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Reimbursement Assurance Programme Terms and Conditions

Effective as of: 29-04-2026

1. Purpose

1.1. Reimbursement assurance

Ahead maintains a coverage checker showing expected supplementary insurance reimbursements for its services. Where the coverage checker indicates that a Customer's insurer will reimburse, and the insurer ultimately does not, Ahead will assist the Customer with corrected documentation and, if the denial stands, issue a credit matching the indicated coverage amount.

1.2. Nature

The Reimbursement Assurance Credit is a voluntary commercial discount. It is not an insurance product, guarantee within the meaning of Art. 111 CO, or indemnity, and does not constitute insurance intermediation within the meaning of the VAG.

1.3. Standalone terms

These Terms are standalone participation conditions (Teilnahmebedingungen). They do not form part of Ahead's Terms & Conditions or Privacy Policy.

2. Definitions

2.1. "Coverage Checker" means the non-binding coverage estimation tool provided by Ahead on its website, which becomes accessible to the Customer once they provide an email address and select their insurer and supplementary insurance package.

2.2. "Indicated Amount" means the maximum reimbursement displayed in the Coverage Checker for the Customer's insurer, package and service at the time of booking, based on the insurer's published terms as known to Ahead. The Indicated Amount reflects the insurer's general policy entitlement (e.g. "75% up to CHF 500 per calendar year") before application of the Customer's individual circumstances, including remaining budget, deductible (Franchise) and co-payment (Selbstbehalt).

2.3. "Credit" means a Reimbursement Assurance Credit issued by Ahead under this Programme.

3. Eligibility

3.1. Eligible services

  • Core MRI check-up
  • Advanced MRI check-up
  • Pro MRI check-up
  • Advanced blood test

3.2. Conditions

The Programme applies when the Customer:

  1. used the Coverage Checker before booking and was shown a non-zero expected reimbursement for their insurer and package;
  2. subsequently booked and completed an eligible service at the full published price;
  3. held valid, active supplementary insurance (VVG) with the indicated insurer and package at the time of the appointment and through the date of claim submission; and
  4. correctly identified their insurer and supplementary insurance package.

3.3. Acceptance

By using the Coverage Checker, the Customer accepts these Terms. The Programme then applies automatically to any subsequent booking that meets the conditions in Section 3.2.

4. Process

4.1. Claim submission

After the appointment, the Customer submits a reimbursement claim to their supplementary insurer within the insurer's stated claim period, or within 90 calendar days of the appointment if no period is stated. Ahead provides the invoice and supporting documentation.

4.2. Notification to Ahead

If the insurer denies the claim or reimburses less than the Indicated Amount, the Customer notifies Ahead within 30 calendar days of the insurer's decision, providing:

  1. the insurer's written denial or partial reimbursement statement;
  2. the Ahead booking confirmation or invoice number; and
  3. confirmation of the insurer and package held at the time of the appointment.

Notification: get@aheadhealth.com

4.3. Documentation support

Ahead reviews the denial and, where appropriate, provides corrected or additional documentation for the Customer to resubmit to their insurer.

4.4. Credit

If the denial stands after the Documentation support process, Ahead issues a Credit representing the reimbursement shortfall from the Customer's supplementary insurance:

  1. Full denial: the Credit equals the Indicated Amount (the amount the supplementary insurance was expected to cover).
  2. Partial shortfall: the Credit equals the difference between the Indicated Amount and the amount actually reimbursed by the supplementary insurance.
  3. Cap: the Credit shall not exceed the Indicated Amount displayed at the time of booking.

4.5. Example

A Customer with CSS myFlex Balance (supplementary insurance) books an Advanced MRI (CHF 2,490). The Coverage Checker shows that CSS is expected to reimburse "50%, max. CHF 500 every 2 calendar years" — i.e., the Indicated Amount is CHF 500. CSS denies the claim entirely. After Documentation Support, CSS maintains the denial. Ahead issues a Credit of CHF 500 (the supplementary insurance shortfall). Had CSS reimbursed CHF 300, the Credit would be CHF 200 (the difference). Ahead does not cover the remaining cost that is not covered by supplementary insurance.

5. Credit delivery

5.1. The Credit is delivered as a bank transfer to the Customer's Swiss IBAN, within 15 business days of approval.

6. Exclusions

6.1. The Programme does not apply where:

  1. the Coverage Checker showed no expected reimbursement for the Customer's insurer and package;
  2. the Customer did not submit a claim to their insurer on time, or did not notify Ahead within 30 days of the insurer's denial;
  3. the Customer's supplementary insurance had already exhausted the applicable benefit limit for the relevant period; or
  4. the insurer applied a standard deductible (Franchise) or co-payment (Selbstbehalt).

7. Limitations

7.1. One Credit per service per applicable benefit period.

7.2. Credits cannot be combined with other Ahead promotions or corporate benefit programmes, unless explicitly stated.

7.3. Credits are personal and non-transferable.

7.4. Ahead may issue a Credit at its discretion where the strict conditions are not met. This does not create precedent.

8. Coverage checker

8.1. Ahead maintains the Coverage Checker on the basis of direct communication with Swiss insurers and publicly available documentation. Ahead reviews and updates the Coverage Checker at least every six months. Changes can be reported to get@aheadhealth.com.

8.2. The Coverage Checker reflects insurer terms as known to Ahead at the time of the last update. Ahead does not guarantee real-time accuracy.

9. Data processing

9.1. Coverage Checker data

When using the Coverage Checker, the Customer provides their email address, insurer and supplementary insurance package. Customers may additionally provide their name and gender. The processing of this data is covered by Ahead's privacy policy, which the Customer accepts at the Coverage Checker email wall.

9.2. Legal basis

Ahead processes data under this Programme on the basis of its legitimate interest (Art. 31(1) nFADP) in administering the Programme and standing behind the accuracy of its published coverage information. This interest is balanced against the Customer's interests, taking into account that (a) the Programme is to the Customer's benefit, (b) the data processed is limited to what is necessary, and (c) no sensitive personal data is proactively collected by Ahead for this purpose.

9.3. Customer-initiated submissions

When making a claim, the Customer voluntarily submits the insurer's denial or reimbursement statement (Section 4.2(a)) and their IBAN for the Credit transfer (Section 5.1). Customers should redact any medical detail from the denial statement that is not relevant to the coverage decision. Ahead will process only the outcome (denied/partial, amount, reason) and will not retain the original document beyond what is necessary.

9.4. Retention

Data collected at the Coverage Checker stage is retained in accordance with Ahead's general data retention policy. Data submitted under a Programme claim (Section 9.3) is retained for at least 3 years from the Credit decision.

9.5. Access restriction

Programme claim data (denial statements, IBANs) is accessible only to the Ahead team members responsible for administering the Programme and, where necessary, finance.

9.6. No third-party sharing

Ahead does not share Customer data with insurers or other third parties under this Programme. Documentation support (Section 4.3) consists of providing corrected documents to the Customer, who submits to their insurer themselves, unless otherwise explicitly requested by the Customer.

9.7. Rights

Customers may exercise their rights under the nFADP (access, rectification, deletion, data portability) by contacting privacy@aheadhealth.com.

10. Changes and termination

10.1. Ahead may modify or discontinue the Programme at any time. Changes apply to future bookings only.

10.2. Participation does not create any ongoing entitlement beyond a specific validated claim.

11. Governing law and jurisdiction

11.1. Swiss law governs these terms.

11.2. Exclusive jurisdiction: Zurich, subject to mandatory statutory provisions.

12. Contact

12.1. Programme: get@aheadhealth.com

12.2. Data protection: privacy@aheadhealth.com