Understanding your statement of benefits

Explanations

Benefits and co-insurance statements include details on the refund of medical invoices. The different sections are designed to help you understand and check which amounts have been refunded, those that remain payable and why. Read our explanations below.

There are two types of refund situations:

either your insurer pays the invoices directly to your doctor, your pharmacy or the hospital, and then asks you to refund the cost-sharing amounts (deductible, co-insurance) by way of a statement of benefits;

or you pay your invoices directly, and then send them to your insurer. Your insurer will then refund the amounts that you are entitled to and send you a statement of co-insurance amounts.

If you need any further information concerning your benefits statement or any other subject,

please read our FAQ (Frequently Asked Questions)
or contact our Customer Services

^{* On the Swiss landline network: national rate / On the Swiss mobile network: according to your mobile network operator}

Some definitions

Deductible
The insured person’s contribution to costs. Through the deductible, the insured pays a portion of the costs incurred by himself. In return, he can benefit from a premium reduction.
The ordinary deductible of CHF 300/year for adults (CHF 0 for children) is the minimum amount that must be paid out of pocket by all insured members.

Amount of optional deductibles

Adults: CHF 500, CHF 1,000, CHF 1,500, CHF 2,000, CHF 2,500 per year.
Children: CHF 100, CHF 200, CHF 300, CHF 400, CHF 500, CHF 600 per year

Co-insurance

10% contribution (20% for some original drugs) towards the costs of medical care exceeding the amount of the deductible.
The law sets the maximum cost-sharing amount at CHF 700 for adults (CHF 350 for children).

Daily tax

Amount of CHF 15 per day that you must pay when staying in hospital.
The following are exempt from this contribution:
a. children up to the age of 18.
b. young adults in training (aged 19 to 25). If this is the case, please send us a certificate of study or training before your stay in hospital.
c. women hospitalised from the 13^th week of pregnancy, during childbirth and up to eight weeks after childbirth.

Recommendations

Keep the payment slip to settle your healthcare providers’ invoices.
Show your insurance card every time you visit a healthcare provider or when you buy drugs in a pharmacy. In this way, the healthcare provider or pharmacist may issue the invoice correctly.
Send us the pharmacy receipt rather than the confirmation of payment by card. We can use the barcode on the receipt to process the invoice as an electronic invoice.