If you experience health problems, your first port of call is always your GP or HMO group practice. You benefit from the optimal coordination of your treatment and can save on your premiums.
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.
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.
With the general practitioner model, your general practitioner or group practice is always the first port of call – regardless of the medical concern. It also coordinates your treatment path going forward and ensures that no time-consuming unnecessary duplicate examinations take place. Additionally, you can consult our medical advice hotline Medi24 free of charge at any time. On top of that, you can use the Medi24 digital services available on the myHelsana app, like the symptom checker and medical video consultation. Likewise, you can also use the BetterDoc service free of charge to find the best specialist for you.
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 go to your selected GP or HMO group practice first in the event of a health problem. If you require a specialist, the referral is made by your GP or HMO group practice. Prior to treatment, you can use the BetterDoc service to look for a suitable specialist yourself and suggest these to your general practitioner for referral. BetterDoc can also help in the event of any doubts regarding ongoing treatment, e.g. prior to any treatment.
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.
The R designations stand for different discount levels. R1 corresponds to the highest and R4 to the lowest discount level. Every doctor is assigned an R level. The doctor selected by you and your place of residence will have a bearing on your premium level. When selecting a doctor, the premium calculator will show you the potential premium discount.
We have collaboration contracts with discount level “R1”, “R2” and “R3” doctors. The doctors have an active, regulated responsibility for the coordination of your treatment and for specific measures aimed at promoting quality. The attending physician coordinates the referral notice. Discount level “R4” doctors do not have a collaboration contract with us.
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 four alternative models. The benefits are the same for all models.
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