Health insurance and benefits explained

Do you sometimes struggle to understand the terminology related to your health insurance? We summarise the main topics and also explain what benefits are paid.

What does HMO mean?

HMO stands for Health Maintenance Organization . This covers alternative insurance models (AVM), which are available as basic insurance alongside the standard variant. This includes telemedicine (Telmed model, initial medical consultation), the general practitioner model (network of doctors) as well as the HMO group practice. The premium for these models is lower than in the standard variant – for the same benefits.

What is included in basic insurance?

Basic insurance ensures basic medical care is provided in the case of illness, accident (insofar as included in your policy) and pregnancy. The Federal Health Insurance Act (KVG) defines which benefits are paid by health insurance. More information can be found in our Overview of benefits (PDF) and on the website of the Federal Office of Public Health. Basic insurance does not cover all treatments, even if they are medically necessary. Voluntary supplementary insurance is recommended to close this gap.

What is a deductible?

This is a fixed amount that you must pay for benefits under basic insurance (e.g. visits to a doctor, hospitals, medication). The deductible is laid down by law and amounts to a minimum of CHF 300 per adult per calendar year. There is no deductible for children. Those who opt for a higher deductible will benefit from a premium discount. Find out more on the blog.

There are also deductibles under Supplementary Hospital Insurance. The amount of the hospital deductible can be individually selected.

How do I terminate health insurance?

Compulsory health insurance and supplementary insurance feature different termination deadlines. Read here to find out how best to proceed and what to take into account. Our blog post about the end of the year provides further information.

When does family insurance end?

You decide. With supplementary insurance, Helsana offers you a lifelong family discount of 5% if there are two people in the same household under the family policy. This increases to 10% for three or more people in the same household. Age does not play a role in the family discount. Children up to age 18 additionally benefit in the basic insurance from a children's discount of at least 75%, while young people up to age 25 receive a 10% discount on the adult premium. Find out more about the children's and young people's discounts and about other discounts for our supplementary insurance.

What does the health insurance contribute?

How much will health insurance pay towards glasses? What about pregnancy? Will health insurance pay for the gym, tooth cleaning or medical aids? What about alternative medicine such as naturopathy, homeopathy and osteopathy? Our glossary provides all the answers: Benefits from A to Z.

The four models under basic insurance

Learn more about the pros and cons of the four different models under basic insurance.

What is actually meant by deductible and excess?

We explain to you the interplay between deductible and excess in basic insurance.

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