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Old 05.11.2015, 17:48
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Insurance claim for miscarriage...

I would have a question for somebody who is "in the know" with the Swiss law and insurance. Namely, I've just received the claim from the insurance company (Groupe Mutuel) where they are stating that we are due to pay them for the abortion procedure my wife had at the end of the 2013 (as baby died after 10 weeks). Based on the info I got from them, they are stating the following: "before March 1st 2014, miscarriage was associated to illness as a complication of pregnancy (Swiss Federal Law on health insurance (FLHI))".


Could you kindly advice what should I do as this entire stuff is just to annoying to deal with...


Thanks in advance!
G.
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Old 05.11.2015, 19:55
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Re: Insurance claim for miscarriage...

Hi G,

I am so sorry for your loss. I think you will find all necessary information here:

https://www.ch.ch/en/pregnancy-health-insurance-covers/


"Complications between the first week of pregnancy up until the 12th week are still classed as illnesses, so you will still have to contribute towards treatment costs during this period of the pregnancy. "

I hope this helps!
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Old 05.11.2015, 20:01
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Re: Insurance claim for miscarriage...

Hi sorry but they are correct. Like many others we went through the same. Miscarriage is classed as maladie.
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Old 05.11.2015, 20:14
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Re: Insurance claim for miscarriage...

"10. Are all services provided in connection with pregnancy or childbirth exempt from cost sharing?
Insured women are not required to contribute to the costs of specific maternity services.
In addition, they are no longer required to contribute to the costs of general services or care services in the event of illness from the 13th week of pregnancy until eight weeks after childbirth. This means that they no longer have to contribute to the costs of treatment for non-pregnancy-related illnesses."

From the federal source.
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Old 05.11.2015, 22:17
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Re: Insurance claim for miscarriage...

Guys many thanks for the info provided!!

All the best;
G.
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Old 06.11.2015, 08:54
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Re: Insurance claim for miscarriage...

Quote:
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Hi G,

I am so sorry for your loss. I think you will find all necessary information here:

https://www.ch.ch/en/pregnancy-health-insurance-covers/


"Complications between the first week of pregnancy up until the 12th week are still classed as illnesses, so you will still have to contribute towards treatment costs during this period of the pregnancy. "

I hope this helps!
Quote:
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"10. Are all services provided in connection with pregnancy or childbirth exempt from cost sharing?
Insured women are not required to contribute to the costs of specific maternity services.
In addition, they are no longer required to contribute to the costs of general services or care services in the event of illness from the 13th week of pregnancy until eight weeks after childbirth. This means that they no longer have to contribute to the costs of treatment for non-pregnancy-related illnesses."

From the federal source.
Just for the record: both of these citations reflect the current legal state of affairs. As the OP's insurance company says, there was a major change in March 2014.

Under the old law, miscarriage at any stage of pregnancy was counted as "illness" (as were all lesser pregnancy complications) and so one's normal franchise/excess/deductible applied.

Heartfelt condolences to you and your wife, Golum.
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