FAQ
Benefits
KLuG needs the original bill.
Beforehand, cut off the payment slip, then you must transfer remuneration to your doctor on your own. Send the original bill to KLuG for accounting and reimbursement. Save a copy for your documentation.
Cost sharing
The first medical expenses that arise from the treatment must be incurred by the Insured. Such amount is referred to as the deductible. The deductible can be modified every time on the 1st of January of the following calendar year.
Adults:
The official minimum deductible for the Insured aged 18 and more amounts to CHF 300.– per calendar year. At the excess of maximum CHF 700.– the highest amount per calendar year totals the maximum of CHF 1'000.–. KLuG offers its clients the possibility to optionally raise the deductible up to maximum
CHF 2'500.–. The insured will receive thereupon a premium discount.
Children:
There is no officially recorded annual deductible for children. This means that solely parents must assume the excess which will arise from treatment costs. Thereby, the excess amounts to maximum CHF 350.– per calendar year.
Parents have the possibility to optionally choose the deductible also for their children, and so, to reduce premiums. Also in this case the excess totals maximum CHF 350.– per calendar year.
If you have more children insured at KLuG the highest amount per calendar year equals the maximum of double the highest amount per child per calendar year.
The excess amount totals 10 percent and will be charged for those treatment costs which surpass the chosen deductible. For an adult the excess equals maximum CHF 700.– per calendar year, for the Insured under 18 - maximum CHF 350.– per calendar year.
If there are generic products (Generika) more beneficial with respect to the original medication at your disposal, the cost sharing increases to 20 %.
Upon a hospital stay, the mandatory healthcare insurance undertakes not only the treatment costs, but also the costs of accommodation and board. That is why, all Insured over 18 must contribute to the costs of the hospital accommodation and board with CHF 15.– per day in hospital.
Alongside the basic deductible of CHF 300.– KLuG also offers a choice of deductibles CHF 500.–, CHF 1'000.–, CHF 1'500.–, CHF 2'000.– and CHF 2'500.–.
When you choose a higher deductible, your premium is reduced accordingly. Whether the higher deductible is profitable for you depends on medical expenses incurred in the ongoing year, because: higher the deductible, higher the share you have to contribute in case of a health problem. Healthy Insured, who do not face any medical expenses, choose a higher deductible to their advantage. Upon high medical costs to expect it is better to choose the officially stipulated deductible of CHF 300.–.
It is worthwhile to think through that in the worst case scenario the chosen deductible and furthermore additional excess of maximum CHF 700.– must also be paid. For the highest optional deductible of CHF 2'500.– the maximum costs to bare would be of CHF 3'200.–.
This is how you proceed when you would like to change your deductible: tick the field with the desired deductible in your policy and then send it signed back to us until Friday, 30.11.... (inbox KLuG). Soon you will receive a new policy with your chosen deductible.
No, you cannot. This modification is only possible at the beginning of the calendar year. The intention to modify the deductible should be registered and communicated to KLuG in writing each time until the end of November.
Health insurance card
There can be various data stored, such as information on illnesses, health consequences of an accident, transplant particulars, as well as on allergies, reactions, medication, vaccinations, blood group, and transfusions. It is also possible to store important contact data. This in turn, when emergency occurs, enables rapid information from people close to you or from the insured person’s family doctors or specialists. On the insured person‘s request a reference in relation to existing advanced health care directive or medical dossier can be stored. It is important to know that the information on medical history or performance and on treatments will not be stored on the card.
It is only you, who determines which data should be additionally stored, or who may read or process those. The access is enabled only to the authorised medical care providers. These persons use their individual electronic care provider’s attestation (eLENA) together with the security certificate. In order to describe the card the care provider needs an individual access card additionally to the health insurance card. Only with both of those cards is it possible to store or read the data. In this way, the information saved on the card is manifold protected. Important information: The health insurance has no access to these data at all.
Switch hospital insurance
Supplementary hospital insurance policies with a closed portfolio are products for which we manage the portfolio of insured persons but no longer sell to new customers. By law, the insured persons of a closed portfolio are entitled to switch from the current supplementary hospital insurance policy to another supplementary hospital insurance policy with coverage that is comparable but with an open portfolio. This is governed by the Supervision Ordinance (ISO). In accordance with the applicable insurance conditions, the benefits of the closed supplementary hospital insurance policy remain unaffected.
You can remain in your existing supplementary hospital insurance policy for as long as you want and continue to profit from the benefits it provides. It can, however, be the case that the premiums for a supplementary hospital insurance policy with a closed portfolio rise more sharply over the longer term than for a supplementary hospital insurance policy whose portfolio is not closed.
All existing benefits have been transferred to the new supplementary hospital insurance policies and the contributions have been increased generously. We have expanded the international benefits and introduced new benefits such as rooming-in, travel costs for your journey to and from hospital and refunds for stays in a lower-level ward. Depending on the product as well as your age, gender and canton, the premium for the new supplementary hospital insurance policy could also be cheaper for you.
Depending on the product as well as your age, gender and canton, the premium for the new supplementary hospital insurance policy could at present be more expensive than your current insurance policy.
Over the longer term, however, Helsana wants to ensure more sustainable premiums for the new hospital product through the exclusion of hospitals and doctors with a below-average price-performance ratio. While this may lead to certain restrictions in terms of the choice of hospitals and doctors, Helsana is endeavouring to reach an agreement with as many hospitals and doctors as possible. The current list of hospitals and doctors without cost coverage can be found here.
In principle, you can switch to an equivalent supplementary hospital insurance policy at any time as of the first of the following month, however with effect on 1 January 2019 at the earliest.
In principle, you can switch to an equivalent supplementary hospital insurance policy at any time without a medical examination as of the first of the following month.
Ideally, you should call your personal customer consultant. The telephone number can be found in the top left of all documents. You can, of course, also visit us.