Key questions about health insurance
You can find the answers to questions about premiums, ways to save money as well as products and services
Frequent questions about insurance
Co-payments are defined by the Federal Health Insurance Act. They are made up of the deductible you have chosen, the mandatory excess under the law and a hospital cost contribution.
More about deductibles, excesses and hospital cost contributions
We can put together an insurance package for you made up of supplementary insurance that is tailored to your personal needs. Do you like going on long trips, for example? Then comprehensive travel cover is important for you. Or do you surf the Internet a lot? Then Internet legal expenses cover might be a good idea for you.
If you are employed by the same employer for at least eight hours a week, you are automatically insured for the treatment costs of both occupational and non-occupational accidents through them. You can therefore exclude accident cover from your compulsory basic insurance. This will reduce your basic insurance premiums by 7%.
If you serve more than 60 days' military service, you can suspend the basic insurance for this period. You will be insured by the military directly during the service and do not have to pay any premiums for the basic insurance.
Note: The suspension only applies to basic insurance and not to any supplementary insurance.
Just send us your marching orders one month after you start your military service at the latest to enable us to suspend cover temporarily. Once your service is over, simply send us the extract from your Dienstbüchlein by way of confirmation so we can make the definitive suspension.
We will always send you the statement for your tax declaration by mid-February each year. It contains all the information you need for your taxes regarding your basic and/or supplementary insurance. If you do not receive the statement by this time, you can simply order it here.
Call centres that want to set up an appointment for a consultation about health insurance with you can find your mobile number in a variety of ways. Have you recently entered your mobile number in a sweepstakes and agreed to be contacted using this number? It is also possible that a dialling computer found your number: the software randomly calls numbers regardless of whether they have been given out. Save these numbers on your mobile under “Contacts” and block them. This ensures you will receive no more calls from these numbers.
No. The benefits covered by basic insurance are stipulated by law. All health insurance companies that provide compulsory health insurance must cover the same scope of benefits prescribed by law. And they must treat all insured persons the same.
Questions about premiums and policies
Children receive a discount on the basic insurance premium. The children’s discount ends on 1 January after their 18th birthday. This is prescribed by law and applies to all Swiss health insurers.
Young adults receive a discount on the basic insurance premium. The discount ends on 1 January after their 25th birthday. This is prescribed by law and applies to all Swiss health insurers.
Yes, as a Helsana Group customer you are able to use our online customer portal myHelsana. This means that you have the most important insurance data and documents to hand at all times, for example, benefit statements, policies or premium summaries. This does away with unnecessary paperwork.
Premiums vary based on the canton and region. In many cantons there are one to three premium regions. Your premium can therefore be higher or lower if you move to a different canton or another municipality. You can use the premium calculator to see how much your premiums will be at your new place of residence.
In 2008 the Swiss federal government placed incentive taxes on environmentally damaging substances such as heating oil, natural gas and various volatile organic compounds (VOCs) that are contained in paints, stains, cleaning products, etc. These taxes are aimed at encouraging the sparing use of such environmentally damaging substances. After deducting financial contributions for building programmes and technology funds, the income from these taxes is returned to the public and the economy. Distributions are made via health insurers. The amount refunded from environmental levies is not fixed. It is a few dozen francs per person per year and is indicated in the policy. The amount is automatically deducted from your insurance premium, divided up among the number of premium invoices that you receive each year.
No. Your individual premium is not related to your personal state of health. If your premium increases, this will happen regardless of how often you go to the doctor. Premiums mainly increase because of a general rise in costs in the healthcare sector, for example due to greater use of medications, more expensive medications, increased use of hospital benefits and more visits to the doctor.
The health insurance company charges each individual the same premium, based on place of residence, age, insurance model and deductible. Every health insurance company sets the premiums for the people it insures. To calculate these premiums, it forecasts the benefit costs that the people it insures will incur. The premiums are then checked and approved by the Federal Office of Public Health.
Questions about saving money
Alongside the minimum compulsory deductible of CHF 300 we offer the following annual deductibles for adults aged 18 and over: CHF 500, 1000, 1500, 2000 and 2500. The rule is: The higher the selected deductible, the lower your premium.
Consider this: if you draw medical benefits under your basic insurance, you will continue to pay these yourself until you reach the amount of the deductible you have selected. We contribute to any further costs after this point. You will therefore only save if your invoices for doctor's visits, hospital treatments and medications are significantly less within a calendar year than the amount of the deductible you chose – i.e. if you are in good health.
Legally under compulsory health insurance there is no mandatory deductible for children under 18. However, so that you also receive a discount on basic insurance for your children, we offer you an optional deductible of CHF 500 per calendar year.
Yes. With the telemedicine or GP model, you benefit from an attractive premium discount. Find out what this will be directly via our premium calculator.
That depends on how much you earn and in which canton you live.
Questions about our products and services
Yes. Alongside civil and legal expenses insurance Helsana Advocare EXTRA offers Internet legal expenses cover. We cover you for up to CHF 1 million per legal case for legal fees, court and trial costs, expert opinions, mediation and court-awarded costs and security guarantees. The insurance covers contractual disputes (e.g. in the case of purchase contracts concluded via the Internet), disputes as a victim of credit card misuse, phishing and hacking (misuse of your account data), disputes in connection with cyberbullying, threats, extortion or blackmail, disputes relating to the infringement of copyright, name and trademark rights (e.g. unauthorised use of a photo).
Yes. PRIMEO supplementary health insurance is private coverage for hospital treatment after which you return home on the same day. This means that you are free to select the doctor (e.g., head surgeon) and benefit from special comfort benefits in our partner clinics and further supplementary benefits.
That depends on where you travel to. If you are travelling within the EU or in an EFTA country, all you need do is show your European health insurance card to receive emergency treatment from a doctor or in a hospital. Approval of the costs by us is generally not required. In other words, you will then be entitled to the same medical benefits in accordance with the law of the country you are in that you would have received if you were insured there. Basic insurance does not necessarily cover the full costs if you are travelling outside EU or EFTA countries. However, you can cover any gaps in your insurance through our supplementary insurance.
No. Your doctor decides which system he wants to use to settle the invoice (direct payment or refund). Basically, the patient owes the service provider, i.e. the doctor, hospital or a therapist. If, on the other hand, we have contractually agreed to pay a service provider directly, they will send the invoice to us, and we will transfer the amount directly to them.
Basic insurance does not cover everything that the doctor prescribes. From basic insurance we may only reimburse that which is mentioned in the law and the regulations relating to compulsory health insurance. We are therefore only permitted to refund the costs for many prescribed medical aids/items and medication from the supplementary insurance.
The purpose of prenatal registration is to enable you to insure your newborn baby optimally from the very first moment easily and without a risk assessment. Prenatal registration means that even children who come into the world with complications have comprehensive insurance cover. If, on the other hand, you register your baby after it is born, a risk assessment will first have to be made for any supplementary insurance. There is a risk that your baby may no longer be accepted for supplementary insurance for a pre-existing condition. So, to be safe, you should take out insurance for your baby before it’s born.
In this situation, you should always contact Telmed. You will be able to contact a medical professional here at any time of the day or night. A doctor will call you back if necessary. This way you can decide on all further binding treatment together. It is important that you always notify Telmed first of all follow-up dates and further transfers. You do not need to notify Telmed of the following:
- Gynaecological check-ups
- Obstetric care
- Dental treatment
- Follow-up adjustments by ophthalmologists in relation to glasses and contact lenses
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