-
ESI Switzerland plan
Claims & reimbursments :The benefits of the ESI PROGRAM SWITZERLAND covers at minimum the same as the listed benefits in the Swiss health insurance law (KVG-LAMal).
Thanks to the ESI SWITZERLAND plan, some benefits are improved compared the Swiss health insurance law (KVG-LAMal).Treatment in Switzerland :
You have a free choice for : general practicioner, specialists, public and university hospitals in Switzerland without cantonal limitation - general ward. (Semi private room or private room are not covered in the benefits list of the Swiss health insurance law (KVG-LAMal).
Dental treatment is not covered in Switzerland. You must pay these costs yourself or apply for an additional insurance (not possible by Swisscare).
Treatment abroad :
It's like Switzerland but the coverage is valid only in case of emergency.
What is on your charge :
The franchise of CHF 300 is the amount on your charge, per calendar year, for medical expenses. After this amount, the insurance company start to reimburse medical costs.
No franchise is charged in case of maternity (KVG-LAMal).
Calendar year = 01.01 to 31.12 and its independent of the contract duration.What is not covered :
• previous conditions (*)
• dentists (*)
• psychologist
• countries at war
*Previous conditions means that if you are ill, have a treatment which is not perfectly healed or if you are pregnant or medical problems, you cannot apply online.How to be reimbursed fast ?
You have to pay first all your medical bills for outpatient treatment, drugs, general practitioner..., specialists, hospital if it's an ambulatory treatment - verify the bill. We refund the hospital only if it's a stationary treatment, means that you stay at the hospital for 1 night and more.
Reimbursment procedure :• download the Claim form
• fill out
• iban & swift is mandatory
• send us original bills
• proof of payment (post or bank)Warning : we reimburse within 30-45 days only if you have follow precisely the procedure.
-
Procedure by a practicioner or specialists :
Inform the doctor or specialist that you are insured like the KVG-LAMal (Swiss law). Ask him to send to your address the bills. Pay the bills and send the originals with proof of payment and claim form (below) to Swisscare - claim service.
Procedure by the pharmacy :
Pay all medication by yourself and send us the prescription with payment receipt and claim (below) form to Swisscare - claim service
Hospital stationary treatment :
In the event of an emergency or planned hospital treatment we ask you to please contact our 24-hour Emergency Service : + 41 840 001 001 (press 3)
Stationary hospital treatment means that you stay at minimum one night in the hospital. If you return home at the same day, please follow the outpatient treatment.
Hospital treatment (outpatient) :
Ambulatory treatment is if you go for a hospital visit and come back the same day. Show the practicioner procedure above.
Maternity & pregnancy claims :
It is important to know that maternity and pregnancy are only covered if the pregnancy has started (1st diagnostic from the doctor) after the effect date of the insurance. This diagnostic has to sent to Swisscare to validate the right of coverage. It's not possible to apply an insurance for a women who is already pregnant.
Childbirth / delivery not covered abroad
Like the Swiss health insurance law, a regular childbirth abroad is not covered. Only in an emergency case, the childbirth can be covered abroad (attention read the article about prenatale coverage).
Emergency case means for example a premature baby or an important medical problem.
Know also that hospitals in the USA, Canada or Japan can be extremly expensive in emergency cases. We advice to apply for an additional travel insurance that covers these countries. In fact, in the case of an emergency, there is no 100% coverage according to the Swiss law. The maximum emergency coverage abroad is twice the amount of what is normally reimbursed according to Swiss cantonal hospital tarifs.
Click here for maternity benefits
Important Pre Natale insurance for the baby :
For maternity, please do not forget to prepare a "Pre Natale" health insurance (Swisscare not provide this insurance). This is to avoid all insurance problems in case of needs (example premature baby or if baby is ill) The premium has to paid only at the end of the first month of the childs birth. This insurance is very important to avoid all coverage and insurance problems by new borns.
Gynecological coverage :
Click here for gynecology benefits
-
• Current news
Get a VISA for your friends and family
- Swiss embassies
› read more
- Insured in 24H
- Quote from CHF 29
- Max age 80 year old -
• Help Box
-
• Direct links
-
• Call center
+ 41 840 001 001
-
Download center
Press & news
Contact