed for these costs.

Registering with the IV

For the IV to bear the treatment costs, you as a parent must register your child with the IV office in your canton of residence. To do this, please use the "Registration for minors" registration form.