If a baby is born with an inborn defect and otherwise is found healthy, is the insurer likely to exclude the birth defect from the scope of health insurance?

Would expenses related to birth defects (consultations, surgery, hospital stay) fall under basic or complimentary insurance?

And 'birth defects' to me do not equal 'complications at birth' which I believe can be covered by pre-birth insurance, but correct me if my reasoning is incorrect.

Please reply with your thoughts or experiences.
Thank you

Basic insurance must cover everything by law. They cannot refuse you.

Some birth defects are covered by the Invalids Insurance (IV), instead of your own private health insurance.

It all depends on the situation.

And as to what your complimentary insurance covers, depends on what policy you have and what in entails.

My daughter's neck didn't develop straight. Chiropractic visits and correction were covered but orthopedic therapy for facial asymmetry was not covered. I have extra insurance (the full works) too. Hope this helps.

Your baby will be covered by basic insurance even if the insurance company knows it will lose money by insuring him/her. This was confirmed to be by a haemophiliac friend who move to this country and got medication which cost the insurance company 17000 chf per month, while his premium was 300chf per month. They have to insure by law where it is deemed essential. I do not believe your baby will be covered for cosmetic stuff which you (and most people) may consider to be essential.

Thank you all for quick replies!

Do you mean the treatment for your daughter above was covered as part of the basic or the extra insurance ?

Anyway, a broker told me there should be no exclusions of pre-existing conditions as long as the baby is born perfectly healthy...

Anyway, I know the defect will require consultations and surgery not just band-aid or cosmetic treatments and would imagine this will cost a lot and find it somewhat hard to believe insurers are willingly going to cover, hence my question.

Thank you!

The basic insurance cannot exclude your child from essential medical treatment. What is considered essential and covered is set down in the swiss regulations.

Our situation is similar, we arrived with one of our children who has type 1 diabetes. His medical costs to the insurance are about 400chf per month. They would not cover him for extras like a private room if he is hospitalised, but he still gets all the standard cover which includes all his specialist appointments, Paediatrician consultations, and medication less 10%.

The 10% medication ends up being 30chf per month for 300chf costs. We're just grateful that he is a) covered, and b) we can afford the extra costs.

It's a pretty generous system - in Australia as a migrant you don't get medicare (universal health cover) for the first two years residency...unless you are really lucky...

Thank you!

What I found on the topic on comparis.ch - see Item 4 Birth defects:

http://en.comparis.ch/krankenkassen/...sicherung.aspx

+ list of birth defects falling under insurance provided relevant conditions are met:

http://www.admin.ch/ch/d/sr/832_112_31/a19a.html

So, in answer to your question, I think you will find that the basic insurance will cover the essentials that your child needs for treatment of their medical condition.

The best person to ask would actually be your obstetrician or specialist who has diagnosed and suggested treatment for your unborn child...they would be definitely aware of what is covered/not covered, and what the treatment is likely to cost, and if it is going to cost you money, alternative sources like charities that support the cost of the treatments...

You could also try phoning your health insurance company - if you already have one. If you have specific health insurance questions, I can also highly recommend 'Insurance Jenny' on our forum - she is an english native-speaker, fluent in French and does freelance insurance brokerage - she can explain you the system, check things for you and she won't even oblige you to take her offer...

her forum name is 'jenny' - do a search for similar threads, or just Pm her...

Congenital birth defects and problems at birth is one of the reasons why the Swiss actually set up the insurance ahead of the birth - usually all the paperwork is completed at the beginning of the 3rd trimester and then the final details (i.e. birthdate, name) at the birth.

This may no longer be relevant in your case though.

Your baby shall be covered by basic insurance even if it is not a good deal for the insurance company. Company cannot deny insurance (basic) in your case.

It cannot exclude your child from essential medical treatment or list covered under insurance regulations.

Yes, had something similar with daughter's neck not turning (problem at birth), but daughters physiotherapy was all covered (private insurance). It may have helped that dr. wrote a note requiring such physio to correct the condition. I think you need to distinguish what is a medical/health illness requiring medical attention versus what is more a therapy to help or improve/alleviate a condition.

In speaking with my daughter's physiotherapist she mentioned in passing that for example, children born with down syndrome in Switz. are generally not covered for physiotherapy, thus many do receive treatment that will help them unless parents pay. Wheras if a child has an accident and breaks a limb, a medical issue, physiotherapy will likely be coverd to get that limb back to normal function. Just passing on her words.

I believe the Invalide Insurance (Invalide Versicherung, IV) covers defects to the child arising before the birth i.e. in the womb.

Your Gemeinde Social Services Department can give you more information. I know for instance the IV will pay for straightening the teeth, but not sure if they pay when the child is born outside of Switzerland.