Outpatient treatment

COMPLETA supplementary healthcare insurance

COMPLETA supplementary insurance combines the advantages of TOP and SANA. However, many of the benefits – e.g. for glasses and contact lenses, medical aids or prevention measures – are even more generous. In addition, COMPLETA covers the costs of treatment received abroad or provided by doctors not under contract, i.e. those whose services are not paid for by basic insurance.

  1. What benefits are covered?
  2. For whom is this insurance recommended?
  3. Good to know
  4. How you can save premiums
  5. Why do I need supplementary healthcare insurance?

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What benefits are covered?

Complementary (alternative medicine)
75% of the costs (outpatient), 100% up to CHF 5000.- (inpatient)

For longer-term treatments, we will examine the medical necessity and request a report from your doctor or therapist.

Outpatient treatment

You receive 75% of the costs of complementary medicines and therapies, such as osteopathy, kinesiology, acupuncture massage and Bach flower therapy, provided there is an established medical necessity.

Inpatient treatment

You receive 100% of the costs of complementary medicines and therapies, provided there is an established medical necessity, up to CHF 5,000 per calendar year.

Conditions:

  • Your doctor, naturopath or complementary therapist is recognised by us.
  • The therapy method is recognised by us and to find on the list "Recognised special forms of treatment" or "Recognised therapeutic methods in complementary medicine".
  • The medicine is provided or prescribed by a doctor or by a naturopath recognised by us and are approved by the Swiss Agency for Therapeutic Products Swissmedic for the treatment of the existing illness. (Medications on the list of pharmaceutical products with a special application (LPPV) are excluded).
  • The inpatient treatment is prescribed by a doctor and is performed in a medical institution or convalescent facility recognised by us.
Doctors not under contract
90%

A non-panel doctor or a doctor who is not under contract is deemed to be a doctor who has refused to provide treatment under the terms of the Health Insurance Act (KVG). For this reason, the costs of treatment provided by these doctors are not covered by basic insurance.

You receive 90% of the costs of outpatient treatment carried out by a non-panel doctor (doctor who is not under contract). Psychotherapy is excluded.

Medicines
90% medications conventional, 75% medications complementary

You receive 90% of the costs of medically prescribed conventional and 75% of the costs of medically prescribed complementary medications that are not covered by basic insurance ("non-reimbursed medications").

This is subject to the condition that the medication is approved by the Swiss Agency for Therapeutic Products Swissmedic for the treatment of the existing illness.

Medications on the list of pharmaceutical products with special application (LPPV) are excluded.

Aids to vision (spectacle lenses and contact lenses)
90% up to CHF 300 per year.

You get 90% of the costs of spectacle lenses and contact lenses up to CHF 300 per calendar year.

Abroad
100% of excess costs

Emergency treatment abroad (outpatient)

You can reach the emergency call centre 24 hours a day on +41 43 340 16 11. They will coordinate medical care locally and take care of all the necessary formalities.

For outpatient emergency treatment during a temporary stay abroad of up to 12 months you will receive 100% of the costs that exceed the cover provided by basic insurance.

Conditions:

  • A journey home or transportation to Switzerland is not reasonable.
  • You arrange for our emergency call centre to handle the organisation at every stage.

Emergency treatment abroad (inpatient)

You can reach the emergency call centre 24 hours a day on +41 43 340 16 11. They will coordinate medical care locally and take care of all the necessary formalities.

For inpatient emergency treatment during a temporary stay abroad of up to 12 months you will receive all of the costs in a general ward that exceed the cover provided by basic insurance.

Conditions:

  • A journey home or transportation to Switzerland is not reasonable.
  • You arrange for our emergency call centre to handle the organisation at every stage.

Planned treatment abroad (outpatient)

The Swiss Health Insurance Act applies as the basis for cost reimbursement.

Please contact our customer service team abroad on 058 340 13 55 to obtain a confirmation of cost reimbursement.

You will receive 90% of costs for planned outpatient treatment abroad, up to CHF 1,000 per calendar year.

Alternative medicine and dental treatments are excluded.

Transport and rescue abroad (personal assistance)
100%

Transport abroad

You can reach the emergency call centre 24 hours a day on +41 43 340 16 11. They will coordinate medical care at the location and take care of all the necessary formalities.

You receive the costs overall for transportation to the nearest suitable hospital.

Conditions:

  • You have to organise the necessary through the emergency call centre.

Rescue abroad

For rescue abroad it is necessary to organise the necessary through the emergency call centre. You can reach the emergency call centre 24 hours a day on +41 43 340 16 11. They will coordinate medical care at the location and take care of all the necessary formalities.

For rescue abroad you receive the costs for transportation abroad to the nearest suitable hospital.

Search and rescue

You can reach the emergency call centre 24 hours a day on +41 43 340 16 11. They will coordinate medical care at the location and take care of all the necessary formalities.

You receive up to CHF 20,000 in any one calendar year for search and recovery operations undertaken for the purpose of rescuing or recovering you.

Conditions:

  • You allow our emergency call centre to handle the organisation at every stage.

Repatriation

Your health is our top priority – including if you become ill or suffer an accident abroad. Our emergency call centre is available around the clock on +41 43 340 16 11.

They will coordinate medical care at the location and take care of all the necessary formalities.

You receive all of the costs of repatriation to your place of residence or to a hospital in Switzerland.

Conditions:

  • You allow our emergency call centre to handle the organisation at every stage.
  • A doctor authorised by us confirms that your repatriation is a necessity.

Travel for visitors

You can reach the emergency call centre 24 hours a day on +41 43 340 16 11. They will coordinate medical care at the location and take care of all the necessary formalities.

If you have to spend more than seven days in a foreign hospital, our emergency call centre will organise and pay for round-trip travel for a close friend or relative (proven costs, up to a maximum of the price of one economy flight). You will also receive the proven costs of up to CHF 200 per day and CHF 1,000 per event for your visitor's room and board.

Conditions:

  • You allow our emergency call centre to organise every stage of the visit.

Return journeys

You can reach the emergency call centre 24 hours a day on +41 43 340 16 11. They will coordinate medical care at the location and take care of all the necessary formalities.

If you are prevented by hospitalisation from boarding your return flight, you will receive the flight re-scheduling fees for your return flight. If you cannot be booked onto another flight, you will receive the fees for a return flight in economy class.

Conditions:

  • You allow our emergency call centre to handle the organisation at every stage.
  • You submit your expired return flight ticket.

Transport and rescue in Switzerland
CHF 100'000.–

Transport at home

In addition to the transportation benefits provided by the basic insurance, you receive CHF 100,000 per calendar year for transportation that is required on medical grounds within Switzerland.

The total amount is payable to cover all rescue, recovery, relocation and emergency transportation services.

Health promotion
75% up to CHF 200

Fitness offers

Choose a course and a provider that is recognised by us.

The total amount for all four areas is CHF 500.--per calendar year.

You will receive 75% of costs up to CHF 200.-- per calendar year for health-promoting fitness offers, such as weight and endurance training (fitness centre membership), and fitness courses (aquafitness, gymnastics etc.).

Conditions:

  • The course, the provider and the fitness centre, respectively, are recognised by us
  • Fitness center in offices of physiotherapists, hospitals, doctors and chiropractors are recognized by us

Further information

Back and body-wellness courses

Choose a course and a provider that is recognised by us.

The total amount for all four areas is CHF 500 per calendar year.

You receive 75% of costs up to CHF 200 per calendar year for selected back and body wellness courses (Alexander technique, pelvic floor training, Feldenkrais).

Conditions:

  • The course and the provider is recognised by us
  • The course is run by physiotherapists

Further information

Courses offered by Helsana and its partners

Choose a course, a programme or a seminar that is recognised by us.

The total amount for all four areas is CHF 500.-- per calendar year.

You receive 75% of the costs of various health seminars, healthy eating and weight reduction courses (e.g. Weight Watchers),eight weeks MSBR courses and fall prevention programmes etc., up to CHF 200.-- per calendar year.

Conditions:

  • The course, the programme, the seminar is recognised by us
  • MBSR courses are carried out by recognised teachers

Further information

Birth preparation

Choose a course, that is approved by us.

The total amount for all four areas is CHF 500.-- per calendar year.

You receive 75% of the costs of various courses up to CHF 500.-- per calendar year.

Conditions:

  • The course is approved by us
  • The course is provided by an accredited midwife, a provider or a physiotherapist recognised by us or the course takes place in the hospital

Note: CHF 150.-- of the costs of childbirth classes provided by midwives are covered by basic insurance.

Further information

Pregnancy exercise

The sum of CHF 500 is to be used in its entirety for health-related measures in connection with the pregnancy, such as birth preparation courses and antenatal and postnatal gymnastics.

You receive 75% of the costs of pregnancy exercise up to CHF 500 per calendar year.

Conditions:

  • The course is recognised by us.
  • The course is carried out by a recognised midwife, by a recognised course instructor or in a hospital.

Further information

Recovery gymnastics

Les 500 francs sont valables globalement pour les quatre domaines de la promotion de la santé:

  • Ecole du dos et du corps
  • Offres de fitness
  • Cours d’Helsana ou de partenaires de coopération
  • Grossesse, p. ex. cours de préparation à l'accouchement, gymnastique prénatale et postnatale

You receive 75% of the costs of post-natal recovery gymnastics up to CHF 500 per calendar year.

Conditions:

  • The programme is recognised by us.
  • The programme is run by a course leader recognised by us.

Further information

Treatment of tooth misalignment
75% up to CHF 10'000.–

Teeth are misaligned if they do not fit ideally into the dental arch; this has a negative cosmetic impact. Braces can be used to correct such misalignments.

If you undergo this treatment abroad, you can claim the actual costs up to the amount which the treatment would have cost in Switzerland. Treatment in Switzerland is subject to the scale of fees published by the Swiss Association of Dentists (SSO)

Until you reach the age of 20, you receive 75% of the costs up to CHF 10,000 per calendar year for the treatment of misaligned teeth (e.g. dental braces).

Our contribution will be reduced by any contribution to costs that you have received from school or youth dental care programmes in Switzerland.

You are not entitled to any contribution for dental products such as toothbrushes, toothpaste or dental floss.

Prevention (preventive medical care)
90% up to CHF 750

Check-ups

You receive 90% of the costs, up to CHF 750 per calendar year, for preventive measures such as vaccinations, cardiovascular checks, ultrasound examinations, examinations for the early detection of cancer, stopping smoking, etc.

Conditions:

  • The procedure is recognised by us.
  • The procedure is performed or prescribed by a doctor.

Further information

Special forms of treatment
75% up to CHF 4,500

Psychotherapy

CHF 4,500 is the total amount payable to cover all special forms of treatment.

You can claim 75% of the costs up to CHF 4,500 per calendar year for special forms of treatment. Non-medical psychotherapy belongs to this group.

Conditions:

  • The therapy is prescribed by a doctor.
  • The therapy is carried out by a psychotherapist recognised by us.

Further information

Sterilisation

CHF 4,500 is the total amount payable to cover all special forms of treatment.

You can claim 75% of the costs up to CHF 4,500 per calendar year for special forms of treatment. Sterilisation is one of them.

Further information

Vasectomy

The CHF 4,500 limit applies to all special forms of treatment.

You receive 75% of the costs up to CHF 4,500 per calendar year for special forms of treatment. Vasectomy is one of them.

Further information

Foot care

75% of the costs for medical foot care, podology, shall be covered (for a flat-rate attendance fee of no more than CHF 110).

Conditions:

  • Treatment is provided by an accredited chiropodist who is a member of a chiropodists' association and is additionally qualified to treat diabetics.
  • Treatment has been prescribed by a doctor.
  • The precise diagnosis is stated in the prescription.

If you do not have diabetes and need foot treatments, please ask us in advance whether and under what conditions you would receive a contribution to help cover the costs from your supplementary insurance policies.

Medical aids and equipment
90% up to CHF 1,500 / Fixed amount

You receive 90% of the costs of medically prescribed aids and equipment that improve restricted body functions, such as blood pressure monitors and orthopaedic shoe inserts, up to CHF 1,500 per year.

This is on condition that the aids and equipment are recognised by us.

For reusable aids, you receive costs up to the fixed amount. You can find these in the list of reusable aids and equipment.

Healthcare and foreign legal expenses insurance
Up to CHF 250,000 per case

Legal protection in health matters

  • Legal advice and representation for legal disputes.
  • You can claim up to CHF 250,000 per dispute (or CHF 50,000 in cases outside Europe) to cover lawyers' fees, court and procedural expenses, expert witnesses, court fees and compensation for the other party.
  • This policy covers disputes with doctors, hospitals and providers of social insurance and private liability insurance.

Legal Protection Abroad

  • Legal advice and representation for legal disputes.
  • You can claim up to CHF 250,000 per dispute (or CHF 50,000 in cases outside Europe) to cover lawyers' fees, court and procedural expenses, expert witnesses, court fees and compensation for the other party.
  • The policy covers disputes in your capacity as the driver, hirer or user of transportation or as a pedestrian during holidays and while attending foreign schools (including transport to and from the school).

Travelcheck
Inclusive

You benefit from free telephone travel advice from Travelcheck. This service provides you with 24-hour individual information about health risks in the country you are visiting: +41 43 340 16 22.


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For whom is this insurance recommended?

  • People who are particularly keen on minimising risks and wish to have comprehensive cover.
  • People who go abroad frequently.
  • People who wish to use complementary medicine alongside conventional medicine.

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Good to know

Who can take out this policy?

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

  • Your official place of residence is in Switzerland.
  • You are under the age of 65 when you take out the policy.
  • We accept your application. For the purposes of risk assessment, we require you to complete a health declaration.
How long does the policy run?

You can also take out a multi-year policy for three or five years. That way, you benefit from a premium discount, and different notice periods apply.

  • The minimum term is one year.
  • The contract is automatically renewed each year on the expiry date for a further year.
  • You can terminate the policy as of 31 December each year. There is a notice period of three months.
  • If the premium is adjusted, a shortened notice period of one month applies.
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 from which you can claim benefits.

With this insurance, a waiting period of 365 days applies to maternity claims. That means you cannot claim these benefits before the end of the first insurance year.

You are, however, covered from the start of insurance for benefits paid as a result of illness or accident.


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How you can save premiums

Multi-year policies
Minimum 3% discount

The longer the term of the contract you select, the more discount you receive:

Term of the contract Saving
Five years, 3 months notice period (standard) 5% discount
Three years, 3 months notice period (standard) 3% discount
One year, 3 months notice period (standard) No discount

Please note that it is not possible to have contracts with different terms, so you have to take out all supplementary insurance policies over the same term.

Accident cover excluded
10 % discount

The accident cover in our supplementary insurance complements certain benefits that are not covered, or are only insufficiently covered, by your employer's compulsory accident insurance (or compulsory basic insurance if you are employed by an employer for fewer than eight hours a week).

That means you can exclude the accident cover from voluntary supplementary insurance if you have equivalent private accident insurance or are well covered by your employer's accident insurance – for example, for a private or semi-private ward instead of the compulsory general ward in the hospital. This reduces the premium for your supplementary insurance by 10%.

If you are not sure which benefits your accident insurance covers, please contact your employer to ask before excluding accident cover from your supplementary insurance.

Family discount
Minimum 5 % discount

Currently, you get the following family discounts on supplementary insurance from the Helsana Group:

  • 5% discount if there are two people in the same household
  • 10% discount if there are three or more people in the same household

Details on family discount


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Why do I need supplementary healthcare insurance?

Many medical benefits are not, or only partially covered by basic insurance, even though they are a real need for many people. That's why it's often a good idea to take out one or more supplementary insurances for outpatient treatment – they're also known as supplementary healthcare policies. These not only cover the cost of conventional outpatient treatment, but also pay contributions towards the cost of fitness courses and gym memberships, cover abroad, medication, dental treatment and much more.

In short, by taking out supplementary insurance you can expand the benefits you receive under basic insurance for outpatient treatment as you see fit and can fill in important gaps in cover.


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