Patient beim Arzt

Bills from service providers

By service providers, we mean doctors, hospitals and other suppliers of healthcare services such as pharmacies and complementary therapists. When they issue bills, what happens next depends on who the bill is addressed to.

Tiers garant vs. tiers payant

Tiers garant – the bill is addressed to you

Refund

  • Check the bill carefully and pay it if everything is correct.
  • Then send the bill to us.
  • We’ll check to see what amount we can cover and let you know.
Checking bills Submitting bills

Tiers payant – the bill is addressed to us.

Direct payment

  • We’ll check the bill and pay it.
  • All the important information about this process will then appear on the benefit statement that is sent to you.
  • Would you like a copy of the bill? You can get this at any time from the biller, i.e. the doctor or pharmacy.
Checking bills Understanding the benefit statement

Understanding benefit statements

A benefit statement provides an overview of one or more bills for services you have obtained, such as medication from the pharmacy or a doctor's appointment.  The benefit statement shows who bears which costs.

The overview of the statement of benefits

A benefit statement gives you information about the following points:

  • You find out which service providers (doctors, hospitals, etc.) have submitted a bill to CSS for treating you.
  • We show you what amount we will pay under basic insurance and how much we will pay under supplementary insurance.
  • You see how high your deductible and retention fee are. Together, they make up your co-payment.

Your co-payment: deductible and retention fee

For basic insurance

The deductible is the amount that you pay towards your treatment costs per calendar year.

Once the deductible has been used up, you pay a 10% retention fee towards any other costs.  The retention fee is capped at CHF 700 a year. We pay the insured costs for any amount above that.

Additional costs apply if you are hospitalised. You pay CHF 15 per day during your entire stay, with no limit on the amount. This is a requirement under the Federal Health Insurance Act. However, this rule does not apply to children, young people under 25 in education or maternity services.

For supplementary insurance

To find out whether your supplementary insurance has a deductible, retention fee or limited benefits, please consult the insurance conditions.

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