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OVERVIEW OF BENEFITS 2012
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Benefit area
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Frais de guérison - Paquet 1
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Treatment costs package 1
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Treatment costs package 2
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ÖKK OPTIMA + ÖKK KOMBI ALLGEMEIN
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ÖKK FAMILY
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Medical treatment
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Treatment by doctors and chiropractors;
Recognised therapies and analyses prescribed by doctors
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Canton of residence and place of work
Medical advice around the clock: 0844 655 655
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90% with KVG doctors in Switzerland
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90% with KVG doctors in Switzerland
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In-patient or out-patient vasectomy and sterilisation
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50%, up to CHF 1'000
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50%, up to CHF 1'000
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Medications
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Medications with doctor's prescription
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As per list of medications and speciality medication list
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Medication not usually covered by insurance
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70%
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90%
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Hospital
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Accommodation and treatment
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General ward as per the cantonal hospital list in Switzerland
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General ward in Switzerland
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General ward in Switzerland
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Daily hospital allowance
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CHF 15 per day, up to 730 days, waiting period: 5 days per year
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Remuneration for choosing a cheaper hospital ward in Switzerland, from 16 years
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Emergency abroad
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Medical treatment
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Up to twice the tariff for the canton of residence, in accordance with the bilateral treaty in the EU
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100%
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100%
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Hospital
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Up to twice the tariff of the general ward of the canton of residence, in accordance with the bilateral treaty in the EU
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General hospital ward
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General hospital ward
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Alternative medicine
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Alternative medicine treatment by doctors and EMR therapists
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Acupuncture, anthrosophic medicine, Chinese medicine, homeopathy, natural therapy, phytotherapy with recognised doctors
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70%, up to CHF 3,000 per year
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70%, up to CHF 10,000 per year
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Treatment by other qualified therapists
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50%, up to CHF 500 per year
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50%, up to CHF 1,000 per year
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Natural medicines
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70%
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90%
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Prevention
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Immunisations
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As per regulation on statutory benefits
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90% up to CHF 200 per year
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50%, up to CHF 200 per year
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Check-up
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90%, up to CHF 300 per year
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90%, up to CHF 300 per year
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Preventive gynaecological check-up
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One check-up every three years
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90% for one check-up per year, if the costs for the check-up were not covered by the basic insurance
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90% of one check-up per year, if the costs for the check-up were not covered by the basic insurance
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Health account (Sectors: Family, Nutrition, Exercise, Other prevention)
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50% up to CHF 200 per sector, up to CHF 400 for all areas(excluding the family area) per year
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50%, up to CHF 200 per sector, up to CHF 500 for all sectors per year
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Glasses and contact lenses
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Spectacle lenses and contact lenses
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CHF 150 per year
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CHF 200 per year
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Eye laser from 18 years
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Transportation , rescue, search
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Transportation required for medical reasons to the nearest hospital
or repatriation to Switzerland; Rescue and recovery operation
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50%, up to CHF 500 per year (transport)
50%, up to CHF 5'000 per year (rescue)
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CHF 60,000 per year, retention CHF 100 per case
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Up to CHF 50,000 per year,
retention CHF 100 per case
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Travel expenses from 30 km (public transport)
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90%, up to CHF 100 per year for regular medical treatment;
90%, up to CHF 300 per year for dialysis, radiation or chemotherapy
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90%, up to CHF 100 per year for regular medical treatment;
90%, up to CHF 300 per year for dialysis, radiation or chemotherapy
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Search operation
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CHF 20,000 per year
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CHF 20,000 per year
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Maternity
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Antenatal classes and postnatal gymnastics
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CHF 100, antenatal classes with midwives only
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CHF 100 per pregnancy
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CHF 200 per pregnancy
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Birth in a hospital and maternity unit
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General ward as per the cantonal hospital list in Switzerland
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General ward in Switzerland
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General ward in Switzerland, Wards: comfort twin room and family room in a hospital as per cantonal hospital list in Switzerland;
ÖKK pays a maximum of CHF 200 per day for twin and family rooms.
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Birth in a recognised maternity unit that is not included in a list of
cantonal hospitals
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CHF 1,000 per birth
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CHF 2,000 per birth
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Domestic help following birth in hospital
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CHF 60 per day, up to CHF 600 per year
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CHF 100 per day, up to CHF 700 per year
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Domestic help following birth at home or out-patient birth
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CHF 60 per day, up to CHF 840 per year
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CHF 100 per day, up to CHF 1,200 per year
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Rooming-in (bringing the child to the hospital or accompanying the child to the hospital overnight)
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CHF 50 per day
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CHF 100 per day
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Breastfeeding allowance
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CHF 150
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CHF 250
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Convalescent treatments
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Recuperation and convalescent spa treatment
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Medical treatment
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Recuperation treatment; stay
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CHF 50 per day, up to 21 days per year
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CHF 50 per day, up to 21 days per year
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Spa treatment; stay
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CHF 10 per day, up to 21 days per year
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CHF 30 per day, up to 21 days per year
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CHF 30 per day, up to 21 days per year
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Thermal baths (prescribed by a doctor)
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50%, up to 12 admissions per year
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50%, up to 12 admissions per year
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Home care
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Home nursing care
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Examination, treatment, care
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Domestic help
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CHF 40 per day, up to CHF 400 per year
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Up to CHF 50 per day, up to CHF 1,000 per year
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Domestic help for looking after a child
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CHF 40 per day, up to CHF 600 per year
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Up to CHF 100 per day, up to CHF 2,000 per year
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Dental treatment
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Treatment by dentists
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Disease of the mastication system, dental accident
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Wisdom tooth extractions
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90%
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90%
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Check-up and prophylaxis
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CHF 60 per year (for children and young adults up to the age of 25)
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CHF 60 per year (for children and young adults up to the age of 25)
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Orthodontic treatment for children and young adults up to the age 25, as per KVG tariff
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70%, up to CHF 5,000
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70%
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Travel insurance
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Visit and special return journey, advance payment on hospital costs, procuring addresses
of hospitals and doctors abroad, medical consultation by doctors
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The ÖKK travel insurance provides world-wide safety in the case of emergencies abroad.
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The ÖKK travel insurance provides world-wide safety in the case of emergencies abroad.
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KVG = Health Insurance Act / Year = calendar year
Our customer consultants would be pleased to outline the benefits of all our products to you. Please contact your branch office.
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