Contact and advice

FAQ – Frequently Asked Questions

  1. Frequent questions about insurance
  2. What you need to know about premiums and policies
  3. All about saving money
  4. What you need to know about our products and services

FAQ - Häufige Fragen

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Frequent questions about insurance

What costs do I pay myself from the basic insurance?

As stipulated by law you bear a portion of the costs yourself. This consists of the deductible and the excess. The treatment date is significant for the calculation that applies per calendar year. You pay until your deductible (CHF 300, 500, 1000, 1500, 200 or 2500) is used up. You then take a 10 per cent excess up to a maximum of CHF 700. We pay you for the insured benefits from the basic insurance in full from this amount.
You pay an additional CHF 15 per day if you have to go into hospital. Adults under 25 and pregnant women are excluded from this.

What is meant by co-payment in the basic insurance in accordance with the Federal Health Insurance Act (KVG)?

The co-payment is prescribed by the Federal Health insurance Act. It is made up of an optional co-payment, the mandatory deductible under the law and the hospital allowance. It is valid per calendar year. You settle all medical costs for medication, visits to doctors and hospital stays that are covered by basic insurance yourself until you have reached the deductible you have selected. From this point adults aged 18 and above each pay 10% up the maximum deductible of CHF 700 (or CHF 350 for a child). We bear the remaining 90% of the costs for you. If the maximum deductible is reached, we will accept all costs still outstanding in this calendar year in full in accordance with the benefits catalogue of the basic insurance.
You pay an additional CHF 15 per day if you have to go into hospital. Adults under 25 and pregnant women are excluded from this.
The co-payment in the basic insurance also does not apply to the costs of treatment in the case of illness but only in the event of an accident.

What is supplementary insurance?

You receive certain benefits from supplementary insurance, which the basic insurance (compulsory health insurance) does not or only partly covers. This includes complementary treatments, convalescence, dental treatments, rescue costs or preventative health measures. An individual consultation will indicate what insurance makes most sense for you. You can ask for a consultation online, by phoning 0844 80 81 82, in person at one of our points of sale or in the comfort of your own home.

Do I need supplementary insurance?

With an additional insurance policy you are able to insure yourself for benefits that are not or only partly covered by the basic insurance.
We can put together and insurance package for you made up of supplementary insurance that is tailored to your personal needs. Do you like going on long trips, for example? Then comprehensive travel cover is important for you. Or do you surf the Internet a lot? Then Internet legal protection makes sense for you. You can ask for a consultation online, by phoning 0844 80 81 82, in person at one of our points of sale or in the comfort of your own home.

Do I have to have accident cover in the basic insurance?

If you are employed for at least 8 hours a week by the same employer, they automatically insure the costs of your treatment for occupational and non-occupational accidents. In this case, you can exclude accident cover from your basic insurance. This will reduce your basic insurance premiums by 7%. More information on the exclusion of accident cover

Can I cancel my basic insurance during military service?

You cannot cancel it but you may be able to suspend cover: if you serve more than 60 days' military service, you can suspend the basic insurance for this period. You will be insured by the military directly during the service and do not have to pay any premiums for the basic insurance.
The suspension only applies to basic insurance and not to any supplementary insurance.
Just give us our marching orders one month after you start your military service at the latest to enable us to suspend cover temporarily. At the end of service you must send us an extract from your service booklet as confirmation of the service days you have served, so that we can make the final suspension. Further information on suspension of cover during military service.

You are always asked for the "sickness and accident costs" you pay for yourself and the insurance premiums in your tax return. Is there a list for this?

We will always send you the extract for your tax return automatically by mid-February each year. If you do not receive it by this date: Simply make a quick request using our Contact form.

Call centres always call me on my mobile. How do they get my number?

Calls from call centres that try to get you book an appointment for a consultation about health insurance get your mobile number in a variety of ways, for example, from a competitor who knows your number and with whom you have permitted contact. It is also possible that a dialling computer found your number: the software randomly calls numbers regardless of whether they have been given out. A data leak from a smartphone may also be the reason. Apps that are disguised as free versions of well-known apps and the owner of the mobile phone downloads extracts entire telephone lists from the mobile phone unnoticed. It is very likely that the dubious data collectors who offer these apps sell the data on. It is important that you protect yourself against this.
One possibility is for you to save the caller's number on your mobile phone and block it. It's worth checking which apps access what data (e.g., using the app "My Permissions" for iOS or "Permission Manager" for Android).
Helsana relies on reliable customer acquisition. As a member of the trade association Curafutura we are committed to fair competition. We want to improve the quality of customer canvassing to such an extent that dubious agents and shady advertising calls disappear from the market.

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What you need to know about premiums and policies

I am 19 years old. My basic insurance premium has now suddenly increased significantly. Why?

We offer a generous child subsidy until you reach 18. This now no longer applies to you, which is why you've seen a significant increase in your premium. Take a look at our Saving tips, on how you can reduce your premium..

I am 26 years old. My basic insurance premium has risen much more sharply than announced by the media. Why is that?

Helsana and Progrès grant young people a basic insurance subsidy until they reach the age of 25. Thereafter the normal adult tariff applies. Take a look at our Saving tips, on how you can reduce your premium.

Am I also able to have the policy and further Helsana Group documents online?

Yes, as a Helsana Group customer you are able to use our online customer portal myHelsana. This means that you have the most important insurance data and documents to hand at all times, for example, benefit statements, policies or premium summaries. This does away with unnecessary paperwork. Learn about the benefits from myHelsana and register.

Will my premium change if I move?

Premiums vary based on the canton and region. In the cantons there are one to three premium regions. Your premium can therefore be higher or lower if you move to a different canton or another municipality. Use the premium calculator to find out the premium at your new place of residence.

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All about saving money

What deductibles are there and how can I save?

Alongside the minimum compulsory deductible of CHF 300 we offer the following optional annual deductibles for adults aged 18 and over: CHF 500, 1000, 1500, 2000 and 2500. The higher the selected deductible, the lower your premium.
However, do consider: if you take medical benefits under the basic insurance, you will pay these yourself until the level of the selected deductible has been reached. We contribute to any further costs after this point. You will therefore only save below the bottom line if your invoices for doctor's visits, hospital treatment and medication are significantly below the selected deductible amount – that is if you are in good health. Undecided? Our customer advisor will be happy to help you further on 0844 80 81 82.

Am I also able to choose a deductible for my children?

Legally there is no compulsory deductible for children under 18. However, so that you also receive insurance for your children, we offer you an optional deductible of CHF 500 per calendar year. Our customer advisor will be happy to advise you further on 0844 80 81 82.

Do I have to pay a lower premium if I opt for the telephone medical consultation service by phone?

Yes. This will reduce your premium by 15%. We recommend the medical consultation service by phone BeneFit PLUS. If you experience a medical problem you always contact the independent Centre for Telemedicine on 0800 800 090. This provides you with the best possible co-ordination of your medical treatment.

At what point am I entitled to a premium subsidy?

That depends on how much you earn and the canton in which you live. All the information you need about premium reduction.

What doesn't the canton pay the premium subsidy to me directly?

This has been decided in this way by legislation. All cantons have had to process the premium subsidy via the health insurance provider in this way since January 2014. The cantons therefore transfer the premium subsidy to the health insurance provider. They deduct the premium subsidy directly from the policyholder's corresponding basic insurance premium.

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What you need to know about our products and services

Is it true that I can take out Internet legal expenses insurance with your company?

Yes. We offer legal expenses insurance Helsana Advocare EXTRA as from 1 January 2016. Alongside civil and motorists' legal expenses insurance Advocare EXTRA offers Internet legal expenses cover for legal advice and representation in legal disputes in Internet law. We cover you for up to CHF 1 million per legal case for legal fees, court and trial costs, expert opinions, mediation and court-awarded costs and security guarantees. The insurance covers contractual disputes (e.g., in the case of purchase contracts concluded via the Internet), disputes as a victim of credit card misuse, phishing and hacking (misuse of your account data), disputes in connection with cyberbullying, threats, extortion or blackmail, disputes resulting from the infringement of copyright, name and trademark rights (e.g., unauthorised use of a picture). You can ask for a consultation online, by phoning 0844 80 81 82, in person at one of our points of sale or in the comfort of your own home.

Can I insure myself privately for outpatient treatment in hospital?

Yes. With our health insurance supplementary insurance PRIMEO you can also insure yourself in the hospital when you return home on the same day. This means that you are free to select the doctor (e.g., consultant) and benefit from special comfort benefits in our partner clinics and further supplementary benefits.
For semi-private or private hospital insurance only covers benefits in case of inpatient treatment – i.e. treatment which requires you to stay the night in hospital.In future, there will be more and more outpatient hospital treatments where you can go home the same day.

Does basic insurance provide me with sufficient cover for medically necessary treatment when I travel abroad?

That depends where you travel to. It is sufficient to show the European health insurance card to receive emergency treatment for a doctor in a hospital if you are travelling within the EU or in an EFTA country. If you have this, approval of the costs by us is generally not required. You will then be entitled to the same medical benefits in accordance with the law of the country you are in that you would have received if you were insured there.
The basic insurance does not necessarily cover the full costs if you are travelling outside EU or EFTA countries. You can cover any gaps in your insurance through our supplementary insurance. Call our customer services on 0844 80 81 82 to find out more. Further information on travel preparations

Can I ask my doctor to send the invoice directly to me?

No. Your doctor decides which system he wants to use to settle the invoice (direct payment or refund). The patient always owes the doctor his fee. If, on the other hand, we have agreed to pay a service provider directly, that is, for example, a doctor, the hospital or therapist, they will send the invoice to us, and we will transfer the amount directly to them.

Why doesn't the insurance always pay when there is a receipt?

Not all doctor's prescriptions are covered by basic insurance. Under the basic insurance scheme, we are only allowed to reimburse you for the cost of things which are listed in the applicable legislation and in the ordinances on compulsory health insurance. We are therefore only allowed to reimburse you for many prescribed medical aids/items and medication under relevant supplementary insurance policies.

Why do I have to register my baby even before the birth?

The purpose of prenatal registration is so that the newborn can be insured optimally with supplementary insurance from the moment they are born – in an uncomplicated way and without having to undergo a risk assessment – for example with the Baby Package.
The pre-birth registration means that even children who come into the world with complications have comprehensive insurance cover. If, on the other hand, the registration is only made after the birth, a risk assessment will first have to be made for any supplementary insurance. There is a risk that your baby may no longer be accepted for supplementary insurance for a pre-existing condition. In order to play it safe, it is therefore essential that you take out the insurance you want for your baby before they are born – the quickest way is directly online.

Who do I have to call if I have a health problem and have opted for telemedicine, the alternative insurance model BeneFit PLUS?

In this case, you always contact telemedicine if you have health problems. You will be able to contact a medical professional here at any time of the day or night. A doctor will call you back if necessary. You decide and lay down any further treatment together. It is important that you always register all follow-up dates and further transfers with telemedicine first. Anyone who has taken out BeneFit PLUS telemedicine will also benefit from a 15 per cent discount in basic insurance. However, we are only able to grant this if you consistently go via telemedicine for your medical treatment. You do not need to contact telemedicine in the following cases:

  • Gynaecological check-ups
  • Obstetric care
  • Dental treatment
  • Follow-up adjustments by ophthalmologists in relation to glasses and contact lenses