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 the healthcare providers, and then asks you to refund the amounts payable by the insured person (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.

Statement of benefits with the amounts paid by the health insurer and those to be paid by the insured person

Statement of benefits: the health insurance refunds the medical expenses paid by the insured person

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

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.
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.
Groupe Mutuel

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