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Quick guide to the benefit statement
When you send Helsana invoices for medical treatment, or benefits such as medication and laboratory tests, we check the information and generate a benefit statement. Here we explain what appears on your benefit statement.
The first page of the benefit statement provides an overview of all invoices that have recently been processed for each family member, together with the associated credit or payment due. If a payment is due to you, the amount is shown in green; amounts payable by you are highlighted in red. To find out how the amount in question is calculated, take a look at the detailed breakdown. The first page also provides an overview of the co-payments balance to date – deductible and excess – for each family member. Example overview page:
On the detailed statement pages, we list the individual benefits associated with each invoice, such as medical treatment or medication. You can see the invoice amount, our contribution and your contribution for each item. Additional information is provided below the total, which is shown in colour. For example, we will tell you which insurance product covers the cost of the treatment, and why we have not covered the full amount in certain cases.
You can find an example of a full benefit statement here (PDF, 93KB) .
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 comprises the deductible, which is a fixed amount, and a 10% excess. The end of your statement shows the maximum annual co-payment, the amount you have already used and amount remaining. The blog explains how you can change your deductible and when the excess applies.