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Old 10.08.2010, 14:17
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Complimentary Insurance terminated with immediate effect what are my rights ?

I signed a Complimentary Medical Insurance contract in Oct'2008 with Sana 24. On the contract there was a question stating :

Besteht eine Zahnfehlstellung resp. eine korrekturbedürftige Zahnstellung ? (ärztlich festgestellt)

From what I understand the question was asking if I had misaligned teeth and was there a correction required for the misaligned teeth à verified/confirmed by a doctor.

I had the problem of severe Bruxism in 2007 and I had to visit my dentist several times in 2007 and 2008

In 2007 as a solution the dentist told me to use a NTI Splint at night time this controlled my Bruxism.

At no time in 2008 did my dentist tell that I had misaligned teeth. So when I signed the contract in Oct’2008 for the Complementary Insurance with Sana 24 I answered the question as “No”.

In Sept’2009 when I visited my dentist I was diagnosed with an open bite.

Now when I sent a bill for new Splint made in Nov’2009 to Sana 24. Sana 24 inquired with my dentist regarding this bill.

This week Sana 24 sent me a letter saying that the Complementary Insurance is being canceled with immediate effect (Ausschluss auf der Zusatzversicherung Basic nach dem Versicherungsvertragsgesetz(VVG))

The reason they give is that apparently my Dentist had diagnosed me with the misaligned teeth prior to me signing the contract and that I had lied in the Contract.

Now when I received the Letter I contacted my Dentist and told him that I was never diagnosed with misaligned teeth in 2008 but I was diagnosed with an open bite in 2009.

My Dentist has asked me to send a copy of Letter from Sana24 and copy of the Original Contract.
I hope my Dentist will be able to clarify this.

But my Question are as follows :
1)What happens that the Dentist says that he told me that I had misaligned teeth. It is then my word against his ! What can I do ? Surely there must be something in his notes. Do I need to get a lawyer or contact a consumer group to resolve the matter with my dentist and with Sana 24?

2)What are rights to defend myself or appeal against Sana24 decision?

3)What can I do to provide the concrete evidence to prove that the Dentist did not diagnose me with this condition ?

4)Sana 24 have written that they could take legal action if I understand the Last Sentence of this letter.

“Dieser Ausschluss bezieht sich auf die Zusatzversicherung Basic mit Spital Allgemein Ganze Schweiz und die Visana Versicherung AG wird für die ausgeschlossenen Behandlungen weder rückwirkend noch zukünftig Leistungen erbringen”

What are they trying to say exactly ? Do I also have to make payments for bills Sana 24 have already paid ?

5)Will this black mark that I lied to a medical Insurance Company go in my profile if I am unable to defend myself. I mean when I apply for a Swiss Passport or apply for a flat or apply for a new complimentary Insurance will they hold this against me ?

Any tips or advice will be much appreciate
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Old 10.08.2010, 14:30
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Re: Complimentary Insurance terminated with immediate effect what are my rights ?

In future. use a font that's more readable on-screen.

I'd wait to hear what your dentist has to say before proceeding. If he's on your side, then the whole thing is moot.
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Old 10.08.2010, 14:32
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Re: Complimentary Insurance terminated with immediate effect what are my rights ?

I think you should go and talk to them or simply call another company and ask...
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