Outpatient treatment

OMNIA Supplementary Healthcare and Hospital Insurance

OMNIA is the policy which takes account of your future needs. It combines the key supplementary outpatient and inpatient benefits at a fair price and ensures acceptance for a higher level of insurance at a later date. That means you enjoy solid all-round cover right now, and, if your insurance requirements change over time, you can extend your cover every five years without undergoing another medical examination.

  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 and hospital cover?

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What benefits are covered?

Medicines
90%

You receive 90% of the costs of medically prescribed 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) or its supplementary list are excluded.

Aids to vision (spectacle lenses and contact lenses)
90% up to CHF 150 per year.

You get 90% of the costs of spectacle lenses and contact lenses up to CHF 150 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.

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 you receive the overall costs for transportation 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 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.

Treatment of tooth misalignment
75% up to CHF 10'000.–
  • Teeth are misaligned if they do not fit ideally 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).
  • Upon reaching the age of 25, you are entitled to take out the dental insurance policy DENTAplus 1000 (Bronze Option) without having to undergo a medical examination.

Until you reach the age of 25, you receive 75% of the costs up to CHF 10,000 per calendar year for the treatment of misaligned teeth by means of orthodontic treatment and oral surgery (including 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.

Special forms of treatment
75% up to CHF 3,000

Psychotherapy

CHF 3,000 is the total amount payable to cover all special forms of treatment.

You can claim 75% of the costs up to CHF 3,000 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 3,000 is the total amount payable to cover all special forms of treatment.

You can claim 75% of the costs up to CHF 3,000 per calendar year for special forms of treatment. Sterilisation is one of them.

Further information

Vasectomy

CHF 3,000 is the total amount payable to cover all special forms of treatment.

You receive 75% of the costs up to CHF 3,000 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 1,000 / 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 1,000 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.
  • 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).

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.

Hospital stays in Switzerland
General – anywhere in Switzerland

Hospital stays

You receive all the costs of a stay, care and treatment in a general ward (multi-bed room).

Choice of hospital

You are free to choose the hospital you want anywhere in Switzerland.

Please note that some hospitals do not have a (recognised) general ward; in such cases, you may incur costs for which you alone will be responsible.

Further information

Hospital stays abroad
100% of excess costs

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 (inpatient)

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

You will receive up to CHF 500 a day for up to 60 days per calendar year for planned inpatient treatment abroad if you have obtained a confirmation of cost reimbursement from us in advance.

Nanny service
30 hours

You can reach the emergency call centre 24 hours a day on +41 43 340 16 11.

You receive up to 30 hours of nanny services per calendar year if you have to be admitted to hospital as an inpatient.

While you are in hospital, an experienced carer will look after your healthy children aged up to 15 years on weekdays. This will enable you to recover in hospital at your leisure, while enjoying peace of mind that your children are being lovingly looked after at home.

Conditions:

  • You as a parent need to spend time in hospital as an inpatient.
  • You took out the insurance for the hospitalised parent (not for the child).
  • You allow our emergency call centre to handle the organisation at every stage.
Intensive and transitional care
CHF 90 per day

You will receive CHF 90 per day for up to 14 days per calendar year for the costs of boarding (room and board) in a nursing home during inpatient acute and transitional care.

Conditions:

  • Acute or transitional care has been prescribed by a doctor.
  • Your acute or transitional care immediately follows a hospital stay.
Household help
CHF 30 per day

Household help

Following an acute inpatient hospital stay, you will receive CHF 30 per day for up to 30 days per calendar year for medically prescribed household help.

Balneotherapy and convalescent therapy
CHF 30 per day

Spa treatment

To find out which therapeutic spas are recognised by us, please contact your customer service team.

The duration of benefits for spa and convalescent therapies is 30 days in total.

You receive CHF 30 per day for up to 30 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 therapeutic spa recognised by us.

Convalescent therapy

To find out which therapeutic spas are recognised by us, please contact your customer service team.

The duration of benefits for spa and convalescent therapies is 30 days in total.

You receive CHF 30 per day for up to 30 days per calendar year for convalescent therapies in Switzerland.

Conditions:

  • The convalescent therapy has been prescribed by a doctor.
  • The convalescent therapy is carried out at a therapeutic spa recognised by us.


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For whom is this insurance recommended?

  • People who are looking for solid insurance cover that provides supplementary outpatient and inpatient benefits and want the security of guaranteed upgrade and extension options in the future.

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Good to know

What possibilities for development does OMNIA offer?

With OMNIA you have a guarantee that in future – regardless of the state of your health – you can enjoy a higher level of outpatient benefits and even take out semi-private or private hospital insurance. The only exception: Benefits excluded when you first took out the policy will continue to be excluded if you take out a higher level of cover later on.

Every five years (initially at the age of 25, and for the last time at the age of 55) you can decide whether you wish to make use of the upgrade option. You can exercise your right to an insurance upgrade once for outpatient cover (upgrade to COMPLETA) and once for inpatient cover (upgrade to HOSPITAL PLUS or HOSPITAL COMFORT) – either at the same time or one after the other. That means that no additional medical examination is required before the supplementary insurance in question is taken out.

Provided you have not yet taken advantage of both upgrade options, every five years you have the opportunity to extend your insurance cover with PRIMEO – this too without another medical examination.

More information on the products which can be selected

  • COMPLETA for top-quality supplementary outpatient benefits
  • PRIMEO for the selection of the doctor of your choice and greater comfort during outpatient treatment
  • HOSPITAL PLUS for greater privacy and freedom of choice in hospital accommodation (semi-private ward)
  • HOSPITAL COMFORT for maximum privacy and freedom of choice in hospital accommodation (private ward)
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 aged between 19 and 49 when you take out the insurance.
  • We accept your application. For the purposes of risk assessment, we require you to complete a health declaration.
How long does the policy run?
  • 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 in cases of pregnancy. That means you cannot claim benefits before the end of the first insurance year. During the first insurance year, any pregnancy-related stays in hospital – for example for childbirth or rooming in – are covered only by your basic insurance. The latter covers 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.
  • By contrast, you are covered from the start of insurance for benefits paid as a result of illness or accident.
Is there a waiting period for a higher level of insurance?

The waiting period for a higher level of cover under OMNIA is the period between the inception date of your policy and the day on which you exercise your entitlement to a higher level of cover for the first time without any further medical examination.

  • With this insurance, a waiting period of 12 months applies before you can claim an insurance upgrade. This means that you cannot exercise your option to upgrade your insurance until the end of the first insurance year (and only if you are at least 25 years of age).

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How you can save premiums

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 and hospital cover?

Compulsory basic insurance covers only the statutory benefits in the event of illness, accident and maternity. By taking out OMNIA, you obtain valuable supplementary benefits covering medication, glasses, medical aids and treatment abroad and offering greater comfort at hospitals and the exclusive Helsana services such as the "nanny service".


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