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Glossary

A brief description of the most important health insurance terms

Accident cover

Your policy indicates whether you have included or excluded accident cover in the basic insurance. If you work for at least eight hours a week at the same employer, you are already insured against the financial consequences of an accident. You can therefore exclude accident insurance from your basic insurance cover (BASIS).


Exclude the accident cover here.

AVB

The general insurance conditions (AVB) regulate the contract relationship between ÖKK and the person taking out the insurance policy.

You can find the current general Conditions of Insurance (AVB) here.

Basic insurance

ÖKK calls the compulsory basic insurance BASIS. The basic insurance is based on the Swiss Health Insurance Law (KVG) and is identical with all health insurance companies.

You can find further information here.

BVG

Federal Occupational Retirement, Survivors’ and Disability Pensions Act (BVG). The occupational provision (2nd pillar) guarantees continuance of the previous standard of life for the insured person up to a certain income in old age, in case of disability, or for dependants in case of death together with the 1st pillar (AHV/IV/EO).

Loss of income due to temporary inability to work is not covered until implementation of the IV and BVG benefits.

You can find further information here.

Cancellation period

The compulsory basic insurance with a standard deductible of 300 CHF or 0 CHF for children can be cancelled to the middle of the year or the end of year (30th June or 31st December). Supplementary insurances can be given notice on 31st December.

You can find further information at the Federal Office for Health.

Cancellation protection

The insurance company expressly waive their statutory right to give notice at the end of the contract period or withdraw from the contract in the event of a damage. The right of cancellation for collective contracts is excluded. The withdrawal from the contract due to conduct in breach of the contract is also excluded.

CASAMED

Alternative insurance plans are variants of the basic insurance, which save premiums. The difference to the regular basic insurance is that the first port of call  for health questions is always the general practitioner, the telemedical service or the HMO centre.

You can find further information here
.

Combination discount

If you have added an ÖKK COMBI FLEX, ÖKK COMBI SEMI-PRIVATE, ÖKK COMBI PRIVATE or ÖKK COMBI GLOBAL supplementary hospital insurance policy to your ÖKK PREMIUM supplementary insurance policy, you will receive a combination discount of 20%. The discount will be applied on the ÖKK PREMIUM product.

Cost sharing

It is a legal requirement that insured persons taking out a basic insurance have to contribute to the costs for medical treatment, hospital stay and medication. The cost sharing is made up of the deductible and excess.

You can find more information in the FAQ.

Deductible

If costs are incurred for a doctor, a hospital, or medication, the insurance policy holders must first, in accordance with the law (KVG), assume a certain portion of these costs themselves in every calendar year.

You can find further information here.

Direct Debit

You give ÖKK the authority to debit your premium directly and easily to your post office account at the beginning of the month using the direct debit (DD) process.

You can find further information here.

Direct Debit (LSV+)

You give ÖKK the authority to debit your premium directly and easily to your bank account at the beginning of the month using the direct debit (LSV+) process.

You can find further information here.

Disability capital

Anyone becoming disabled as a result of an illness or accident often has to cope with the minimum pension. The ÖKK capital sum insurances help to minimise these risks and therefore pay out a disability capital in the event of disability caused by an accident or illness.

You can find further information here.

E-invoice

You will receive your invoices electronically and directly to your e-banking/e-finance account with the e-invoice. You no longer have to fill in a pay-in slip as everything is already fully completed. You can approve or reject the invoice in a few clicks.

This is how it works.

Excess

If the costs of outpatient and inpatient treatment exceed the agreed yearly deductible, in the calendar year, the health insurance company takes over 90% of the additional costs. The remaining 10%, the so-called excess, is charged to the insurance policy holder.

You can find further information here.

Family discount

Children and adolescents up to 25 years of age receive a family rebate on supplementary insurances ÖKK FAMILY and ÖKK FAMILY FLEX .

You can find the conditions for the discount here.

Frontier workers

As soon as you gain an income from employment from Switzerland, you are subject to the mandatory insurance obligation applicable in Switzerland. ÖKK EUROLINE is the basic insurance to the Health Insurance Law (KVG) for frontier workers working in Switzerland.

You can find further information here.

General practitioner model

The first contact person is always your general practitioner, who you have selected from ÖKK's list of general practitioners.

You can find further information here.

Health declaration

You have to complete the health declaration when taking out a supplementary insurance. It contains questions about the state of your health. The health declaration must be filled out truthfully. Incorrect information can result in refusal or curtailment of benefits, reclamation, retroactive conditions or retroactive rejections, or exclusion or withdrawal of the insurer.

HMO model

HMO stands for Health Maintenance Organization. Your HMO centre doctor is always your first contact person.

You can find further information here
.

Insurance card

Our customers receive an insurance card to be able to obtain medication in the pharmacy and medical services in a straight-forward way.

You can find further information here.

Insurance cover during military service

When you perform military service, your basic insurance is provided under the government's military insurance. If you perform more than 60 consecutive days of service, you can have your basic insurance suspended during this time.

For more information, please see our FAQ.

Loss of income

Loss of income means loss of salary or salary cut due to inability to work. Businesses cover their obligation to continue to pay salaries to employees who are unable to work due to illness.

Individuals (self-employed people, employees (for the part of the salary not insured by the employer), homemakers, and students or trainees) can take out a daily allowance insurance policy for financial losses due to illness or accident. Further information can be found under ÖKK COMPENSA.

Companies can include loss of income due to accident and maternity or paternity (VVG). We are also offering variants with or without health restrictions as well as variants which are based on your Federal Law on Occupational Benefit Plans concerning Old-Age, Survivors and Invalidity (BVG) insurance and which can exceed the minimum statutory standard. You can find further information about the loss of income insurance here.

Loyalty rebate

We thank you for your being loyal to ÖKK with a 15% discount on hospital supplementary insurances  ÖKK COMBI FLEX, ÖKK COMBI HALF-PRIVATE, ÖKK COMBI PRIVATE or ÖKK COMBI GLOBAL. You will receive the discount from the start of the year following your 60th birthday.

OEKK COMPENSA

Loss of income insurance for individuals (as per VVG) covers financial losses caused by inability to work due to illness, accident or birth.

You can find further information here.

Policy

Your insurance certificate tells you your insurance plan type and the amount of your premium. Take good care of this proof. If the policy or the endorsement do not correspond with the agreements made you as the insured person have to request that they are rectified within four weeks of receipt of the certificate otherwise their content is considered approved (art 12. para 1 VVG).

Premium correction in accordance with Art. 106 KVG

In the years 1996 to 2013, premium imbalances between the cantons accrued in the social health care system. The Federal Office of Public Health is responsible for approving the premiums each year and for calculating the premium correction, while the health insurers are responsible for implementing it.

Cantons with credit payments (AI, FR, GE, GR, TG, TI, VD, ZH, ZG)

People who are residents of one of these cantons as at 1 January 2017 will receive a one-off premium credit in June 2017. The size of the credit will be announced by the Federal Office of Public Health in early 2017.

Cantons with a surcharge (AR, BE, BL, GL, JU, LU, NW, OW, SG, SH, SO, UR, VS)

Depending on where you live on 1 January 2017, you fall into one of the following groups of cantons.

Cantons with no correction (AG, BS, NE, SZ)

People who are residents of one of these cantons as at 1 January 2017 will not be affected by the premium correction. The reimbursement of the environmental levy is listed on their policies.

More information on the premium correction can be found on the website of the Federal Office of Public Health.

Premium reduction

People on modest incomes receive support from the canton so that they can pay their basic insurance premiums.

You can find further information here.

Premiums

The premiums are based on age, the place of residence and sometimes also depending on the gender. 

You can find further information here.

Rebate for unused benefits

This rebate is based on the "bonus/malus" system. If you do not claim any insurance benefits in a calendar year, you will benefit from a rebate the following year. The rebate can only be applied for in the supplementary hospital insurance ÖKK COMBI.

You can find further information about this discount on the fact sheet or enquire in your agency.

Supplementary insurance plans

The voluntary supplementary insurances are no longer subject to the Social Insurance Law since the introduction of the new Health Insurance Law (KVG) but to the Law on Insurance Contracts (VVG). Supplementary insurances cover benefits, which are not covered by the basic insurance. You have to complete a health declaration in order to conclude a supplementary insurance.

You can find further information here.

Tarmed

Pricing system between health insurers and doctor’s organisations for flat settlements for outpatient medical services. For services included in the basic insurance plan as per (KVG), Tarmed went into effect on 1 January 2004.

Telmed model

Prior to arranging an appointment for treatment or if you have any questions regarding your health, always call Medgate first. Your first contact person is always the telemedical centre of Medgate.

You can find further information here.

Third child

The following conditions apply for the free-of-charge supplementary insurance from the third child:
  • The child lives in the same household with one parent and both older siblings,
  • The child is insured in the same family policy,
  • The child is insured in the basic insurance with ÖKK,
  • Both older siblings are not older than 25, they are also insured in the basic insurance with ÖKK and have, as a minimum, equal supplementary insurance cover as the third child,
  • One parent has taken out the basic insurance with ÖKK as well as an in-patient or out-patient supplementary insurance.

Treatment costs

Treatment costs are costs incurred for benefits such as medical treatment, therapies, medication, hospital stays, care, transport of a sick person, aids, convalescent treatments, prevention etc.

UVG

According to the Bundesgesetz über die Unfallversicherung (UVG), every employer is required to provide accident insurance for his or her employees. If you work for at least eight hours a week for the same employer, you are insured against occupational and non-occupational accidents (BU/NBU) and illness through your employer.

You can find further information here.

VVG

The Law on Insurance Contracts (VVG) governs the provisions for the supplementary insurances.

You can find further information about the law here.
Further information about the ÖKK supplementary insurances can be found here.