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The benefit statement made easy

How should I read a benefit statement, and how is the co-payment calculated? A brief guide.

The first page of your benefit statement is a summary. You can see at a glance the recently processed invoices for each family member including the cost of the treatment, our credit to you and your share of the costs. If you want to see the invoice details, you can easily find the relevant benefit statement on the next page using the reference number. Example of an overview page:

Leistungsabrechnung

On the detailed pages, we list the individual benefits per invoice, such as medical treatment or medications. You can see which insurance product the costs were reimbursed from and the amount of your and our share of the costs. If we do not cover an amount in full, you will find a detailed explanation for this in the statement.

Leistungsabrechnung

You can find a full example of a benefit statement here (PDF, 289KB) .

How is the co-payment calculated?

In Switzerland, every insured person contributes towards the cost of the medical benefits claimed under compulsory basic insurance, such as visits to the doctor, medication and hospital costs. This co-payment consists of the deductible (a fixed amount) and the excess of 10%. The amount of your annual co-payment, how much you have already paid and how much remains to be paid is shown at the end of your benefit statement. You can find out from the blog how to change your deductible and when the excess applies.