In the event of a health problem, your first port of call is always your GP or HMO group practice. You benefit from the optimum coordination of your treatment and can save 10%, 12%, 14% or 16% on your premiums, depending on the service provider.
The list of doctors includes all doctors and group practices (HMOs) that are part of the BeneFit PLUS General Practitioner insurance model.
Whether treatment, referral to a specialist or admission to hospital: your GP or HMO group practice is your first port of call.
Emergency: in an emergency, always go directly to an emergency doctor or a hospital.
Please note: You must subsequently notify your general practitioner of any such emergencies so that he/she is kept informed of the situation and can discuss any further check-ups with you.
In the BeneFit PLUS General Practitioner model, you can also select a Medbase medical centre as your first port of call for medical matters. This means that you can receive medical support in Medbase medical centres or Medbase pharmacies anywhere in German-speaking Switzerland. This will save you time and offers you greater flexibility.
The benefits are the same for all basic insurance models. With the General Practitioner model, we will reimburse you the following benefits after deduction of the statutory co-payment (deductible/excess/hospital cost contribution).
You receive the costs of medically prescribed medication on the specialities list.
If several pharmaceuticals are listed with the same combination of active ingredients, the excess can amount to 20%.
Under the Swiss Health Insurance Act (KVG), health insurance is compulsory for anyone living in Switzerland. It provides basic medical care in the event of illness, accidents and maternity.
The scope of benefits it covers is regulated by law. This means you receive exactly the same benefits from every health insurer in Switzerland.
When taking out the General Practitioner model, you have to select a doctor or HMO group practice from our list of doctors as your main contact. If your current GP is on our list of doctors, you can continue to be treated by them.
When you opt for the BeneFit PLUS General Practitioner model, you agree to always first go to your selected GP or HMO group practice in the event of a health problem. If you require a specialist, the referral is made by your GP or HMO group practice.
If you consult a specialist directly, without having been referred, you are breaching your obligations under the General Practitioner model. As a result, Helsana may switch you to the standard model of basic insurance. This means you not only lose your insurance under the General Practitioner model but also your discount on the basic insurance premium.
When suffering from a chronic illness, your first point of contact should still be your GP. They will determine your individual course of treatment. If necessary, they will refer you to a specialist.
The following obligations continue to apply even during stays abroad:
Important: Your general practitioner or your HMO group practice cannot provide any information on cost coverage or cost refusal for emergency or planned treatments abroad.
Everyone who lives within the service area of the selected doctor network. Use our general practitioner search function to find out if the General Practitioner model is available where you live.
If you have taken out the statutory BASIS standard option with the deductible of CHF 300 with us, you can switch to this alternative insurance model on the first of any month and take advantage of its benefits..
Contact us if you would like to change your current insurance.
You can terminate the insurance on 31 December of each year and switch to another health insurance company in Switzerland, provided that you have no outstanding premium invoices. There is a one-month notice period. Notice of termination must reach us by no later than the last working day in November.
Adults aged 18 and over can either select the statutory minimum deductible of CHF 300 or one of five optional deductibles between CHF 500 and CHF 2,500. The higher your deductible, the lower your basic insurance premium.
There is no minimum deductible for children. However, by choosing the optional deductible of CHF 500 for them, you can save on their premium too.
Still not sure which deductible would be best for you? We would be happy to help. Call us on 0844 80 81 82.
For cross-border commuters from EU/EFTA countries, the statutory annual deductible for adults is also CHF 300 a year and there is no annual deductible for children up to the age of 18. However, cross-border commuters cannot be offered optional deductibles, i.e. they cannot opt for a higher deductible in return for a reduction in premium.
You can increase or decrease your deductible on 1 January of the following calendar year. The following deadlines apply:
Please note that notification of change must reach us by no later than the last working day before the respective date.
Cross-border commuters from EU/EFTA countries cannot be offered optional deductibles, i.e. they cannot opt for a higher deductible in return for a reduction in premium.
In BeneFit PLUS General Practitioner, the choice of doctor determines the premium discount on the basis model (R1=16%, R2=14%, R3=12%, R4=10%). Please see our Search service providers for your actual premium discount. The reduced premium is calculated on the basis of the premium that you would pay while living in your current place of residence, in your current age group, with a standard deductible of CHF 300 and no special insurance model.
Those whose income and assets justify financial support are entitled to a premium reduction (PR). The premium reduction differs from canton to canton. This often needs to be requested by the policyholder in order for it to take effect. It is therefore worth asking the competent office in your canton of residence whether you are entitled to financial support for your health insurance.
Helsana offers basic insurance as a standard version as well as three alternative models. The benefits are the same for all models.
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