Dental treatment and ceiling
I sent you an invoice for dental treatment amounting to 5 000 CHF but was reimbursed only 2720 CHF, even though the annual ceiling shown in the list of benefits is 3300 CHF. Is this a mistake?
No. The ceilings for dental treatment and other items, as shown in the list of CHIS benefits, are ceilings for expenditure and not for reimbursement. This means that 3300 CHF is the maximum amount of expenditure that can be used as the basis for calculating the reimbursement. The table below explains how the amount of reimbursement is calculated, assuming that no other invoice for dental treatment has been submitted in the year concerned (initial cumulated FCA = 0 CHF, invoice = 5000 CHF).
| Dentist's invoice | Reimbursement | At your expense | Total FCA | Rate |
|---|---|---|---|---|
First 2 500 CHF | 2 500 CHF*80%=2 000 CHF | 500 CHF | 500 CHF | 80% |
Following 800 CHF (3 300 CHF ceiling reached) | 800 CHF*90%=720 CHF | 80 CHF | 580 CHF | 90% |
Remaining 1 700 CHF | 0 CHF (ceiling reached) | 1 700 CHF | 580 CHF | 0% |
Total 5 000 CHF | 2 720 CHF | 2 280 CHF |