With a comprehensive range of products and services in

Overview
Benefits
available
to you
With a comprehensive range of products and services in the areas
of basic, supplementary and accident insurance, Helsana is committed to the lives of each and every one of its members. Whether
it's for illness, an accident, maternity or long-term care in old age,
with us you can put together exactly the right cover to fit your individual needs and wishes.
Compulsory healthcare insurance (OKP)
BASIS
Basic insurance
Outpatient treatment
Complementary medicine
Health promotion
Prevention
Treatment (prescribed by a doctor) provided by Federally certified doctors, chiropractors and medical support staff (speech therapists, nurses, physiotherapists,
etc.).
Benefits for complementary medical treatments by trained and legally recognised
doctors or by naturopaths and therapists recognised by the Helsana Group.
Benefits for gym memberships, fitness courses, back and full-body courses, prenatal care, pregnancy/postnatal exercise classes, relaxation and nutrition courses,
etc.
Costs covered for specific examinations for the early detection of illnesses and for
preventive measures (e.g. benefits for vaccinations). Carried out or prescribed by a
doctor.
At home or at work, according to agreed rates
Acupuncture, anthroposophic medicine, pharmacotherapy with traditional Chinese medicine (TCM), medical traditional homoeopathy and phytotherapy, carried out by doctors with
recognised training pursuant to the Health Care Benefits Ordinance (KLV).
At home or at work
Implants
Hotline
Medication
Medical hotline, online services
Medication covered by statutory health insurance
As per List of Pharmaceutical Specialties
Medication not covered by statutory health insurance (excluding medications on
the List of Pharmaceutical Products with Special Application (LPPV)
Glasses/contact lenses
Dental treatment
Maximum of CHF 180 per year up to 18th birthday
Accident-related tooth damage
At home or at work
Serious diseases of the masticatory system
At home or at work
Serious general illnesses
At home or at work
Correction of misaligned teeth up to the age of 20 (e.g. orthodontic treatment and
oral surgery)
Special forms of treatment
Non-medical psychotherapy by recognised psychotherapists, sterilisation,
vasectomy, etc.
Aids
Medically necessary and prescribed by a doctor
In accordance with prescription for aids and equipment
Transportation
Medically required transport by ambulance, plane
50% up to a maximum of CHF 500 per year
Rescue
In Switzerland: 50% up to a maximum of CHF 5,000 per year (excluding search and recovery
costs)
Various e.g. public transport or taxi
Personal assistance
Rescue, transportation, repatriation
Search
International
Outpatient and inpatient treatment in the event of acute illness requiring
emergency treatment during a temporary stay abroad
Within EU/EFTA: benefits in accordance with the social tariff schedule of the country of
temporary residence (show European Health Insurance Card)
Outside EU/EFTA: up to a maximum of twice the amount under tariff for Switzerland (place
of residence)
Inpatient treatment for acute illness requiring emergency treatment
Within EU/EFTA: benefits in accordance with the social tariff schedule of the country of
temporary residence (show European Health Insurance Card)
Outside EU/EFTA: up to a maximum of twice the amount under tariff for Switzerland (place
of residence)
Foreign legal expenses insurance
Legal expenses cover in health Comprehensive legal expenses cover for disputes with doctors, hospitals and
providers of social insurance and private liability insurance
matters
Maternity
Check-ups (7 before the birth, 1 after)
Hospital (Switzerland)
8 check-ups, 2 ultrasound examinations
Breastfeeding guidance (by midwives or specially trained nurses)
3 sessions
Birth preparation (courses given by midwives)
CHF 150
Inpatient treatment
See Hospital stays (in Switzerland)
Outpatient treatment
Benefits as with illness
Treatment in a recognised acute-care clinic on the cantonal list of hospitals
Full cover for the general ward of a listed hospital anywhere in Switzerland, up to the tariff
in the canton of residence
Treatment in one of the Helsana Group's KVG contract hospitals
Full cover for the general ward of a Helsana KVG contract hospital
Stay (room comfort)
Multi-bed room
Stay in higher class ward than covered by other insurance
Fast Track/Expert Second
Opinion
Acute and transitional care
Spa treatment
Quick initial consultation with a specialist (Fast Track) as well as an expert second
opinion from a renowned professor
Benefits covering food and accommodation in the event of acute and transitional
inpatient care (healthcare benefits fully covered)
Medically required and prescribed by an approved doctor. In recognised spas
Convalescent therapy
Medically required and prescribed by an approved doctor, at recognised
convalescent facilities in Switzerland
Household help
Home nursing care (Spitex)
With a medical prescription and complete incapacity to work after an acute
inpatient hospital stay
Medically prescribed nursing care given at home by recognised service providers
KidsCare
Care and nursing for sick children (insured person: child)
Nanny service
Care of healthy children when one parent is in hospital (insured person: parent)
Rooming-in
Contribution to the cost of accommodation/food in hospital for closely related
persons.
Nursing home
Nursing care in a recognised nursing home
Medical treatments and therapies in accordance with the tariff in the place of treatment
and CHF 10 per day, for a maximum of 21 days per year
At place of residence
At place of residence
Supplementary health care insurance
TOP
The standard supplement to BASIS with top
marks from VZ VermögensZentrum
SANA
The natural health insurance with top marks
from VZ VermögensZentrum
Outpatient treatment: 75% of the costs not covered by basic insurance; inpatient treatment: max.
CHF 5,000 per year
75%, max. CHF 500 per year, max. CHF 200 per
area. For methods and providers recognised by the
Helsana Group.
75%, up to a maximum of CHF 500 per year as per
Helsana Group list
COMPLETA
Comprehensive health insurance
PRIMEO
Supplementary outpatient benefits, exclusive
and available only from Helsana!
By doctors not under contract (excluding psychotherapy): 90%
Choice of specialists in Helsana partner hospitals
Outpatient treatment: 75% of the costs not covered by basic insurance; inpatient treatment: max.
CHF 5,000 per year
75%, max. CHF 500 per year, max. CHF 200 per
area. For methods and providers recognised by the
Helsana Group.
90 %, up to a maximum of.CHF 750 per year as per
Helsana Group list
Maximum of CHF 1,700 for check-ups within
3 years as per Helsana Group list
90% to a maximum of CHF 5,000 per year. On the
share that is not covered or not fully covered by
basic insurance (excluding dental implants).
Maximum of CHF 300 per year as per Helsana
Group list
90% for medications approved by Swissmedic,
maximum 50% as per Helsana Group list
90% up to a maximum of CHF 150 per year
75% for complementary medicines
90% for medication approved by Swissmedic, 75%
for complementary medicines
90% up to a maximum of CHF 300 per year
75% of the cost, up to a maximum of CHF 10,000
per year
75% of the cost, up to a maximum of CHF 10,000
per year
75%, up to a maximum of CHF 3,000 per year as
per Helsana Group list
75%, up to a maximum of CHF 4,500 per year as
per Helsana Group list
90%, up to a maximum of CHF 1,000 per year as
per Helsana Group list
90%, up to a maximum of CHF 1,500 per year as
per Helsana Group list
Maximum CHF 100,000 per year in Switzerland
Maximum CHF 100,000 per year in Switzerland
Maximum CHF 100,000 per year in Switzerland
Maximum CHF 100,000 per year in Switzerland
90%, up to a maximum of CHF 5,000 per year for
innovative types of treatment and diagnosis as per
Helsana Group list
Maximum of CHF 5,000 per year. In accordance
with prescription for aids and equipment. Share in
excess of basic insurance
Maximum of CHF 500 per year for travel from or to
a service provider
Unlimited, abroad
Unlimited, abroad
Up to CHF 20,000 abroad
Up to CHF 20,000 abroad
Twelve months’ cover, worldwide
Within EU/EFTA: co-payments
to social insurance costs from CHF 300 upwards.
Twelve months’ cover, worldwide. Planned outpatient treatment abroad (excluding complementary
medicine): 90% up to a maximum of CHF 1,000 per
year. Within EU/EFTA: co-payments to social insurance costs from CHF 300 upwards.
Lawyer and court costs: up to CHF 250,000 per case
in Europe, CHF 50,000 per case outside Europe
Maximum CHF 250,000 per case in Europe,
maximum CHF 50,000 per case outside Europe
Lawyer and court costs: up to CHF 250,000 per case
in Europe, CHF 50,000 per case outside Europe
Maximum CHF 250,000 per case in Europe,
maximum CHF 50,000 per case outside Europe
Additional ultrasound examination (see prevention
benefits)
Additional ultrasound examination (see prevention
benefits)
For planned outpatient treatment after approval of
costs
Overnight stays and comfort benefits in the event
of outpatient treatment, maximum CHF 400 per
treatment, maximum CHF 1,200 per year
Supplementary hospital insurance
HOSPITAL ECO
General ward, anywhere in Switzerland*
HOSPITAL PLUS
HOSPITAL PLUS BONUS
Semi-private ward, anywhere in Switzerland*
HOSPITAL COMFORT
HOSPITAL COMFORT BONUS
Private ward, anywhere in Switzerland*
HOSPITAL FLEX
Free choice of ward (accommodation/meals and
medical benefits combined), anywhere in
Switzerland*
Option 1
Option 2
CHF 500 per day, for a maximum of 60 days per
year in the event of emergencies and planned
treatment abroad
CHF 1,000 per day, for a maximum of 60 days
per year in the event of emergencies and planned treatment abroad
Full cover in the event of emergencies, for a
maximum of 60 days per year. CHF 1,500 per
day, for a maximum of 60 days per year in the
event of planned treatment abroad
CHF 500 per day, for a
maximum of 60 days
per year in the event of
emergencies and planned treatment abroad
See Hospital stays (in Switzerland)
See Hospital stays (in Switzerland), if included
See Hospital stays (in Switzerland), if included
See Hospital stays (in Switzerland)
Full cover for a general ward anywhere in Switzerland*
Full cover for a semi-private ward anywhere in
Switzerland*
Full cover for a private ward anywhere in Switzerland*
Multi-bed room
Two-bed room and free choice of doctor
Single-bed room and free choice of doctor
Private ward: 20% of benefits; semi-private ward:
40% of benefits
Private ward: 75% of benefits
CHF 1000 per day, for a
maximum of 60 days
per year in the event of
emergencies and planned treatment abroad
CHF 500 lump sum on birth for births at home
CHF 90 per day, for a maximum of 14 days per year
CHF 30 per day, for a maximum of 30 days per year
(in Switzerland and Europe)
CHF 30 per day, for a maximum of 30 days per year
(spa and convalescent therapies combined: max.
30 days per year)
CHF 30 per day, for a maximum of 30 days per year
Maximum of 30 hours per year
Maximum of 30 hours per year
Included. In selected partner clinics
Included. In selected partner clinics
CHF 120 per day, for a maximum of 14 days per
year
CHF 60 per day, for a maximum of 30 days per
year (in Switzerland and Europe)
CHF 60 per day, for a maximum of 30 days per
year (spa and convalescent therapies combined: max. 30 days per year)
CHF 60 per day, for a maximum of 30 days per
year
CHF 180 per day, for a maximum of 14 days per
year
CHF 90 per day, for a maximum of 30 days per
year (in Switzerland and Europe)
CHF 90 per day, for a maximum of 30 days per
year (spa and convalescent therapies combined: max. 30 days per year)
CHF 90 per day, for a maximum of 30 days per
year
HOSPITAL PLUS for a maximum of
60 hours per year
HOSPITAL PLUS for a maximum of
60 hours per year
HOSPITAL COMFORT for a maximum of
90 hours per year
HOSPITAL COMFORT for a maximum of
90 hours per year
Full cover for general, semi-private and private
wards anywhere in Switzerland* taking into
account the co-payment selected
Co-payment
Co-payment
prvt. ward: 50% (max.
prvt. ward: 35% (max.
CHF 9,000 per year);
CHF 4,000 per year);
semi-prvt. ward: 35%
semi-prvt. ward: 20%
(max. CHF 3,000 per
(max. CHF 2,000 per
year) gen. ward: none
year) gen. ward: none
Free choice of hospital ward anywhere in
Switzerland*
Option: CHF 100 per day, for a maximum of 14 days
per year
Option: CHF 100 per day, for a maximum of 21 days
per year (in Switzerland and Europe)
Option: CHF 100 per day, for a maximum of 21 days
per year (spa and convalescent therapies combined: max. 21 days per year)
Option: CHF 50 per day, for a maximum of 30 days
per year
Option: Maximum of 30 hours per year
CHF 50 per day, for a
maximum of 15 days
per year
* Cantonal listed hospital, Helsana KVG contract hospital
CHF 100 per day, for a
maximum of 15 days
per year
Other products
DENTAL INSURANCE
LONG-TERM CARE INSURANCE
DENTAplus
Dental insurance for every need
→ Dental treatment related to an illness, orthodontics, oral surgery
→ Check-ups, dental hygiene
→ Worldwide cover (max. Swiss tariff)
→ Choice of maximum costs of CHF 300, 1000, 2000,
3000 or up to unlimited cover per calendar year
(with a 6-month waiting period)
VIVANTE
Long-term care insurance with free choice of carer
→ Supports care by family members or specialists at home or in a
nursing home
→ No proof of use required when a claim is made,
daily allowance for use at own discretion
→ Choice of daily allowances of CHF 40, 60, 80, 100,
140, or 180, single or capable of being combined
→ In the event of illness or accident, regardless of basic insurance
benefits
HOSPITAL ALLOWANCE INSURANCE
HOSPITAL EXTRA
More freedom and financial options when you have to go into hospital
→ Financial contribution towards additional costs during hospital
stay
→ Entitlement to benefits during acute inpatient treatment (acci-
CURA
Long-term care insurance supplementing basic insurance benefits
→ Contribution to costs of household help or nursing home not otherwise covered
→ For when illness or accidents mean care is regularly needed
→ Choice of daily allowance: CHF 10, 20, 30, 40, 50,
60, 70, 80, 90, 100, 110, 120, 130, 140, 150, 200, 250, or 300
→ Choice of waiting period of 180, 360, 720, or 1080 days
dent, illness, maternity) and during inpatient rehabilitation following acute treatment in Switzerland
→ Choice of daily allowance of CHF 50, 100, 150, 200
or 300 (maximum)
→ Benefits paid for a maximum of 30 days per year
CAPITAL INSURANCE
LEGAL EXPENSES INSURANCE
PREVEA (PREVEA Illness/PREVEA Accident)
Helsana Advocare PLUS
Capital insurance in the event of death or disability
Solid legal expenses insurance for people with TOP,
→ Financial protection with capital benefits to an insured amount in
COMPLETA or OMNIA insurance
the event of an illness or accident resulting in death or disability
→ Civil and motorists' legal expenses insurance
– irrespective of other existing insurance policies
→ Up to max. CHF 300,000 per case in Europe, max. CHF 30,000
→ Choice of insured sums in increments from CHF 10,000 upwards
→ Maximum insured sum: PREVEA Accident: up to CHF 300,000;
PREVEA Illness: aged 0-20, up to max. CHF 300,000, from the age
of 21, up to max. CHF 500,000
→ Age to take out cover: PREVEA Accident: from before birth up to
the age of 70; PREVEA Illness: from birth up to the age of 55
per case elsewhere
Helsana Advocare EXTRA
Comprehensive legal expenses insurance for people with TOP,
COMPLETA or OMNIA insurance
→ Civil, motorists' and internet legal expenses insurance
→ Up to max. CHF 1 million per case in Europe, max. CHF 100,000
per case elsewhere
DAILY ALLOWANCE INSURANCE
SALARIA VVG
Daily allowance insurance
pursuant to VVG
SALARIA KVG
Daily allowance insurance
pursuant to KVG
Duration of
benefits
365 days or 730 days
720 days within 900 calendar days
Daily allowance
amount
CHF 10 to CHF 600 per day
That is equivalent to benefits of max.
CHF 18,000 per month
CHF 10 to CHF 30 per day
That is equivalent to benefits of max.
CHF 900 per month
Maternity
—
16 weeks (112 days)
Accident
Can be included
Can be included
Waiting periods
3, 7, 14, 21, 30, 60, 90, 120, 150, 180, 240, 270
or 360 days
0, 3, 7, 14, 21, 30, 60, 90, 120, 150, 180, 240,
270 or 360 days
Savings opportunities
BASIS
INSURANCE
We
offerBASIC
alternative
insurance models to BASIS compulsory health insurance
Save with alternative insurance models (AIMs)
Everyone's needs are different. That's why there are several options to choose from when taking out basic insurance. In addition to the standard statutory option, you can also choose alternative insurance models (AIMs). The medical benefits you get from them are the same everywhere. With an AIM, though, you save on premiums, and the efficient and competent way you're dealt with by a central contact person means
you also avoid multiple examinations. We reward you for this with a premium discount.
BeneFit PLUS Telemedicine
BeneFit PLUS GP
PREMED-24
Minimum 15 %
discount
Minimum 12 %
discount
Minimum 6 %
discount
Access to medical care by telephone
around the clock
Coordination of medical treatment by the
selected family doctor or group practice
Free medical advice before any visit
to the doctor
Save with an adjustable deductible
More savings opportunities
Deductible1
500
1,000
1,500
2,000.–
2,500.–
Various
Discount on premium
Children's discount (aged 0 to 18), 1st and 2nd child 75%
Children's discount (aged 0 to 18), from 3rd child
90%
Young people's discount (aged 19 to 25)
10%
Accident exclusion (working persons only)
7%
Discount on premium
8% (50% for children)
20%
30%
40%
50%
1
10% excess
SUPPLEMENTARY INSURANCE*
Family discount: 5% from 2 people, 10% from 3 people
Multi-year discount: 3-year contract 3%, 5-year contract 5%
Child's starting discount: 50% for children under the age of 18 (applies only for the first year of insurance, subject to basic insurance being taken
out with Helsana at the same time. In addition, at least one adult in the same household must have their basic insurance with Helsana.)
PRIMEO combination discount
Supplementary hospital insurance
Legal expenses insurance
→ 20% discount when combined with
→ Minimum 15% discount with choice of
Helsana Advocare PLUS /
Hospital Plus/Plus Bonus/Plus Classica
Helsana Advocare EXTRA
deductibles
→ 100% discount for children up to the
→ 30% discount when combined with
age of 18
Hospital Comfort/Comfort Bonus/
→ 50% discount for young people aged
Comfort Classica
between 19 and 25
→ 25% discount if at least two
adults (aged 26 and over) take out
Helsana Advocare PLUS / Helsana
HEL-00090-en-0816-0017-35505
Advocare EXTRA in the same contract
(family contract)
For further information:
0844 80 81 82
helsana.ch
* The Helsana Group reserves the right to amend the conditions or discounts at any time. This brochure is provided for information purposes only and does not constitute a binding offer.
The Helsana Group reserves the right to modify the information contained therein.
The Helsana Group comprises Helsana Insurance Company, Helsana Supplementary Insurance, Helsana Accidents and Progrès.