Basic insurance

Basic health insurance BeneFit PLUS Telemedicine

You don't have a GP or travel a lot and have an active lifestyle. If so, the basic heath insurance model BeneFit PLUS Telemedicine is the right choice for you. No matter what time of day or night or where you happen to be, you have access to medical care from the independent Centre for Telemedicine, round the clock – all without appointments or time spent in doctors' waiting rooms.

  1. What benefits are covered?
  2. For whom is this insurance recommended?
  3. Good to know
  4. How you can save premiums
  5. How the BeneFit PLUS Telemedicine model works in detail

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What benefits are covered?

You receive the following benefits less a deduction representing the reimbursed statutory cost contribution (deductible / co-payment / contribution to hospital costs) from basic insurance.

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).

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.

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.

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.

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.

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.

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.

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.

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For whom is this insurance recommended?

  • People who do not have a GP.
  • People who want access to medical care around the clock and at the same time want to benefit from lower basic insurance premiums.
  • People who want to contribute actively to stabilising steadily rising health costs and prefer to have their treatment co-ordinated by their medical contact person.

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Good to know

Who can take out this policy?

The health insurers are obliged to accept all applicants irrespective of age and personal state of health without any reservations.

You can take out this policy if you meet the following conditions:

  • You are officially resident in Switzerland.

If you have already taken out the statutory standard model BASIS with us and now want to enjoy the benefits of BeneFit PLUS, you can switch to this alternative insurance model at any time with effect from the first of the month.

Please contact us if you would like to switch your existing insurance policy.

How long does the policy run?
  • The policy runs until the end of the policyholder's life.
  • You can cancel the policy as of 31 December of any year and switch to another Swiss health insurer, provided you have no premium arrears. There is a one-month notice period.
Is there a waiting period?

The waiting period is the period between the date on which the insurance cover under your policy begins and the date on which you can claim benefits.

  • This policy does not have a waiting period, so you are eligible for benefits from as soon as it starts.

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How you can save premiums

Choice of annual deductible
Minimum 8% discount

The statutory minimum deductible for insured persons from the age of 19 upwards is CHF 300 per calendar year. However, by opting for a higher deductible, you can take on more responsibility. In return, you are given a premium discount:

Optional deductible Maximum saving*
Adults CHF 500 8% discount
CHF 1,000 20% discount
CHF 1,500 30% discount
CHF 2,000 At least 35% discount
CHF 2,500 At least 40% discount
Children CHF 500 50% discount

* Unfortunately, it is not always possible to exploit the maximum possible deductible discount. The law requires that the reduced premium may not be less than 50% of the basic premium with accident cover and statutory minimum deductible.

Details on choice of annual deductible

Accident cover excluded
7% discount

If you are employed by the same employer for at least eight hours a week, you are automatically insured against both occupational and non-occupational accidents through them. That means you can exclude this accident cover from your compulsory basic insurance policy because your employer's accident insurance covers the costs of treatment. This reduces your basic insurance premium by 7%.

Premium subsidy
Individually based on income

You can claim a premium subsidy if you have compulsory health insurance (basic insurance) with a health insurer recognised by the government and your income and assets are low enough to qualify you for financial support. The way in which this support is provided varies from canton to canton and often doesn't take effect until the policyholder has asked about it. That's why it's worth asking the competent office in the canton where you live whether you can claim financial support.

Details on premium subsidy

Supplementary benefits
Individually based on income

The supplementary benefits on top of AHV and disability insurance are monthly social insurance contributions. They are awarded when the insured person's pensions and other income and assets do not amount to the minimum required to cover the cost of living. The cantons arrange for the payment of these contributions.

Details on additional benefits on top of AHV and disability insurance


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How the BeneFit PLUS Telemedicine model works in detail

When you take out the policy you choose the independent Centre for Telemedicine as your medical contact.

Procedure in the event of illness or an accident
  1. If you experience a medical problem you always telephone the independent Centre for Telemedicine on 0800 800 090.
  2. A specialist trained in telemedicine will discuss your problem with you and assess the urgency of further treatment.
  3. A medical professional will call you back and discuss possible treatment options for your problem with you. If necessary the medical professional will refer you to a doctor, specialist or hospital for a physical consultation. If the condition requires it, the medical professional will also call you again to check on your well-being.
  4. Important: If further appointments are set up or you receive another referral, you must contact the independent Centre for telemedicine again.
You do not need to contact the independent Centre for Telemedicine in the following cases:
  • Gynaecological check-ups
  • Obstetric care
  • Dental care
  • Follow-up adjustments by ophthalmologists in relation to glasses and contact lenses
Procedure in emergencies
  1. In an emergency you can go directly to a hospital or emergency practitioner. An emergency is defined as a situation where you regard your medical condition as life-threatening or requiring immediate treatment.
  2. N.B.: After the treatment you must inform the independent Centre for telemedicine of the consultation to ensure that your medical records are brought fully up to date. This ensures that the best possible treatment is guaranteed in future as well.


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