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1 - FIRST CALL - Why is FIRST CALL different?1 - FIRST CALL - Why is FIRST CALL different?

FIRST CALL rewards the responsible policy holder and helps keep health care costs under control. FIRST CALL includes the full benefits of the Swiss compulsory health insurance under KVG. You receive a premium reduction, but you must notify MEDGATE before you seek medical treatment.
If MEDGATE approves treatment, you can arrange to see the doctor of your choice.

2 - What is reimbursed in the event of hospitalization?2 - What is reimbursed in the event of hospitalization?

The scope of benefits is governed by the General Terms and Conditions of Insurance (AVB) and Special Conditions of Insurance (SVB) of each insurance product.

3 - What maternity coverage does INTRAS provide?3 - What maternity coverage does INTRAS provide?

Under the Swiss compulsory health insurance:
Benefits under the Swiss compulsory health insurance scheme (KLV) articles 13 - 16(Special maternity coverage)

• Medical check-ups
  - Screening check-ups
  - Ultrasound check-ups
  - Antenatal check-ups
  - Amniocentesis, chorion biopsy
  - Postpartum check-ups (after delivery)
• Antenatal classes
• Breastfeeding advice
• Midwife services
• Delivery at home or in a hospital

This is just a general summary. The scope of benefits is governed by the provisions of the Swiss Federal Health Insurance Act (KVG).


Additional coverage:
Benefits under the terms of the special policy conditions

• UNO+ and DUE+
  - Antenatal classes or pregnancy and postnatal exercises
  - Home help
  - Nursing mothers’ allowanceAdditional hospital coverage
• OPTIMA +  
  no reimbursement of expenses relating to maternity
• QUADRA +  
  treatment in semi-private or private ward throughout Switzerland
• FLEXIMA 
  24-month waiting period

This is just a general summary. The scope of benefits is governed by the General Terms and Conditions of Insurance (AVB) and Special Conditions of Insurance (SVB) of each insurance product.

4 - FIRST CALL - Can anyone join FIRST CALL?4 - FIRST CALL - Can anyone join FIRST CALL?

FIRST CALL is open to everyone. Admission to FIRST CALL insurance or the transfer from MINIMA insurance to FIRST CALL insurance is possible at any time on the first of the month following application (Article. 4, FIRST CALL Information Sheet on Compulsory Health Insurance, special conditions).

5 - FIRST CALL - Can I change a step in the treatment agreed with MEDGATE?5 - FIRST CALL - Can I change a step in the treatment agreed with MEDGATE?

Yes if you arrange this change in advance with MEDGATE. For example: you have a health problem and discuss self-treatment with the MEDGATE doctor. Your condition does not improve and so you would like to consult your family doctor. You call MEDGATE once more so that the health problem can be re-evaluated and another treatment step agreed.

6 - FIRST CALL - Can INTRAS look into my patient file?6 - FIRST CALL - Can INTRAS look into my patient file?

No. The consultations with MEDGATE are confidential and are protected by professional confidentiality. The administration of INTRAS cannot see protected medical data, but only information concerning the date of your phone call and the recommendation given by MEDGATE (self-treatment, doctor, hospital or other service provider). MEDGATE has knowledge of the following data about the insured person: insurance number, name and given name, date of birth, gender, address and insurance cover.

7 - FIRST CALL - How does the MEDGATE consultation process work?7 - FIRST CALL - How does the MEDGATE consultation process work?

You dial the special FIRST CALL service phone number and are connected with MEDGATE. You give your insurance number and the reason for your phone call. A callback time is agreed for a MEDGATE doctor to contact you directly. You discuss your health problem or your medical question with the MEDGATE doctor. Together you agree whether you can look after yourself under medical guidance or whether a visit is necessary to your family doctor, a specialist or possibly a hospital facility.

8 - FIRST CALL - Is a health examination required for admission?8 - FIRST CALL - Is a health examination required for admission?

No health examination is required, because FIRST CALL is a variation of compulsory health insurance and not supplementary insurance.

9 - FIRST CALL - Must I also call MEDGATE if I become ill on holiday abroad, for example?9 - FIRST CALL - Must I also call MEDGATE if I become ill on holiday abroad, for example?

Yes. In an emergency treatment abroad, you must contact MEDGATE as quickly as possible, but no later than within 20 days after starting treatment information.
For further medical treatment (doctor, hospital, pharmacy) for EU / EFTA countries you need your insurance card. The costs accepted by INTRAS depend on your insurance cover - compulsory health insurance or supplementary insurance. Ask your INTRAS agency about your coverage before travel begins and take out travel and holiday insurance in any case.

10 - FIRST CALL - What are my responsibilities as a FIRST CALL affiliate?10 - FIRST CALL - What are my responsibilities as a FIRST CALL affiliate?

You always must contact and consult with MEDGATE first.

• For health issues due to an illness or injury, as long as the risk is insured, you – or a third party should you be unable to do so – agree to contact MEDGATE by phone prior to any consultation with a doctor or a chiropractor or prior to hospital admission, and follow its recommendations.
• You must tell MEDGATE if the treating doctor recommends further consultation, referral to another doctor or hospital admission or admission to a nursing home.
• You must inform MEDGATE if you are discharged from a hospital or nursing home as soon as possible but no later than within 20 days.

Exceptions

• For emergency treatment in Switzerland or abroad, you must inform MEDGATE as soon as possi-ble or at the latest within 20 days of starting treatment.
• You do not need to inform MEDGATE of your annual gynaecological check-up.
• You can arrange one ophthalmologic examination per calendar year without consulting MEDGATE.
• You do not have to inform MEDGATE if you are prescribed physiotherapy, occupational therapy or speech therapy. You do not have to inform MEDGATE of any check-ups during pregnancy.
  

11 - FIRST CALL - What happens if I did not call MEDGATE before a doctor's visit or do not follow the advice of MEDGATE?11 - FIRST CALL - What happens if I did not call MEDGATE before a doctor's visit or do not follow the advice of MEDGATE?

In this case you must pay 50% of the corresponding invoice(s). This amount cannot exceed five times the amount of the annual premium reduction granted. If you fail to contact MEDGATE or disregard other conditions more than three times within one calendar year, INTRAS has the right to exclude you from FIRST CALL and transfer you into another compulsory health insurance plan.

12 - FIRST CALL - What is special about FIRST CALL?12 - FIRST CALL - What is special about FIRST CALL?

FIRST CALL contains all the benefits of compulsory health insurance with medical check-ups, doctor's visits, physiotherapy etc. You are free to choose your doctor and you will receive a reduction in premium of up to 10 % (calculated on the premium of MINIMA compulsory health insurance).

13 - FIRST CALL - What is the model based on?13 - FIRST CALL - What is the model based on?

The FIRST CALL insurance model is based on the principle that you first call the MEDGATE tele-consultation centre before each intended visit to a doctor and discuss your health problem with one of the MEDGATE doctors by telephone.

14 - FIRST CALL - What must I do after the visit to the doctor?14 - FIRST CALL - What must I do after the visit to the doctor?

You must tell MEDGATE if the treating doctor recommends further consultation, referral to another doctor or hospital admission or admission to a nursing home. You do not have to inform MEDGATE if you are prescribed physiotherapy, occupational therapy or speech therapy. Sanctions go into effect if you fail to inform FIRST CALL of the appointment or ignore recommendations given, e.g., you must pay 50% of the insured costs (excluding excess).

15 - FIRST CALL - Who is responsible for the medical consultation?15 - FIRST CALL - Who is responsible for the medical consultation?

MEDGATE is responsible for the medical consultation within the scope of conventional medical practise. The consultations are recorded electronically and stored in archives. In the event of a dispute, the recordings can be presented as evidence. INTRAS has no direct access to these recordings.

16 - What is the difference between OPTIMA+ and QUADRA+ coverage?16 - What is the difference between OPTIMA+ and QUADRA+ coverage?

OPTIMA+ and QUADRA+ offer practically the same benefits. The QUADRA+ plan offers in addition the reimbursement of semi-private or private hospitalization expenses for pregnancy and delivery.

17 - What is the difference between UNO+ and DUE+ coverage?17 - What is the difference between UNO+ and DUE+ coverage?

UNO+ and DUE+ offer practically the same benefits. However, in the DUE+ plan the maximum benefit amounts per year are higher (e.g. for prescription glasses for adults INTRAS grants Sfr. 100.- every 3 years in the UNO+ plan and Sfr. 300.- in the DUE+ plan).

18 - Is there a list of the drugs that are reimbursed under the LAMal?18 - Is there a list of the drugs that are reimbursed under the LAMal?

Prescription drugs that are reimbursed by compulsory health insurance appear on the list of drugs (LMT) and on the list of specialties (LS). A doctor must prescribe them.

19 - What benefits are allocated for dental expenses?19 - What benefits are allocated for dental expenses?

Dental treatment expenses are reimbursed as follows:

- under the MINIMA compulsory health insurance plan:

Reimbursement of dental expenses as a result of an accident or serious illness (such illnesses are listed in the LAMal).

- under supplementary insurance plans:

DENTA:
Reimbursement of expenses for care provided by a dentist, up to 80% after applying the chosen deductible. Laboratory expenses are capped per calendar year (Sfr. 500.- for crowns, Sfr. 600.- for braces and Sfr. 900.- for bridges and dentures). INTRAS also grants an amount of Sfr. 200.- for an annual check-up and scaling.

ECODENTA
Reimbursement of 80% of expenses for care provided by a dentist, including laboratory costs, up to the insured amount (from Sfr. 1’000.- to Sfr. 5’000.-). INTRAS also grants an amount of Sfr. 150.- for an annual check-up and scaling.

20 - Why is it necessary to have a sight test done by an ophthalmologist when requesting the reimbursement of glasses for the first time?20 - Why is it necessary to have a sight test done by an ophthalmologist when requesting the reimbursement of glasses for the first time?

The federal health insurance law (LAMal) requires a sight test by an ophthalmologist when first purchasing glasses, for adults. For children up to age 18, the test is required for each purchase.

21 - What is the purpose of the European card of health insurance?21 - What is the purpose of the European card of health insurance?

Only the french and german versions are available. For more informations in english please follow this link: The European Health Insurance Card

22 - What should I do in the event of an accident?22 - What should I do in the event of an accident?

In the event of an accident you must contact your INTRAS agency and request the “accident report” form, which must be returned within 5 days, duly completed, dated and signed. MINIMA compulsory health insurance provides accident coverage. However, if you are employed you must report the accident to your employer, who insures you against accidents in compliance with the LAA law.

23 - When will I receive my insurance card and how can I use it?23 - When will I receive my insurance card and how can I use it?

You will receive your insurance card as soon as you become a member. The insurance card is a document that has two purposes. When purchasing prescription drugs, the pharmacy can check immediately whether or not those drugs are reimbursed by health insurance.

24 - What are the conditions to qualify for supplementary insurance?24 - What are the conditions to qualify for supplementary insurance?

You must be a Swiss resident and under 65 years of age. If these conditions are met, the application is examined by INTRAS who determines the acceptance conditions in accordance with fixed guidelines.

25 - I am moving abroad; what documents do I need to send to INTRAS to cancel my coverage?25 - I am moving abroad; what documents do I need to send to INTRAS to cancel my coverage?

It is necessary to attach to your cancellation letter a certificate from the population office confirming that you are officially leaving Switzerland.

26 - May I be insured in Switzerland if I reside in a EU country?26 - May I be insured in Switzerland if I reside in a EU country?

Yes, if you are the recipient of Swiss retirement or unemployment payments or if you are a cross-border worker.

27 - What is the notice period for cancellation of compulsory health insurance?27 - What is the notice period for cancellation of compulsory health insurance?

Compulsory health insurance may be canceled each year for December 31st with one month’s notice following the announcement of the new premium. Insured persons with the standard Sfr. 300.- deductible have the additional option of canceling each year for June 30th with three months’ notice.

28 - What is the procedure to insure a newborn?28 - What is the procedure to insure a newborn?

Before the birth of your child, simply request an admission form from your INTRAS agency. Basic LAMal insurance is compulsory and supplementary insurance plans are inexpensive for infants. What’s more, they are approved without prior health examination if the request is made on a prenatal basis.

29 - What notice periods apply to cancellation of supplementary insurance plans?29 - What notice periods apply to cancellation of supplementary insurance plans?

Supplementary insurance plans may be canceled each year for December 31st with three months’ notice. The notice period is one month in the event of a premium increase.

30 - Why is a pharmacist tax due?30 - Why is a pharmacist tax due?

Pharmacy taxes are required under the agreement between the Swiss pharmacy society and insurers, in compliance with the new remuneration system put into place by the federal government. Pharmacists are no longer remunerated by a fixed margin on drugs, but partly for the service they provide (controlling prescriptions, advising customers, dispensing generics, etc).

31 - Do I have to pay invoices before I send them to you?31 - Do I have to pay invoices before I send them to you?

It is not necessary. The payment of invoices is generally due within 30 days. If you send your bill to INTRAS as soon as you receive it, you may be able to wait for reimbursement before paying it.

32 - Where should I send my medical bills for reimbursement?32 - Where should I send my medical bills for reimbursement?

Invoices to be reimbursed must be sent to the right INTRAS agency, the address of which appears on your insurance policy and statements.

33 - How can I reduce the amount of my premiums?33 - How can I reduce the amount of my premiums?

The possibilities for reducing the amount of your premiums are numerous and yet sometimes unknown.

• Subscribe to FIRST CALL, the compulsory health insurance in partnership with MEDGATE, and benefit from a more favorable premium. All you have to do is first call an independent doctor of MEDGATE and follow his/her advice before consulting your doctor.
• The choice of an annual deductible amount larger than the standard Sfr. 300.- for the MINIMA compulsory health insurance will allow you to economize up to 50% of your premium:
  - Adult's deductible: Sfr. 300.-, 500.-, 1’000.-, 1’500.-, 2’000.- and 2’500.-.
  - Children's deductible: Sfr. 0.-, 100.-, 200.-, 300.-, 400.-, 500.- and 600.-.
• The choice of an annual deductible in OPTIMA+ and QUADRA+ hospitalization insurance offers a discount of up to 50% of your premium (deductible amount: Sfr. 1’000.-, 2’000.-, 3’000.- and 5’000.-).
• If you have LAA accident insurance through your employer, you can request cancellation of accident coverage on the MINIMA compulsory health insurance and benefit from a 5% discount.
• By paying your premiums yearly, you benefit from a 1% discount.
• Refunds by postal check cause high administrative expenses of Sfr. 20.- per refund. You can avoid this expense by receiving refunds directly in your bank account.
• 30% of the insured benefit from Cantonal grants. Check whether you qualify by contacting the health insurance service of your Canton!

34 - I moved; why did my premium change?34 - I moved; why did my premium change?

Premium calculations take into account the cost of health care in different cantons or regions (the LAMal allows 3 regions per canton). If an insured moves to another canton or rate region, his/her premium is adjusted accordingly.

35 - What steps is INTRAS taking to prevent premium increases?35 - What steps is INTRAS taking to prevent premium increases?

Premium increases are merely the reflection of cost evolution. Therefore, it is necessary to take measures to slow down the rise in cost. Here are a few of the steps taken by INTRAS:

- inspection of invoices by competent staff members
- collaboration with medical consultants
- participation in health care networks
- rate negotiations with health care providers
- free access granted to medical assistance from MEDGATE by telephone
- the opportunity to request a second medical opinion
- awareness-raising to insured persons.

36 - Why are premiums adjusted?36 - Why are premiums adjusted?

Premium adjustments are necessary to maintain financial balance between insurance income and expenditures. Given the constant rise in health care costs and medical consumption, insurers are required, at the beginning of each year in accordance with legal dispositions, to pass on the cost increase by adjusting the amount of the premium.