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Old 25.11.2008, 01:05
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Health Insurance and Pre-existing conditions?

Abt to move to Switzerland (Zurich).

I'm curious as to whether the mandatory insurance I'd purchase will cover pre-existing conditions? Our child has a (treatable) heart condition that will require significant surgery when he turns about 2 years old?

I assume it goes without saying that health facilities, etc in Switzerland are excellent....
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Old 25.11.2008, 03:53
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Re: Health Insurance and Pre-existing conditions?

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I'm curious as to whether the mandatory insurance I'd purchase will cover pre-existing conditions?
Yes, pre-existing conditions are covered.

Cheers,
Martin
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Old 25.11.2008, 08:00
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Re: Health Insurance and Pre-existing conditions?

I can concur. Our son has type 1 diabetes. There is nowhere in the application progress where you have to declare these things, and it doesn't affect your compulsory insurance.

I have recently discovered that the Australian authorities are not as forgiving - you would probably be denied permanent residency in Australia if your child had a serious health issue...

In fact, I'd daresay that Switzerland must be one of the few places in the world where you can get such high quality health care for all...of course, you pay it through your health insurance fees.. as a family of 5 we are paying around 800chf a month from our after-tax salary for our compulsory health cover...

Oh, and if our recent experience is anything to go by, at the children's hospital (kinderspital) all the professional staff and most of the administration staff speak good English...



Oh, and if you are looking for a broker for your health insurance, I can recommend 'Insurance Jenny' - she's here on the forum...she explained and translated all the basic information for us and made recommendations for combined insurance for our family that was cheaper than the 'comparis' prices, and significantly lower price than the insurance suggested by our employer...
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Old 25.11.2008, 09:36
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Re: Health Insurance and Pre-existing conditions?

Just to clarify, by law you can't be refused basic health insurance for pre-existing conditions.
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Old 25.11.2008, 11:06
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Re: Health Insurance and Pre-existing conditions?

On a practical note, our insurer took longer to stuff around with our son's application (the one with health issues) and the other two children's paperwork arrived much faster.

I was 'cheeky' (our doctor told us no problem) and declared that my child was insured with the particular insurance company, but the papers hadn't arrived yet, and they allowed us to see the doctor and hospital specialist...they said they could contact the insurer themselves and request the insurance number (and would get faster service than we would...)...

They do back-date cover, so even though for the first 2.5 months we were here we didn't see a doctor, our first paperwork came with a bill covering those months...which was a fairly hefty bill when it finally arrived...
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Old 26.11.2008, 01:10
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Re: Health Insurance and Pre-existing conditions?

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Just to clarify, by law you can't be refused basic health insurance for pre-existing conditions.
This is true but one might not be entirely satisfied with the basic insurance, which is why many people take the supplementary insurance giving additional benefits and more extensive coverage. For example, with the basic insurance, it will only cover you for a hospital in your own canton. What if the top specialist is at a hospital in a different canton? I would want to have that choice. There are other benefits as well offered in the supplementary insurance.
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Old 04.09.2013, 09:52
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Re: Health Insurance and Pre-existing conditions?

This is interesting because I have heard on a documentary that pre-existing conditions are not covered in Switzerland.

Perhaps they were refering to the complementary insurance instead of the basic insurance?

What about in the US now?
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Old 04.09.2013, 10:03
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Re: Health Insurance and Pre-existing conditions?

You will get basic cover for pre-existing conditions which would be based on KVG

Supplementary insurance may refuse cover

I've no idea about the US but if you're travelling there, take out travel insurance and talk to your provider of KVG (I assume it's with regards to visiting the US that you ask this question).
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Old 04.09.2013, 11:04
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Re: Health Insurance and Pre-existing conditions?

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This is interesting because I have heard on a documentary that pre-existing conditions are not covered in Switzerland.

Perhaps they were refering to the complementary insurance instead of the basic insurance?
An insurance covers risks and a pre-existing condition is no longer a risk but a fact, i.e., no real insurance covers pre-existing risks. Since Switzerland's mandatory health insurance is only an insurance by name, pre-conditions are always covered.
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Old 04.09.2013, 12:31
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Re: Health Insurance and Pre-existing conditions?

carcharhinus, out of curiosity, why is the mandatory health insurance "by name" only?
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Old 04.09.2013, 12:51
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Re: Health Insurance and Pre-existing conditions?

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An insurance covers risks and a pre-existing condition is no longer a risk but a fact
Hi, well it depends on what language you apply. In France you will call it "sécurité sociale" and so the word "insurance" dissapears...

The concept of national health insurance is slightly different to life, car or home insurance. The basic idea is to leverage health costs in a way that is bearable by the society as a whole, regardless whether the condition is pre-existing or not. In this context, I would however argue that zero coverage be provided for pre-existing conditions where delibarate misconduct is proven (lung cancer and smoking for example).

All that said, I do clearly recall having seen / heard that pre-existing conditions are not being covered in Switzerland, just the same as in the US - hence my inquiry
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Old 04.09.2013, 13:04
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Re: Health Insurance and Pre-existing conditions?

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carcharhinus, out of curiosity, why is the mandatory health insurance "by name" only?
Because the premium is not based on risk, i.e age of person & existing health conditions.
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Old 04.09.2013, 14:05
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Re: Health Insurance and Pre-existing conditions?

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carcharhinus, out of curiosity, why is the mandatory health insurance "by name" only?
Because technically speaking an insurance product prices risk. It does not - as many people believe - pool costs.

The basic Swiss health insurance packages do not price risk at all, in fact they are forbidden by law to do that (thus preconditions don't matter).

Instead, they pool costs, so they're not real insurance products but more akin to "social security".

Unlike most European countries, Swiss health insurance is not priced proportionally (or "progressively" proportionally) to the payer's income. I personally like that.
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Old 04.09.2013, 14:36
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Re: Health Insurance and Pre-existing conditions?

As of 2012, on the basic insurance you can go to another kanton for care. Out patient services, e.g. specialists consult should be covered. Inpatient care is a bit more confusing and seems to depend on the kanton. If you go outside your kanton you might be charged for the difference between your home kanton and the kanton where you choose to receive care. But if it's something you cannot get within your kanton, or an emergency, I'm pretty sure you're covered.

I live in Zurich. My frauenarzt and oncologist and my husband's eye surgeon are in Bern. We've been covered for all our visits over the past year and a half.
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Old 04.09.2013, 16:08
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Re: Health Insurance and Pre-existing conditions?

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In fact, I'd daresay that Switzerland must be one of the few places in the world where you can get such high quality health care for all...of course, you pay it through your health insurance fees.. as a family of 5 we are paying around 800chf a month from our after-tax salary for our compulsory health cover.
Then you're doing well because we pay that just for two of us - admittedly we're getting on a bit, but apart from OH having type 2 diabetes we're in good health.
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Old 04.09.2013, 16:31
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Re: Health Insurance and Pre-existing conditions?

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Then you're doing well because we pay that just for two of us - admittedly we're getting on a bit, but apart from OH having type 2 diabetes we're in good health.
Sounds like you have some extra insurance & a low franchise.
Premiums from age 35-75 don't change for basic,
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Old 04.09.2013, 16:49
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Re: Health Insurance and Pre-existing conditions?

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Sounds like you have some extra insurance & a low franchise.
Premiums from age 35-75 don't change for basic,
No, just basic. I think our excess is CHF700. Our premiums go up year on year.
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Old 04.09.2013, 17:00
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Re: Health Insurance and Pre-existing conditions?

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As of 2012, on the basic insurance you can go to another kanton for care. Out patient services, e.g. specialists consult should be covered. Inpatient care is a bit more confusing and seems to depend on the kanton. If you go outside your kanton you might be charged for the difference between your home kanton and the kanton where you choose to receive care. But if it's something you cannot get within your kanton, or an emergency, I'm pretty sure you're covered.

I live in Zurich. My frauenarzt and oncologist and my husband's eye surgeon are in Bern. We've been covered for all our visits over the past year and a half.
I think that the exception to this is when you sign up for some of the lowest cost LaMal plans where they are HMO/Network setups. There are then restrictions as to the doctor you can go to. You also need to go to your GP first before going to a specialist etc.

If someone needs/wants flexibility on who they see and where (often when you work in one canton and live in another), be sure to ask if the specific plan you sign up for allows this or not (a bit of buyer beware on the low cost plans).
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Old 04.09.2013, 17:41
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Re: Health Insurance and Pre-existing conditions?

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I think that the exception to this is when you sign up for some of the lowest cost LaMal plans where they are HMO/Network setups. There are then restrictions as to the doctor you can go to. You also need to go to your GP first before going to a specialist etc.

If someone needs/wants flexibility on who they see and where (often when you work in one canton and live in another), be sure to ask if the specific plan you sign up for allows this or not (a bit of buyer beware on the low cost plans).
Absolutely right. If you want to maximise your flexibility, the telemedicine or classic plan is best.
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Old 04.09.2013, 17:50
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Re: Health Insurance and Pre-existing conditions?

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I think that the exception to this is when you sign up for some of the lowest cost LaMal plans where they are HMO/Network setups. There are then restrictions as to the doctor you can go to. You also need to go to your GP first before going to a specialist etc.

If someone needs/wants flexibility on who they see and where (often when you work in one canton and live in another), be sure to ask if the specific plan you sign up for allows this or not (a bit of buyer beware on the low cost plans).
I have HMO, but recently had some blood tests & Dr appointment in another canton due to work, it was just deducted from my excess as normal. I see an eye specialist again in another canton, again no problems. Having a 2500 franchise I always end up paying everything myself, so that way you have the lowest premiums & can go pretty much where you like. I had a minor operation in France cost 74.45 euro, I hate to think how much of my franchise I would have used in CH! Probably 1,000 or more.
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