BeneFit PLUS Hausarzt
If you have any health problems, always contact your family doctor or your HMO group practice. You benefit from optimal coordination of your treatments and, depending on the service provider, save 10%, 12%, 14% or 16% on premiums.
- One point of contact for all concerns
- 10% (R4), 12% (R3), 14% (R2) or 16% (R1) discount on your insurance premium (depending on the service provider)
Find your family doctor or your HMO group practice
The list of doctors includes all doctors and group practices (HMO) who belong to the BeneFit PLUS family doctor insurance model.
This is how BeneFit PLUS family doctor works
Whether therapy, referral to a specialist or admission to hospital: your family doctor or your HMO group practice is your first point of contact.
Illness or
Accident
Family doctor or
HMO
group practice
Further
Treatment
Emergency: In an emergency situation, contact an emergency doctor or hospital directly.
Emergency
Emergency doctor
or hospital
Family doctor or
HMO
Group Practice
Important: Please also report emergencies to your family doctor so that he or she is informed and further check-ups can be discussed.
The benefits are the same for all basic insurance models. We will reimburse you for the following services after deducting the statutory cost contribution (deductible / deductible / hospital cost contribution) from the family doctor model.
Hospital stays in Switzerland
You will receive the costs for the stay, care and treatment in the general ward (multi-bed room).
Foreign Protection
In the event of an emergency, you will receive the relevant social tariff in the EU/EFTA countries. In all other countries we will reimburse a maximum of twice the amount insured in Switzerland.
Transportation and rescue in Switzerland
For transport you receive 50% of the costs up to a maximum of 500 francs per calendar year. For rescue operations, we reimburse 50% of the costs up to a maximum of 5,000 francs per calendar year.
Medicines
You will receive the costs for medications prescribed by a doctor that are listed in the specialty list.
If several medicines with the same active ingredient composition are listed, the deductible can be 20%.
If several medicines with the same active ingredient composition are listed, the deductible can be 20%.
Outpatient treatments – conventional medicine
You will receive the costs according to the rate of the recognized specialist throughout Switzerland.
Outpatient treatments – complementary medicine
You will receive the costs according to the rate of the recognized specialist throughout Switzerland.
Prevention (medical care)
You will receive the costs for certain preventive examinations and measures.
Utilities and items
You will receive the costs up to the statutory maximum amount for medically prescribed aids and items.
Pregnancy
You will receive costs for examinations and birth preparation measures.
Nursing
You receive contributions towards the costs of care at home (Spitex) and in the nursing home.
Spa treatments
You will receive 10 francs per day for spa treatments in recognized spas in Switzerland.
Downloads
Frequently Asked Questions
Why do I need basic insurance?
Health insurance under the Health Insurance Act (KVG) is mandatory for all people living in Switzerland. It guarantees basic medical care in the event of illness, accident and maternity.
The scope of services is specified by law. You will therefore receive exactly the same services from every health insurance company in Switzerland.
The scope of services is specified by law. You will therefore receive exactly the same services from every health insurance company in Switzerland.
What are the advantages of the family doctor model?
- Your family doctor or your HMO group practice knows your medical history exactly and optimally matches your medical treatments to any illnesses and medications.
- You only have one contact person with whom you have a personal, trusting relationship.
- You will be referred specifically - unnecessary examinations are no longer necessary.
- Depending on the service provider, you will receive a 10%, 12%, 14% or 16% discount on your basic insurance premium.
- The treating doctors are in intensive contact with each other. This increases security and saves time and costs.
- You only have one contact person with whom you have a personal, trusting relationship.
- You will be referred specifically - unnecessary examinations are no longer necessary.
- Depending on the service provider, you will receive a 10%, 12%, 14% or 16% discount on your basic insurance premium.
- The treating doctors are in intensive contact with each other. This increases security and saves time and costs.
Can I keep my current family doctor?
When you take out the family doctor model, you select a doctor or an HMO group practice as your contact person from our list of doctors. If your previous family doctor is listed on our list of doctors, you can continue to keep him.
What happens if I go straight to a specialist?
By choosing the BeneFit PLUS family doctor model, you have committed yourself to always visiting your chosen family doctor or HMO group practice if you have health problems. If you need a specialist, the referral will be made via your family doctor or your HMO group practice.
If you go to a specialist directly without a prior referral, you are ignoring the rules of the family doctor model. Helsana can therefore transfer you to the standard basic insurance model. As a result, you not only lose your insurance in the family doctor model, but also your discount on the basic insurance premium.
If you go to a specialist directly without a prior referral, you are ignoring the rules of the family doctor model. Helsana can therefore transfer you to the standard basic insurance model. As a result, you not only lose your insurance in the family doctor model, but also your discount on the basic insurance premium.
What should I do if I have a chronic illness?
Even if you have chronic illnesses, contact your family doctor first. This determines your individual treatment process. If necessary, he will refer you to a specialist.
How should I behave abroad?
The obligations generally continue to apply even during stays abroad:
- The emergency call center should primarily be contacted on +41 58 340 16 11.
- Please hand in your European insurance card within the EU / EFTA states.
- Your family doctor or your HMO group practice in Switzerland should be contacted as soon as possible.
- If follow-up treatments are necessary after the first emergency treatment, discuss this with your family doctor or your HMO group practice. This way you can plan and coordinate further treatments in Switzerland.
Important: Your family doctor or your HMO group practice cannot provide any information about cost coverage or rejection of costs for emergency or planned treatments abroad.
- The emergency call center should primarily be contacted on +41 58 340 16 11.
- Please hand in your European insurance card within the EU / EFTA states.
- Your family doctor or your HMO group practice in Switzerland should be contacted as soon as possible.
- If follow-up treatments are necessary after the first emergency treatment, discuss this with your family doctor or your HMO group practice. This way you can plan and coordinate further treatments in Switzerland.
Important: Your family doctor or your HMO group practice cannot provide any information about cost coverage or rejection of costs for emergency or planned treatments abroad.
Who can take out the family doctor model?
All people who live in the service area of the selected doctor network. You can use our family doctor search to find out whether a family doctor model is offered where you live.
Can I switch from the BASIS model to the family doctor model?
If you have insured the legal standard version BASIS with a deductible of 300 francs from us, you can switch to this alternative insurance model on the first of each month and from it Benefit from the advantages.
Please contact us if you would like to change your existing insurance.
Please contact us if you would like to change your existing insurance.
How and when can I cancel this health insurance?
You can cancel the insurance on December 31st and switch to another health insurance company in Switzerland. The prerequisite is that you do not have any outstanding premium invoices. A one-month notice period applies. The notice of termination must be received by us no later than the last working day in November.
What franchises are there?
Adults aged 18 and over can choose either the statutory minimum deductible of 300 francs or one of five optional deductibles between 500 and 2500 francs. The higher your deductible, the cheaper your basic insurance premium will be.
Children have no minimum deductible. However, you can also save on premiums with an optional deductible of 500 francs.
Are you still undecided about which franchise makes sense for you? We will be happy to help you on 0844 80 81 82.
Different regulations for cross-border commuters
For cross-border commuters from EU/EFTA countries, the statutory annual deductible for adults is also 300 francs per year. There is no annual deductible for children up to 18 years of age. However, elective deductibles are not permitted for cross-border commuters. You therefore have no option to choose a higher deductible in conjunction with a premium reduction.
Children have no minimum deductible. However, you can also save on premiums with an optional deductible of 500 francs.
Are you still undecided about which franchise makes sense for you? We will be happy to help you on 0844 80 81 82.
Different regulations for cross-border commuters
For cross-border commuters from EU/EFTA countries, the statutory annual deductible for adults is also 300 francs per year. There is no annual deductible for children up to 18 years of age. However, elective deductibles are not permitted for cross-border commuters. You therefore have no option to choose a higher deductible in conjunction with a premium reduction.
How and when can I change my franchise?
You can increase or decrease the deductible on January 1st of the following calendar year. The following deadlines apply:
On the reduction (reduction) of the franchise: November 30th
To increase the franchise: December 31st
Please note that the notification of the change must be received by us by the last working day before the specified date.
Different regulations for cross-border commuters
Voting deductibles are not permitted for cross-border commuters from EU/EFTA countries. You therefore have no option to choose a higher deductible in conjunction with a premium reduction.
On the reduction (reduction) of the franchise: November 30th
To increase the franchise: December 31st
Please note that the notification of the change must be received by us by the last working day before the specified date.
Different regulations for cross-border commuters
Voting deductibles are not permitted for cross-border commuters from EU/EFTA countries. You therefore have no option to choose a higher deductible in conjunction with a premium reduction.
How and when can I change my franchise?
You can increase or decrease the deductible on January 1st of the following calendar year. The following deadlines apply:
On the reduction (reduction) of the franchise: November 30th
To increase the franchise: December 31st
Please note that the notification of the change must be received by us by the last working day before the specified date.
Different regulations for cross-border commuters
Voting deductibles are not permitted for cross-border commuters from EU/EFTA countries. You therefore have no option to choose a higher deductible in conjunction with a premium reduction.
On the reduction (reduction) of the franchise: November 30th
To increase the franchise: December 31st
Please note that the notification of the change must be received by us by the last working day before the specified date.
Different regulations for cross-border commuters
Voting deductibles are not permitted for cross-border commuters from EU/EFTA countries. You therefore have no option to choose a higher deductible in conjunction with a premium reduction.
What does the designation R1, R2, R3 and R4 mean in the BeneFit PLUS family doctor?
In the BeneFit PLUS family doctor, the choice of doctor determines the premium discount on the basic model (R1=16%, R2=14%, R3=12%, R4=10 %). You can see the effective premium discount in our service provider search. The basis for calculating the reduced premium is the premium that you would pay at your current place of residence in your current age group with a normal deductible of CHF 300 and without a special insurance model.
Will I receive a premium reduction?
People whose income and assets justify financial support are entitled to a premium reduction (PV). The premium reduction is regulated differently from canton to canton. Often it only starts when the insured person makes an inquiry. It is therefore worth asking the responsible office in your canton of residence whether you are also entitled to financial support for health insurance.
How can I save on premiums?
There are several ways you can save on premiums for basic insurance.
