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Helsana BeneFit PLUS - Hausarzt 16%

Family doctor model
Primary care: family doctor

General

General information:

Health insurance model «BeneFit PLUS - Hausarzt 16%» of the Swiss insurance company Helsana.

Health insurance model:

Family doctor model: When you use a family doctor policy, you are required to visit your relevant family doctor first. Your doctor may then refer you to specialists, therapists or hospitals. A primary consultation from your doctor is not necessary in the event of medical emergencies, gynecological examinations and treatments by eye doctors.

Choice of doctor:

Your choice of family doctor is limited to just one doctor from the Helsana doctor list.

Medical partner:

Argomed, Ärztenetz Nordwest, Ärztenetzwerk Thurgau, Beodocs, Doccare, Docnet, DOXnet, Grisomed, Hapmed, HARESO, HAV Schwyz, HAV-SH, Hawa, Igomed, localmed, Medbase, MediX, mediX limmimed, mediX luzern, mediX säntis, mediX winterthur, MedNet Biel-Bienne, mednetbern, PizolCare, Réseau de Soins Neuchâtelois, Réseau Delta, RhyMed, xundart, zimdoc, zmed, Zolamed, Zürcher Gesundheitsnetz.

Pharmacy choice:

You get free choice of pharmacy

Payment methods:

18% of payments are made using the tiers garant payment method, in which you pay and claim reimbursement.
82% of payments are tiers payant, meaning the bills are paid directly by the insurance (Helsana).

Reimbursement:

The average waiting period before tiers garant reimbursement from Helsana is 9 days.

Financial reserves:

The solvency ratio shows how available financial reserves compare to Federal Office of Public Health (FOPH) minimum reserve requirements. The solvency ratio of Helsana is 119% (according to FOPH data). The minimum ratio required by the FOPH is 100%.

Number of policyholders:

A total of 1,412,757 people hold compulsory health insurance policies from Helsana.

Additional child-discount:

Helsana does not offer additional premium reductions for more than one child.

Administrative costs:

4.5% (ratio of adminstrative costs to risk-adjusted premiums as per BAG data).

Administrative costs per policyholder:

CHF 171 (as per the most recent BAG data).