BeneFit PLUS General Practitioner
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.
How BeneFit PLUS General Practitioner works
Whether treatment, referral to a specialist or admission to hospital, your GP or HMO group practice is your first port of call.
Illness or accident 
GP or HMO group practice 
Further treatment
Emergency: in an emergency, always go directly to an emergency doctor or a hospital.
Emergency 
Emergency doctor or hospital -
GP or HMO group practice
Please note: you must subsequently notify your general practitioner of any such emergencies so that they are kept informed of the situation and can discuss any further check-ups with you.
Your exclusive benefits with Helsana
- Everything to hand at all times with the myHelsana app
- Quick and easy reimbursement
- Round-the-clock medical advice with Medi24
- Access to BetterDoc: find the specialist you need fast
- Collect points with Helsana+ and receive up to CHF 75 per year
Insured benefits
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).
Choice of hospital
You enjoy free choice among all the hospitals in Switzerland that are included on the cantonal hospital lists (“listed hospitals”) but receive no more than the costs up to the rate of your canton of residence.
Exceptions
- If you need to find a hospital outside of the canton for medical reasons.
- If an out-of-canton hospital is on the hospital list for your canton of residence.
Hospital stays
If you have opted for an alternative insurance model, you will only receive these benefits subject to the following conditions:
- BeneFit PLUS General Practitioner: if the hospital stay has been prescribed by your GP or group practice.
- BeneFit PLUS Telemedicine: if the hospital stay has been prescribed by a doctor at the telemedicine centre.
- BeneFit PLUS Flexmed: your hospital stay is ordered by your GP practice, your group practice or a doctor at the Centre for Telemedicine.
- PREMED-24: if you have called the advice hotline and received non-binding health advice before the hospital stay.
Emergency treatment abroad (inpatient and outpatient)
The Agreement on the free movement of persons (AFMP) ensures that you have access to the same public healthcare services (doctors, pharmacies, hospitals and ambulances) within EU/EFTA/UK as the residents of the respective country. In the event of a medical emergency, you will therefore receive costs equivalent to the social tariff in the country of temporary residence.
In all other countries, you receive the costs of outpatient and inpatient emergency treatment up to twice the amount that would be covered by basic insurance in Switzerland (tariff in your canton of residence).
Take your insurance card with you when you travel and always have it on you. The uniformly designed back of the card is valid as a European Health Insurance Card and is recognised within EU/EFTA/UK.
Transport
Overall, you receive 50% of the costs of planned transportation to a medical facility for medically necessary treatment, up to CHF 500 per calendar year.
Requirement
You choose a recognised mode of transport, such as a Spitex vehicle, a wheelchair-accessible taxi, a disability vehicle or an ambulance.
Rescue
You receive 50% of the costs of rescue operations in Switzerland, up to CHF 5,000 per calendar year.
You receive the costs of medically prescribed medication on the specialities list.
If several medecines are listed with the same combination of active ingredients, the excess can amount to 40%.
You receive the costs according to the tariff of the recognised specialist for the whole of Switzerland for treatment by federally certified doctors, chiropractors and medical support staff, such as physiotherapists, occupational therapists, nurses, midwives, speech therapists, etc.
Requirements
The treatment is prescribed by a doctor and listed in the benefits catalogue of the basic insurance.
You receive contributions towards the costs of the following types of complementary medicine:
- Anthroposophic medicine
- Classical homoeopathy
- Phytotherapy
- Pharmacotherapy within traditional Chinese medicine (TCM)
- Acupuncture
The costs are reimbursed according to the tariff of the recognised specialist for the whole of Switzerland.
Requirement
Your doctor holds a recognised certificate of competence awarded by the Swiss Medical Association (FMH) for these methods.
You receive the costs related to specific examinations for the early detection of illnesses and preventive measures that are prescribed or carried out by a doctor (e.g. isolated vaccinations).
The costs of a gynaecological check-up are covered for women every three years. The costs of mammograms are covered subject to certain conditions.
We would be happy to provide you with information on which examinations are covered by basic insurance in a phone call.
You receive the costs of medically prescribed aids and apparatus, such as crutches, blood glucose meters, inhalation/respiratory therapy equipment and compression stockings, up to the maximum amount specified by law.
Requirements
The medical aids are listed in the aids and equipment list and obtained from an authorised provider.
Check-ups and ultrasound examinations
- During a normal pregnancy, you are entitled to seven check-ups to be carried out by a doctor or by a midwife.
- We will also reimburse you for two ultrasound examinations carried out by a doctor.
- For a high-risk pregnancy, you will receive the costs of all necessary check-ups and ultrasound examinations.
Breastfeeding guidance
- You receive three sessions of breastfeeding guidance from a midwife or specially trained nurse.
Preparing for the birth
You receive CHF 150 per calendar year for
- birth preparation courses run by the midwife for individuals or groups
or
- a consultation with the midwife on the birth, planning and organisation of the postnatal period at home as well as preparations for breastfeeding.
Home birth
For a home birth, you receive the costs in accordance with the applicable tariff or contract of the midwife.
Hospital stays
If you have opted for an alternative insurance model, you will only receive these benefits subject to the following conditions:
- BeneFit PLUS General Practitioner: if the hospital stay has been prescribed by your GP or group practice.
- BeneFit PLUS Telemedicine: if the hospital stay has been prescribed by a doctor at the telemedicine centre.
- PREMED-24: if you have called the advice hotline and received non-binding health advice before the hospital stay.
You receive the costs of a stay in a general ward (multi-bed room), care and treatment in accordance with the standard rate in your canton of residence.
Exceptions
- If you need to find a hospital outside of the canton for medical reasons.
- If an out-of-canton hospital is on the hospital list for your canton of residence.
Spitex
With care at home, the care specialist determines your expected care needs in terms of time required. We cover this cost based on the corresponding amount in Swiss francs specified by law. This is subject to the condition that Spitex (home nursing) is medically prescribed and that the chosen Spitex organisation or care specialist is qualified and recognised.
Nursing home
You receive the costs according to the applicable tariff for care services in a nursing home. The tariff is based on the level of care needed, as determined on your admission.
We cannot assume boarding costs (room and board at the nursing home) under basic insurance.
You receive CHF 10 per day for up to 21 days per calendar year for balneotherapy at recognised therapeutic spas in Switzerland.
Requirements
- The spa treatment is medically certified as necessary.
- The spa treatment is prescribed to you by a doctor.
- The spa treatment is carried out at a recognised therapeutic spa.
Downloads
Frequently asked questions
Under the Federal 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.
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.
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:
- Primarily, the Emergency Call Centre is to be contacted under the telephone number +41 58 340 16 11.
- Please hand in your European Insurance Card in the EU / EFTA countries.
- Your general practitioner or HMO group practice in Switzerland should be contacted as soon as possible.
- If follow-up treatments are necessary after the first emergency treatment, consult your general practitioner or your HMO group practice. This will enable you to plan and coordinate further treatment in Switzerland.
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.
Details about annual deductible
Still not sure which deductible would be best for you? We would be happy to help. Call us on 0844 80 81 82.
Different rules for cross-border commuters
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:
- When reducing the decutable: 30 November
- When increasing the decutable: 31 December
Please note that notification of change must reach us by no later than the last working day before the respective deadline.
Different rules for cross-border commuters
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.
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 insured person 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.
There are several ways of saving on your premium for basic insurance.
Other models under basic insurance
Helsana offers basic insurance as a standard version as well as four alternative models. The benefits are the same for all models.
Do you have questions?
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