Outpatient treatment

PRIMEO supplementary healthcare insurance

Thanks to the technical progress being made in medical treatment, more and more operations are being performed on an outpatient basis. It's with that in mind that the Helsana Group is the first Swiss health insurance provider to offer innovative supplementary cover which provides you with optimum benefits for outpatient treatment: PRIMEO gives you a free choice of doctor, a great deal of comfort and privacy, as well as attractive additional benefits such as check-ups, high-quality implants, innovative diagnostics and treatment, etc.

  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 cover for outpatient procedures?

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What benefits are covered?

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.
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.
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.
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.
Check-ups
75% 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.
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.

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.
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.
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.
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.).


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For whom is this insurance recommended?

  • People who prefer to choose their own doctor and expect greater comfort when they require outpatient procedures.
  • People of all ages who attach great importance to innovative solutions and sensible supplementary benefits, even in the case of minor outpatient treatment.

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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 fill in 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

PRIMEO combination discount
20 % or 30 % discount

If you combine PRIMEO with a supplementary hospital insurance for inpatient hospital stays in semi-private wards (two-bed rooms) or private wards (single rooms), you get the following discount on the monthly PRIMEO premium:

  • 20% discount in combination with HOSPITAL PLUS, HOSPITAL PLUS BONUS or HOSPITAL PLUS CLASSICA.
  • 30% discount in combination with HOSPITAL COMFORT, HOSPITAL COMFORT BONUS or HOSPITAL COMFORT CLASSICA.

Details on combination discount


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Why do I need supplementary cover for outpatient procedures?

What does «outpatient» mean? Outpatient procedures are any form of treatment for which hospitalisation is not medically necessary, so the patient can return home on the same day.

Thanks to the latest advances in medicine, more and more operations – e.g. on bunions or hernias, tonsillectomy, tendinitis, tennis elbow or knee arthroscopy – are being performed on an outpatient basis. As a result, the patient can return home on the same day and get back to work more quickly.

However, basic insurance only covers the statutory mandatory benefits. This is because the supplementary benefits which are included in any hospital cover which you may have (e.g. for semi-private or private wards, free choice of doctor etc.) do not apply to outpatient treatment, only to inpatient treatment, i.e. if you have to spend a few days in hospital.


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