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Old 15.10.2011, 11:33
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Question for USA folks on Health Insurance

Hello,

I would very much like my US boyfriend to come live with me in Switzerland.

He has pre-existing condition which is not excluded under his current health insurance in the US, because he has had constant coverage before and since the condition. How could he work this if he moved to switzerland?

Can he somehow "internationalise" is US cover? Are their US insurers that do this? I dont speak about travel health cover, but of true international health cover where you can get ongoing treatment in a country of your choice.

I understand that the insurers in Switzerland will need to cover him, irrespective of pre-existing, for mandatory insurance but if he left switzerland he'd be back in the same boat of having to get a new insurer who would exclude the pre exsisting.

Any advice?
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Old 15.10.2011, 11:39
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Re: Question for USA folks on Health Insurance

As far as I know, and you can confirm this by talking to an insurer, that pre-existing conditions aren't excluded in health insurance, per se
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Old 15.10.2011, 11:41
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Re: Question for USA folks on Health Insurance

Im not American but, you obviously understand the situation. He could get basic cover here irrespective of his condition but, as you say, he would have a problem returning to the US under their system.

Is there any way he can maintain his US cover if he leaves as this seems to be the only solution that I can think of.
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Old 15.10.2011, 11:45
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Re: Question for USA folks on Health Insurance

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Is there any way he can maintain his US cover if he leaves as this seems to be the only solution that I can think of.
I have maintained an international policy with BUPA in the UK, just in case something happens, 17 years later I am not sure it was the best use of money....

If he pays the premiums the policy will continue I would have thought.
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Old 15.10.2011, 12:00
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Re: Question for USA folks on Health Insurance

I'm an American who's lived in Europe for 8 years split between Switzerland(2x's) and Germany.

Regarding your question about internationalizing your boyfriends health insurance, it's not about what the US company will do, it's about the rule for your Canton. The Cantons have an official list of recognized heath insurance companies, to my knowledge they are not standardized across Switzerland but I could be wrong on that point.
Speak to them to find out who's on the list. The size of the insurance company and what they claim is or is not covered abroad doesn't matter, if the Canton doesn't list it then it's not accepted as meeting the legal requirement to have health insurance.

If your boyfriend drops his coverage in the US the cannot go back and get his pre-existing condition included. Unless there's a health insurer who's taken a completely different twist on things in the last few years there, once he's out he is considered a new applicant subject to all of their pre-existing condition clauses.

In the case of my company, all people being transferred into Switzerland get any pre-existing conditions included when signing up for public health insurance. I have one myself and it was included, I'm insured through Helsana.
Perhaps you have such an option available through your company. I've found that benefits coverage for partners is much different here than in the states where they only care if you're married or not.

If your boyfriend is coming for a limited period of time then, in my opinion, he should absolutely find a way to keep paying for his US insurance, you wouldn't want him to loose that coverage for couple of months of premiums.

I know a number of Brits and American who maintain dual health coverages here and in their home country. You may need to consider this and, if the idea is he will be here long term, see what he could reduce in his coverage there while still keeping the critical coverage for his condition.
Many expats go back to their home countries for critical care and even things like dental care, eye care and other needs that are not covered by Swiss insurance.

Hope some of this you find useful. This is based only on my experiences and what I've learned from my expat co-workers, I am not an expert.

Good luck
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Old 15.10.2011, 14:49
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Re: Question for USA folks on Health Insurance

Thanks Dante,

I had considered that we might need to keep his insurance in the US and get the Swiss one to conform to swiss regulations. You don't see any problem with maintaining the US insurance if he is long term resident in Switzerland?

However you arrive in Switzerland, employed or not, I believe you can get Swiss insurance without exclusions. I have no concerns about our ability to have him covered in Switzerland. We'd just be stuck here or stuck with potentially a lot of bills if we moved elsewhere.

We cant be sure where we will end up i.e. Switzerland, USA or elsewhere in Europe. He may not want to return to the USA (I hope) but I don't want him to feel like he has closed a door.

He would not be transferring to Switzerland with an employer and I'm not American so im not transferring either. Marriage is not on the cards for now.
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Old 15.10.2011, 15:13
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Re: Question for USA folks on Health Insurance

Bear in mind that while the basic obligatory insurance does not exclude coverage based on pre-existing conditions, the supplementary insurance can and, in my case, does.

Whether this affects the care available to your boyfriend is very much dependent on his condition, and on where you live in Switzerland.

From what others have posted on this subject on other threads, folks living in cantons like ZH, where a wider range of health care options are available, are very happy with only basic coverage.

I have not had good experiences, however. One factor is, IME, that not having the supplementary insurance limits my access to more highly qualified doctors. In a hospital, my insurance does not allow me to be seen by a Chefarzt, or Oberarzt. In a larger canton this may not be a problem, as good doctors, regardless of title, seem to abound. But in the boondocks were expertise is somewhat thinner on the ground, this has been a problem for me.

This is very much a YMMV issue. As said, many find the basic cover perfectly adequate, even for complicated conditions.

I would urge your boyfriend to try to maintain his US coverage if possible. It likely won't help him in Switzerland but it might be critical if he plans a return to the US in the future. A couple friends of mine have had a bad time upon their return to the US, unable to get the kind of insurance coverage they had prior to leaving due to pre-existing conditions. This terrifies me, looking ahead to the day when I go back to the US - I wish I had kept my US policy, in hindsight it would have been a good investment.

(But then again, I have no idea what healthcare reform will look like if/when it gets off the ground...)
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Old 15.10.2011, 15:48
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Re: Question for USA folks on Health Insurance

I think the answer may depend on the status your boyfriend would have here in Switzerland, and the status he'd have if he went back to the US.

Would he come on an employer sponsored work permit? On a fiance visa? Or as a 3 month tourist. As a tourist I don't think he has to get Swiss Insurance and in fact I don't know that he'd be eligible for it.

And similarly, if he came and went back, on what terms would he go back? Working directly for a large company? As a self employed consultant? As a retiree?

Regarding US law, if he would likely be covered by employer coverage, there are HIPPA regulations which apply at the federal level, and individual states often have additional protections. Note that I'm not sure if foreign health insurance counts as "creditable coverage". By common sense it should be, but in practice I wouldn't want to guess.

I know that it can be very problematic to find insurance without a preexisting condition waiver as an individual or small business owner. I would also expect it to be problematic for retirees.
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Old 15.10.2011, 16:58
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Re: Question for USA folks on Health Insurance

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Thanks Dante,

I had considered that we might need to keep his insurance in the US and get the Swiss one to conform to swiss regulations. You don't see any problem with maintaining the US insurance if he is long term resident in Switzerland?
W
From what I remember, and I haven't had US health insurance for more than 8 years now, one thing in the US which is similar to Europe is that it's partially based on residency as they include that in calculating premiums. I do not know how it would work if he no longer has a US address. It would be a good question to ask an agent over there.

When I applied for health insurance both times in Switzerland I had to disclose any pre-existing conditions but was told it's not a problem per the agreement with my company, so I really do not know how it works if such an agreement does not exist with his or your company, sorry I can't be of more help on that one. All I can recommend is to ask for the details now before making your final decision.

Regards,
Dante
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