Information on cost sharing and reimbursement
Insured persons have to participate in the costs of their medical treatment. This participation includes a fixed annual amount (franchise), plus 10% of the costs exceeding the amount of the franchise (share). Further, in case of in-patient hospital treatment, a daily contribution has to be paid.
If the invoice is paid by the Gemeinsame Einrichtung KVG direct to the medical service provider (tiers payant), the cost participation will be charged to the insured person separately afterwards. In case of a reimbursement (tiers garant) to the insured person, the cost participation will be deducted from the amount due.
The invoicing by the medical service provider occurs according to the different Cantonal contracts and tariffs, either to the Gemeinsame Einrichtung KVG (tiers payant) or to the insured person (tiers garant).
To be able to deal with a reimbursement efficiently and free of charge, we need the original invoice, a copy of the claim certificate as well as the complete bank details of the insured person: