*Mandatory fields
What was the annual salary and degree of employment at or just before the onset of the incapacity for work or to earn?
During which period and to what degree was the insured person unable to work or earn an income?
Insurance institutions involved in this case:
Contact person
For further information please provide your contact details or the contact details of the responsible contact person at your employer’s company.
Please enclose copies of daily benefits statements from the onset of the incapacity for work until today.
Note: If your employee benefits contract is managed by a dedicated foundation with reinsured benefits, we require the following documents:
You can upload the documents as a file here.
Note: In order to definitively enter the incapacity for work or incapacity to earn you reported, we need additional information from the employee concerned.
Please give the following form to your employee for further details of the incapacity for work or to earn. This form must be completed and signed by your employee and then returned to us.
Form for incapacity for work or incapacity to earn – employee section
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All personal data will be processed in accordance with the current legislation: For compulsory occupational benefits, the data protection regulations of LOB (Art. 85a ff. LOB) apply. The provisions of the FADP apply in addition. The FADP applies to purely supplementary occupational benefits (for information e.g. identity and contact details of responsible persons, processing purposes, etc. please see www.helvetia.ch/privacy).
All personal data will be processed in accordance with the current legislation: For compulsory occupational benefits, the data protection regulations of LOB (Art. 85a ff. LOB) apply. The provisions of the FADP apply in addition. The FADP applies to purely supplementary occupational benefits (for information e.g. identity and contact details of responsible persons, processing purposes, etc. can be found under the keyword data protection at www.servisa.ch.
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If, prior to retirement, an insured person is at least 40% unable to work for an uninterrupted period that is longer than the waiting period specified in the benefit plan, the obligation to pay contributions ceases in full or in part upon expiry of the waiting period.
During the first year from the start of incapacity for work, contributions are waived on the basis of the incapacity for work as certified by a doctor; thereafter, contributions are waived on the basis of the degree of disability set by the invalidity insurance scheme (IV).
The waiver of contributions is calculated according to the following scale:
Download PDF form
You can download blank forms as a PDF via the following links:
or:
Download current interim status of the online form as PDF
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