Overview of insurance products

Insurance models within the compulsory basic health insurance

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BeneFit PLUS Telemedicine model

With the Telemedicine model, you always call the free hotline 0800 800 090 of the independent Centre for Telemedicine when you experience health problems. If further examination or treatment is necessary, you will immediately be referred to a doctor or hospital.

As a result, you receive medical assistance around the clock, irrespective of your location, and save 15% on your health insurance premiums. The medical benefits are the same as with standard basic insurance.

With the Telemedicine model, you have access to medical care at all times – without having to sit in a waiting room or arrange an appointment.

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How the Telemedicine model works

With the Telemedicine model, you benefit from access to medical care by phone at any time from wherever you are and receive a generous discount on your basic insurance premium. In exchange, you agree to receiving coordinated care from the independent Centre for Telemedicine. The centre serves as your point of contact for all medical issues.

Krankheit und Unfall

In the event of illness or accident

If you experience a health problem, always call the Centre for Telemedicine on 0800 800 090 first.

Notfall

In the event of an emergency

In an emergency, go directly to an emergency physician or hospital.

Insurance benefits

You receive the following insurance benefits after deduction of the statutory co-payment (deductible/excess/hospital cost contribution) with the Telemedicine model.

Details about the co-payment >

Hospital stays in Switzerland General - canton of residence

Hospital stays

If you have opted for another insurance model, you will receive benefits only subject to the following conditions:

  • BeneFit PLUS Telemedicine option: The stay in hospital is prescribed by a doctor at the Centre for Telemedicine.

You receive the costs of a stay in a general ward (multi-bed room) and medical treatment in accordance with the standard rate in your canton of residence.

Choice of hospital

You are free to choose among all the hospitals in Switzerland that are included on the cantonal hospital lists (“listed hospitals”), but receive no more than the costs specified by the tariff of your canton of residence.

Further information

Abroad EU/EFTA Member States: respective social rate / Other countries: double amount of the insured costs in Switzerland

Emergency treatment abroad (outpatient)

By virtue of the Swiss-EU Bilateral Agreement on the Free Movement of Persons, you have the same access to public healthcare (doctors, pharmacies, hospitals or ambulances) in EU/EFTA countries as the residents of the country you are in at that moment. In the event of a medical emergency you will therefore receive costs in accordance with the basic rate of the country in question.

In all other countries outside Switzerland you will receive the costs for outpatient emergency treatment up to double the amount that the same treatment would cost in Switzerland (rate of your canton of residence).

Emergency treatment abroad (inpatient)

By virtue of the Swiss-EU Bilateral Agreement on the Free Movement of Persons, you have the same access to public healthcare (doctors, pharmacies, hospitals or ambulances) in EU/EFTA countries as the residents of the country you are in at that moment. In the event of a medical emergency you will therefore receive costs in accordance with the basic rate of the country in question.

In all other countries outside Switzerland you will receive the costs for inpatient emergency treatment up to double the amount that the same treatment would cost in Switzerland (rate of your canton of residence).

Transport and rescue 50% up to CHF 500.–

Transport at home

You receive overall 50% of the costs, up to CHF 500 per calendar year, of scheduled transportation to a medical facility for medically necessary treatment at home and abroad.

This is on condition that you choose a recognised mode of transport, e.g. a vehicle operated by Spitex, a wheelchair-accessible taxi, a Red Cross vehicle or an ambulance.

Rescue at home

You can claim 50% of the costs up to CHF 5,000 per calendar year for rescue operations in Switzerland.

Medicines Medications on the specialities list

You receive the costs of medications prescribed by a doctor which are included on the specialities list.

Special case for points limitation:

Certain medications are divided into therapeutic groups. You receive the costs for a predetermined quantity from this group within 90 days. The doctor or pharmacist is required to inform you of this.

Further information

Outpatient treatment – conventional medicine According to the tariff in the canton of residence

Outpatient treatment

You receive the costs according to the tariff in your canton of residence for treatment by Federally certified doctors, chiropractors and medical support staff such as physiotherapists, occupational therapists, nurses, midwives, speech therapists, etc.

This is subject to the condition that the treatment has been prescribed by a doctor and is listed in the benefits catalogue of the basic insurance.

Further information

Outpatient treatment – complementary medicine Defined methods

Complementary (alternative medicine)

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

Please ensure that your doctor holds a recognised certificate of competence awarded by the Swiss Medical Association (FMH) for these methods.

Prevention (preventive medical care) Costs for certain preventive measures

Check-ups

You receive the costs for specific examinations for the early detection of illnesses and for preventive measures (e.g. vaccinations) that are performed or prescribed by a doctor.

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 give you information on this by phone.

Medical aids and equipment According to list

You receive the costs of medically prescribed aids and apparatus, such as crutches, blood-sugar measuring devices, inhalation/respiration therapy equipment and compression stockings, up to the maximum amount specified by law.

This is on condition that the medical aids are listed in the aids and equipment list and that you obtain them from an authorised provider.

Further information

Maternity Examinations and consultations

Pregnancy

Check-ups and ultrasound examinations
  • For a regular pregnancy, you are entitled to seven check-ups carried out by a doctor or six examinations 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 3 sessions of breastfeeding guidance from a midwife or specially trained nursing staff. In case of multiple births, you receive up to 2 additional guidance sessions.
  • Breastfeeding guidance replaces the breastfeeding allowance. This was abolished with the 1996 revision of the Health Insurance Act.

Birth preparation

You can claim CHF 150 per calendar year for ante-natal courses provided by an accredited midwife.

Home birth

For a home birth you can claim costs in accordance with the applicable rate or contract with the midwife.

Hospital stays

If you have opted for another insurance model, you will receive benefits only subject to the following conditions:

  • BeneFit PLUS Telemedicine option: The stay in hospital is prescribed by a doctor at the Centre for Telemedicine.

You receive the costs of a stay in a general ward (multi-bed room) and medical treatment in accordance with the standard rate in your canton of residence.

Nursing care Cost contribution

Spitex

With home care, the care specialist determines your expected need for care with the direct time requirement. The specialist completes a relevant statement of requirements. We pay for the duration of care required based on the corresponding amount in francs specified by law.

You receive a contribution to the costs for Spitex at home (home nursing care), if prescribed by a doctor.

This is subject to the condition that the chosen Spitex organisation or healthcare professional is qualified and recognised.

Further information

Nursing home

You receive the costs according to the applicable tariff for inpatient 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) from basic insurance.

Spa treatment CHF 10 per day

You receive CHF 10 per day for up to 21 days per calendar year for spa therapies at recognised therapeutic spas in Switzerland.

Conditions:

  • The spa treatment is medically certified as necessary.
  • The spa treatment has been prescribed by a doctor.
  • The spa treatment is carried out at a recognised therapeutic spa.

FAQs

Answers to frequently asked questions about the BeneFit PLUS Telemedicine model:

What are the advantages of the Telemedicine model?
  • Whatever the time of day or night, or wherever you happen to be, you can receive medical support by phone round the clock.
  • No need to sit in a waiting room or arrange an appointment.
  • Medical advice can be provided in German, French, Italian and English.
  • Your medical treatment is perfectly coordinated, and unnecessary multiple examinations are avoided.
  • You receive a 15% discount on your basic insurance premium.
Can the doctor at the Centre for Telemedicine write a prescription for medication?

Yes, but only for certain illnesses. The healthcare professional or doctor at the Centre for Telemedicine will be happy to discuss this with you.

To which doctor will I be referred for a consultation?

The healthcare professional or doctor at the Centre for Telemedicine will discuss the referral with you and suggest several appropriate physicians near you. You can then choose one of the suggested physicians.

Can I send photos to aid in the evaluation of my health problem?

If the healthcare professional or doctor at the Centre for Telemedicine thinks this will be helpful, it is generally possible.

You will receive a link via SMS or e-mail after the telephone consultation. The link will take you to a secure area of the Centre for Telemedicine website, where you can upload your photo. The doctor will assess the photo within four hours and, if necessary, initiate additional measures.

Does the Centre for Telemedicine also work with paediatricians?

Yes. If necessary, the Centre for Telemedicine will request the advice of a paediatrician.

What happens if I go directly to a specialist?

By choosing the BeneFit PLUS Telemedicine model, you agree to always call the Centre for Telemedicine for any health problems. If you need a specialist, the Centre for Telemedicine will refer you to one.

If you consult a specialist directly, without having been referred by the Centre for Telemedicine, you are breaching your obligations under the Telemedicine model. As a result, Helsana may switch you to the standard model of basic insurance. This will result in you losing the discount on your basic insurance premium associated with the Telemedicine model.

What is a course of treatment and how is it determined?

The course of treatment comprises all medical steps until your complete recovery.

The appropriate and binding course of treatment is defined by you and the healthcare professional or doctor at the Centre for Telemedicine.

What do I have to do if the treating physician refers me to another physician (e.g. a specialist)?

You should inform the Centre for Telemedicine so that it is always aware of the current status of your treatment.

Will I be charged for calling the Centre for Telemedicine?

Calls to the Centre for Telemedicine are generally free of charge. Depending on your phone plan, however, there may be some connection charges.

When does the co-payment (annual deductible/excess) apply?

Only when you receive a face-to-face consultation following a referral from the healthcare professional or doctor at the Centre for Telemedicine.

What do I do if I have a chronic illness?

When suffering from a chronic illness, your first point of contact should still be a healthcare professional or doctor at the Centre for Telemedicine. They will discuss the next steps with you. Extended periods with no contact or a long-term referral for one year can also be agreed.

Do I need to contact the Centre for Telemedicine for vaccinations as well?

Yes. Please first contact the telemedicine service for vaccinations too.

Who can take out the Telemedicine model?

Everyone who lives in Switzerland (official place of residence).

Can I switch from standard basic insurance to the Telemedicine model?

If you have taken out the mandatory BASIS standard variant 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 switch your current insurance.

How and when can I terminate this health 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 overdue premiums. There is a one-month notice period from notification of the premium for the following year.

Details about termination >

What deductibles are available?

Adults age 19 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 CHF 500 deductible for them, you can save on their premium too.

Details about the annual deductible >

Still not sure which deductible makes the most sense in your case? Our advisor will be happy to help you. Call us on 0844 80 81 82.

How and when can I change my deductible?

You can increase or decrease your deductible on 1 January of the following year.

We must receive your notification regarding the change in deductible by no later than 31 December.

Change deductible >

Do I receive a premium reduction?

Those whose income and assets justify financial support are entitled to a premium reduction (PR). The premium reduction varies from canton to canton and often does not take effect until the policyholder has asked about it. So it is worth asking the competent office of the canton in which you live whether you are entitled to financial support for your health insurance.

Details about the premium reduction >

Is there a discount? How can I save on premiums?

There are several ways of saving on your premium for basic insurance.

Tips for saving on basic insurance premiums >

Why do I need basic insurance?

Under the Swiss Health Insurance Act (KVG), healthcare insurance is compulsory for anyone living in Switzerland. It provides basic medical care in the event of illness, accidents and maternity, and is therefore known as basic health insurance.

The scope of benefits it covers is regulated by law. This means you receive exactly the same benefits from every health insurer in Switzerland.

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