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Krankenkassen-Center Schweiz
Telefon 041 740 66 00

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Fill in this form only for general questions. For a comparison of quotations and/or of benefits please fill in the form at quotations.
 Quotation request / Requirements analysis
Your information will be kept strictly confidential!
 
Surname, First Name:
Exact Address:
Post Code/Zip Code, City/Town: /
Tel. Private:
Tel. Business:
The best time to phone me: Date: Time:
E-Mail:
 
Personal Data
 
First Name Date of Birth Franchise Sex Accident cover
e.g. Thomas 10 May 1975 Select Select Select
Family member 1
Family member 2
Family member 3
Family member 4
Family member 5
Family member 6
Family member 7
 
Additional models of the compulsory basic insurance
I would like the HMO-Model
I would like the family doctor / GP model
I would like the telephone model
 
Daily allowance / Loss of earnings insurance:
Sfr. per day including accident
From Day excluding accident
 
Current health insurance company:
 
I would like a quotation only for basic insurance
I would like a quotation with supplementary insurance
   
Additional benefits at the hospital:
General Section (Switzerland and Liechtenstein)
General Section (Switzerland and Liechtenstein) in a single room
General Section (Switzerland and Liechtenstein) in a double room
Semi-private section (Switzerland and Liechtenstein)
Private section (Switzerland and Liechtenstein)
Flexible choice of hospital section Ward
For women:    with maternity cover without maternity cover
 
     
Supplementary Insurance
For a quotation with supplementary insurance we need additional information from you. Please mark in the table below which supplementary benefits are important for you.
 
Very
 
Not
 
Important
Important
Important
Insurance abroad
Alternative medicine
Eyeglasses and contact lenses
Fitness centre costs
For children: Dental corrections
 
Capital in fatal accident
3,000.- 5,000.- 10,000.- 20,000.-  
30,000.- 40,000.- 50,000.-  
 
Capital in invalidity accident ( progressive 350%)
20,000.- 30,000.- 40,000.- 50,000.- 60,000.-
80,000.- 100,000.- 150,000.- 200,000.-
 
Additional information
Very
 
Not
 
Important
Important
Important
Parents and children in the same health insurance company
Compulsory basic insurance and Supplementary insurance with the same health insurance company
Additional insurance schemes:
I need a legal protection/expenses insurance
I need a personal liability insurance
I need a home insurance
Comments:
 
What is 1 + 1?
 
   

 

Krankenkassen-Center Schweiz
Zugerstrasse 47 Telefon: 041-740 66 00
CH-6312 Steinhausen Telefax: 041-740 66 01