Customer magazine

Health insurance: fact and fiction

You often hear them bandied about when people get together or in the tram, you can read about them in the paper, they also roll glibly off the tongue: health insurance myths. We have picked out the six most common examples and shed some truth on them.

Myth 1

“Health insurers are just payment offices: take the premiums, pay the bills.”

Mythos 1 Helsana is strongly committed to keeping premiums affordable over the long term, with high quality and access for all at cheap prices. Besides invoice control, the company is involved in fraud control, purchasing services at preferential conditions and providing advice and support in the event of an accident or illness. Our political efforts to achieve a liberal healthcare system and academic commitment to increased transparency in the healthcare system to the benefit of the insured contradict the payment office myth.

Myth 2

“Health insurers only look after healthy people because they don’t cost anything.”

Mythos 2 Helsana is committed to its policyholders regardless of their state of health and supports optimal care for everyone. We offer many programmes in support of healthcare and improving well-being. That also includes our engagements in health promotion, prevention of falls and case management, which means accompanying insured persons back to work following an extended absence due to illness or accident.

Myth 3

“We all pay the same premiums under compulsory health insurance.”

Mythos 3 The benefits covered by basic insurance are provided by law; the premiums must cover the costs of the individual insurers in the premium regions. Different costs per insurer and region thus yield different premiums. The needs of the insured parties also cause premiums to vary: for example, if an insured person receives a premium discount due to selecting a higher deductible or if they forego their unrestricted choice of doctor in favour of a more efficient integrated model.

Myth 4

“Health insurers make so much profit that they can even build up reserves.”

Mythos 4 Health insurers are not allowed to profit from basic insurance. The law obliges them to build up reserves to cover unforeseen costs, such as an unexpectedly high number of serious and expensive events, epidemics or cross-border pandemics. The reserves enable them to avoid going into debt. Any surpluses remain in the basic insurance, thus contributing to stable premiums.

Myth 5

“Health insurers waste premium income on advertising.”

Mythos 5 Advertising is part of a competitive healthcare system. Competition forces insurers to work in the interests of the customer and offer the best possible benefits in return for attractive premiums. The money spent on advertising and business development amounts to less than 1 percent of basic insurance premiums.

Myth 6

“Health insurers’ administrative costs are too high.”

Mythos 6 Administration only accounts for about 5 percent of health insurers’ total costs. There is no other social insurance in Switzerland that has such low administrative expenses. They are much higher at the unemployment insurance and the Swiss accident insurer Suva.

Texts: Guido Klaus