BeneFit PLUS General Practitioner

If you experience health problems, your first port of call is always your GP or HMO group practice. You benefit from the optimal coordination of your treatment and can save on your premiums.

  • Access to a quality-tested GP
  • Additional medical advice through Medi24 (0800 100 008) – at the weekend, for instance
  • Attractive premium discount
Find your GP or HMO group practice

The list of doctors includes all doctors and group practices (HMOs) that are part of the BeneFit PLUS General Practitioner insurance model.

How BeneFit PLUS General Practitioner works

Whether treatment, referral to a specialist or admission to hospital, your GP or HMO group practice is your first port of call.

  • Illness or accident
  • GP or HMO group practice
  • Further treatment

Emergency: in an emergency, always go directly to an emergency doctor or a hospital.

  • Emergency
  • Emergency doctor or hospital
  • GP or HMO group practice

Please note: You must subsequently notify your general practitioner of any such emergencies so that he/she is kept informed of the situation and can discuss any further check-ups with you.

Your exclusive benefits with Helsana

  • Everything to hand at all times with the myHelsana app
  • Quick and easy reimbursement
  • Round-the-clock medical advice with Medi24
  • Access to BetterDoc: find the specialist you need fast
  • Collect points with Helsana+ and receive up to CHF 75 per year

Insured benefits

The benefits are the same for all basic insurance models. With the General Practitioner model, we will reimburse you the following benefits after deduction of the statutory co-payment (deductible/excess/hospital cost contribution).

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

In an emergency, you will receive the respective social tariff schedule in the EU/EFTA country. In all other countries, we will cover a maximum of twice the amount insured in Switzerland. 

You receive 50% of the costs for transport, up to CHF 500 per calendar year. We will reimburse 50% of the costs for rescue operations, up to CHF 5,000 per calendar year.

You receive the costs of medically prescribed medication on the specialities list.

If several pharmaceuticals are listed with the same combination of active ingredients, the excess can amount to 40%.

Specialities list (SL)

You receive the costs according to the tariff of the recognised specialist for the whole of Switzerland.

You receive the costs according to the tariff of the recognised specialist for the whole of Switzerland.

You receive the costs for certain preventive examinations and measures.

You receive the costs of medically prescribed aids and apparatus up to the maximum amount specified by law.

You receive the costs of examinations and birth preparation measures. 

You receive contributions towards the costs for care at home (Spitex) and in a nursing home.

You receive CHF 10 per day for balneotherapy at recognised therapeutic spas in Switzerland.

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Frequently asked questions

Under the Swiss Health Insurance Act (KVG), health insurance is compulsory for anyone living in Switzerland. It provides basic medical care in the event of illness, accidents and maternity. 

 

The scope of benefits it covers is regulated by law. This means you receive exactly the same benefits from every health insurer in Switzerland.

With the general practitioner model, your general practitioner or group practice is always the first port of call – regardless of the medical concern. It also coordinates your treatment path going forward and ensures that no time-consuming unnecessary duplicate examinations take place. Additionally, you can consult our medical advice hotline Medi24 free of charge at any time. On top of that, you can use the Medi24 digital services available on the myHelsana app, like the symptom checker and medical video consultation. Likewise, you can also use the BetterDoc service free of charge to find the best specialist for you.

When taking out the General Practitioner model, you have to select a doctor or HMO group practice from our list of doctors as your main contact. If your current GP is on our list of doctors, you can continue to be treated by them.

When you opt for the BeneFit PLUS General Practitioner model, you agree to always go to your selected GP or HMO group practice first in the event of a health problem. If you require a specialist, the referral is made by your GP or HMO group practice. Prior to treatment, you can use the BetterDoc service to look for a suitable specialist yourself and suggest these to your general practitioner for referral. BetterDoc can also help in the event of any doubts regarding ongoing treatment, e.g. prior to any treatment.

 

If you consult a specialist directly, without having been referred, you are breaching your obligations under the General Practitioner model. As a result, Helsana may switch you to the standard model of basic insurance. This means you not only lose your insurance under the General Practitioner model but also your discount on the basic insurance premium.

When suffering from a chronic illness, your first point of contact should still be your GP. They will determine your individual course of treatment. If necessary, they will refer you to a specialist.

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Other models under basic insurance

Helsana offers basic insurance as a standard version as well as four alternative models. The benefits are the same for all models.

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