For certain benefits, applications for cost approval are not required, or the benefits are directly processed by us. You will find all information about the special cases here.
Since 1 January 2013, we have been handling the direct processing of transplants.
To give notice of a planned transplant, send the completed application form for confirmation of cost reimbursement / notification of a transplant to the Helsana Service Centre that is responsible for you. We shall examine our obligation to pay benefits and will confirm the approval of costs to you.
For any additional costs relating to the donor, such as loss of earnings benefits or travel expenses, you or the donor should send the form for transplant donors' costs to Helsana together with the necessary documents. We shall settle directly with the donor or a third party (such as the donor's employer).
Since 1 January 2013, we have been handling the direct processing of benefits in connection with dialysis at dialysis centres and at home. To simplify the process, we have eliminated cost approval applications for dialysis at dialysis centres and at home.
Send home dialysis prescriptions to the relevant supplier with one copy to us:
Patients requiring dialysis who perform the dialysis themselves at home receive compensation for the additional costs incurred due to the dialysis (e.g. water, electricity, support from a partner). This arrangement helps us to support and encourage home dialysis at reasonable cost.
Since 1 January 2013, we have been handling the direct processing of benefits in connection with mechanical ventilation at home.
If this is a standard KVG benefit, submit the Prescription form for mechanical ventilation at home to us. The rates and prices agreed with Helsana have been in force since January 2013.
Thanks to several partnerships with equipment suppliers and dealers, persons insured with the Helsana Group can rent inhalation and respiration therapy equipment at favourable rates and can also benefit from beneficial conditions when buying consumables. Please prescribe your patients equipment from one of the Helsana Group's preferred partners.
Since 1 January 2013, we have been handling the direct processing of reimbursement costs in connection with artificial nutrition at home. The tariffs and prices agreed with Helsana apply.
You have previously submitted an application for reimbursement of costs for compulsory KVG benefits. Starting 1 May 2015, we will be renouncing reimbursement applications and will no longer issue written confirmations of cost reimbursement. Costs will be reimbursed if the product is listed on the FSMP list and the conditions laid down in the Swiss Clinical Nutrition Society (GESKES) guidelines are met.
However, nutrition treatment at home will still require a prescription from a physician. You are therefore requested to send the prescription forms for any patients insured by Helsana directly to the homecare service. This ensures that patients are treated immediately and competently and are efficiently supplied with artificial nutrition products. You can get prescription forms from a homecare service or from GESKES.
Since 1 June 2019, we have been handling the direct processing of benefits in connection with defibrillator vests. A new partnership with ZOLL Medical Switzerland AG has made this possible. This means that the preferential conditions agreed with Helsana will apply.
For statutory KVG benefits, please submit the prescription form for the LifeVest wearable defibrillator to ZOLL Medical Switzerland AG.
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