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Supplementary insurance for outpatient treatment

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Free choice of doctor for outpatient operations: PRIMEO supplementary healthcare insurance

Ever more operations are being performed as outpatient procedures – patients leave the hospital on the same day. Nevertheless, many patients would like to have the free choice of doctor and other privileges provided by private supplementary hospital insurance. Such insurance only applies for inpatient treatments that require the patient to stay at least one night in hospital.

With PRIMEO supplementary healthcare insurance, you enjoy an unrestricted choice of doctor, maximum comfort and privacy for outpatient operations too. In addition, you also enjoy attractive extra benefits such as check-ups, high-quality implants, innovative diagnostic and treatment forms, and much more.

Ideal for everyone who would like the free choice of doctor and comfort of private hospital insurance for outpatient operations too.

Insurance benefits

With PRIMEO supplementary healthcare insurance, you receive the following insurance benefits in addition to the statutory basic insurance benefits:

Choice of doctor Free choice of doctor at recognised institutions

If you have selected an alternative insurance model, please note the following:

  • BeneFit PLUS Family Doctor option: Please contact your family doctor or group practice first.
  • BeneFit PLUS Telemedicine option: Please contact the Centre for Telemedicine first.
  • PREMED-24: Please contact the medical advice service first.

You have an unrestricted choice of doctor in the hospital for outpatient procedures or operations (e.g. eye cataract, bunion, tendonitis, tennis elbow, knee arthroscopy, etc.) or for an outpatient birth. For example, you can even choose to be operated on by the head physician.

Conditions:

  • The outpatient surgery is performed at an institution recognised by us.
  • The selected doctor is on the list of specialists (senior physician, head physician, professor) at the hospital in question.

Further information

What does basic insurance cover?

Costs are not covered by basic insurance. Patients must pay any additional costs for the free choice of doctor for outpatient treatment themselves.

Details about basic insurance >

Benefits for additional comfort Inclusive

Find out in advance about the procedure and other services provided by our contracting party on 0844 80 81 82.

In the case of outpatient treatment at our partner clinics, you benefit from various comfort benefits such as rapid access to a doctor with no waiting times on the day of treatment, a separate recovery area following surgery, including free access to the Internet, radio, TV and print media, as well as snacks and beverages for the patient and a designated companion, and a free parking space or taxi journey home.

Conditions:

  • The outpatient surgery is performed at an institution recognised by us.

Further information

What does basic insurance cover?

Costs are not covered by basic insurance. Patients must pay for comfort benefits during outpatient treatment themselves.

Details about basic insurance >

Options for overnight stays in the event of outpatient procedures CHF 1200.–

There are no medical reasons requiring patients undergoing outpatient procedures or surgery to spend a night in hospital. If, however, you do wish to stay overnight – because you live far away, for instance – you receive CHF 400 per course of treatment up to CHF 1,200 per calendar year to cover overnight stay costs including half board (supper and breakfast).

Conditions:

  • You spend the night at a hospital recognised by us or at a hotel designated by the hospital.
  • You spend the night there immediately before and/or after the outpatient procedure.

Further information

What does basic insurance cover?

Costs are not covered by basic insurance. Patients must pay the costs for overnight stays for outpatient treatment themselves.

Details about basic insurance >

Transport at home CHF 500.–

You receive overall CHF 500 per calendar year for transportation and travel costs for public transport services (the Swiss Federal Railways SBB, bus, tram) or private transport at home and abroad.

Conditions:

  • Transport is required to reach a medical facility for outpatient treatment that is covered by the basic insurance policy or by the PRIMEO policy and for travel costs to reach a facility for physiotherapy or radiotherapy.
What does basic insurance cover?

Costs are not covered by basic insurance. Patients must pay travel costs related to outpatient treatment themselves.

Details about basic insurance >

Check-ups up to CHF 1,700

You receive up to CHF 1,700 every three calendar years for pre-specified check-up programmes for the prevention of diseases. Various packages are available, ranging from a basic check-up for exercise/fitness, sport, nutrition and stress reduction to complementary packages with ECG and ultrasound examinations.

Conditions:

  • The check-up is part of a pre-specified package.
  • The check-up is carried out in a facility recognised by us.

Further information

What does basic insurance cover?

Costs are not covered by basic insurance. Patients must pay the costs for these predefined check-up packages themselves.

Details about basic insurance >

Medical aids and equipment Excess amount

Applies if you also receive a contribution from basic insurance.

You do not receive any contributions for excesses of other social insurance institutions such as AHV or disability insurance.

If the benefits you receive for medical aids from your basic insurance are not enough to cover the entire cost, you receive up to CHF 5,000 per year towards the uncovered part of the cost.

Further information

What does basic insurance cover?

Only the statutorily defined maximum costs for medical aids and equipment prescribed by a doctor that is included on the list of aids and equipment (MiGeL) are covered Patients must pay the costs in excess of this themselves.

Details about basic insurance >

Implants 90% up to CHF 5,000

If the benefits you receive from your basic insurance for implants fitted on an outpatient basis, such as cataract lenses, are not enough to cover the entire cost, you receive 90% of the uncovered part of the cost, up to CHF 5,000 per calendar year. Does not include dental implants.

Conditions:

  • The intervention is performed on an outpatient basis.
  • It relates to a compulsory KVG benefit, i.e. basic insurance covers part of the cost.
What does basic insurance cover?

Costs for implants that exceed the benefits covered by basic insurance must be paid by the patients themselves.

Details about basic insurance >

Innovations 90% up to CHF 5000

Find out in advance about the procedure and other services provided by our contracting party on 0844 80 81 82.

Benefits will be paid up to 90% of the amount to pay for costs up to a maximum amount of CHF 5,000 per calendar year for innovative diagnosis and treatment methods that are not yet recognised in Switzerland and are thus not (yet) covered by the basic insurance.

Conditions:

  • The diagnosis or treatment method is recognised by us.

Further information

What does basic insurance cover?

Costs are not covered by basic insurance. Patients must pay the costs for innovative diagnostic and treatment forms themselves.

Details about basic insurance >

Medical hotlines & online services Up to CHF 300.-

You receive up to CHF 300 per calendar year towards medical advice provided via a chargeable hotline or online service, such as the children's hotline at the children's hospital or the online medical consulting service offered by University Hospital Zurich.

Conditions:

  • You can show that you incurred these expenses by sending us the relevant phone bill or invoice from the online service.
  • The advice came from a service provider approved by us.

Further information

What does basic insurance cover?

Costs are not covered by basic insurance. Patients must pay the costs for medical hotlines and online services themselves.

Details about basic insurance >

Abroad On receipt of confirmation of cost reimbursement

Planned treatment abroad (outpatient)

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

Please contact your customer service team to obtain a confirmation of cost reimbursement.

You will receive the costs for the planned outpatient treatment abroad if you have obtained a confirmation of cost reimbursement from us in advance.

The same conditions and limits apply as in Switzerland (e.g. for comfort benefits, overnight stays, free choice of doctor and hospital, etc.).

What does basic insurance cover?

Costs are not covered by basic insurance. Patients must pay the costs for planned outpatient treatment abroad themselves.

Details about basic insurance >

FAQs

Answers to frequently asked questions about PRIMEO supplementary healthcare insurance:

I have supplementary hospital insurance. Do I still need supplementary cover for outpatient treatment?

Thanks to the latest advances in medicine, more and more operations – e.g. to treat bunions, hernias, tendinitis or tennis elbow, tonsillectomies, or knee arthroscopies – are performed on an outpatient basis. Patients can leave hospital the same day and return to work more quickly.

However, outpatient treatment is only covered in accordance with the statutory benefits provided under basic insurance. This is because supplementary hospital insurance only covers inpatient treatment for which the patient must remain in hospital for at least one night. For this reason, the benefits of your supplementary hospital insurance (for example, staying on a semi-private or private ward, free choice of doctor, etc.) unfortunately do not apply for outpatient operations.

So if you would like to enjoy the free choice of doctor and more comfort while in hospital when undergoing outpatient treatment too, you must either pay for these yourself or take out PRIMEO supplementary healthcare insurance cover. PRIMEO closes precisely these gaps in coverage and allows you to enjoy the benefits of semi-private or private hospital cover when receiving outpatient treatment.

Why are overnight stays covered? With outpatient operations, patients return home by the end of the day.

With outpatient treatment, it is not medically necessary for patients to stay in hospital overnight. However, in some cases patients do not want to go home until the next day – if they live far away, for example. Or if the procedure is being performed early in the morning, they may want to arrive at the hospital the evening before.

You do not have to stay in hospital. You can also stay in a hotel referred by the hospital.

Why would I want comfort benefits in hospital if I leave the same day?

Precisely because you leave hospital the same day it is important that you feel completely comfortable both before and after the procedure. With comfort benefits, your time in hospital will be as comfortable as possible, and you can return home in the evening with a good feeling:

  • No waiting time on the day of treatment
  • Private relaxation and recovery zone following the procedure
  • Free access to the Internet, radio, TV, newspapers and magazines
  • Snacks and drinks for the patient and accompanying person
  • Free parking or a taxi home
Does PRIMEO cover the costs for eye laser treatment for people suffering from short-sightedness?

No, because this procedure is not classified as a medically necessary statutory benefit under basic insurance.

Does PRIMEO cover all implants that are provided on an outpatient basis, such as breast implants?

No. PRIMEO only covers implants that are classified as a statutory benefit under basic insurance. This does not include breast implants – breast augmentation is not considered a medically necessary operation.

Does PRIMEO cover the costs to stay overnight if I need outpatient chemotherapy, dialysis or radiation treatment? Or will I only be reimbursed for outpatient operations?

Yes. You can generally request reimbursement of the costs to stay overnight for all outpatient treatment covered by PRIMEO.

Who can take out this insurance?

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

  • You have your official place of residence 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 fill in a health declaration.
How and when can I terminate the insurance?
  • 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 on 31 December of each year, subject to three months' notice.
  • If the premium is adjusted, a shortened notice period of one month applies.

Details about termination >

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

Details about long-term policies >

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.

  • For maternity benefits, there is a waiting period of 365 days. That means you cannot claim these benefits before the end of the first insurance year.
  • However, you are covered from the start of insurance for benefits paid as a result of illness or accident.
Is there a discount? How can I save on premiums?

If you combine PRIMEO with supplementary hospital insurance for inpatient hospital stays in a semi-private (two-bed room) or private ward (one-bed room), you will receive the following discount on your monthly PRIMEO premium:

  • 20% discount when combined with HOSPITAL PLUS, HOSPITAL PLUS BONUS or HOSPITAL PLUS CLASSICA.
  • 30% discount when combined with HOSPITAL COMFORT, HOSPITAL COMFORT BONUS or HOSPITAL COMFORT CLASSICA.

Details about combination discount >

If you conclude a three or five-year insurance policy, you receive a premium discount of 3% or 5% respectively.

Details about long-term policies >

If you have equivalent accident insurance, you can exclude the accident cover and thus reduce your premium by 10%.

Details about accident cover exclusion >

For two or more family members insured under the same contract we grant a family discount of 5% on this and other supplementary insurance; for three or more insured family members the discount is 10%.

Details about the family discount >

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