hi all!

I've scanned through previous posts but haven't found one that is exactly what I'm looking for. Here's the situation:
- new to Switzerland end of November
- put in application to Avanex for basic and supplemental insurance mid-December
- received notice on Dec 30 that they needed more time to process (due to holiday season I'm guessing)
- found out earlier this week they are still going through my supplemental application, but they can sign me up for basic now if I wanted
- discovered last night I am pregnant

so I have 2 questions as my application is still in the processing stage on if I should change anything before they put it through:

1) I had put in a deductible of 2500 since I never go to a doctor. Now that is going to be changing, what would be the advisable for this year? should I drop it down to 300 or somewhere in between? No idea how much having a baby in Switzerland is going to cost...

2) is there anything else I should make sure I should request in the supplemental??

Thanks in advance for your help! Still in shock, but need to pull myself together since I have this opportunity to tailor make the insurance for a year where I am preggers

Hi,

first of all congratulations!

Pregnancy is fully covered on basic insurance (including e.g. the prenatal checkups and tests and a certain number of scans, delivery in a public hospital, c-section if medically necessary, midwife care at home after the birth, etc.. ). It is thankfully not treated as an 'illness' and is handled separately to your deductible (i.e. you don't pay anything). So there's no need to change your deductible in preparation for it.

The only things I remember having to pay myself were the prenatal vitamin pills and the phone calls from my hospital bed after giving birth.

If your supplementary options include private or semi-private cover, the chances are you won't be covered by those for your pregnancy - most insurers require you to have been with them for a period of time (e.g. 6/12/18 months) before the private or semi-private cover extends to pregnancy. Some hospitals offer 'upgrades' to a private room for a fee.

Edit: I found this useful info on the topic in english.

I had a look around on the Avanex site and their general terms and conditions. And if you get pregnant within 365 days of signing the application, they do not extend the supplemental coverage to the pregnancy, e.g. no private/semi-private room. You still are covered by the basic insurance, though.

Congrats!

I would say it's probably not worth it to change your deductible, since your pregnancy will be covered (and yes, you can have an epidural if you want, and nope, your extra insurance won't cover this pregnancy). I have had two babies here with basic insurance and I have had excellent care, so don't worry!

All visits, tests, the delivery and the first neonatal check will be covered.

However, do keep in mind that if you have another problem in your pregnancy that is NOT strictly pregnancy-related it won't be covered. Example: I had a killer migraine about 1 week before my daughter was born. Because I was pregnant, they couldn't give me any of the good drugs and instead admitted me to the hospital for two days for observation. I had a big work-up done: CT scan and everything, to make sure it wasn't a pregnancy-related issue (apparently, there is a tiny tiny tiny possibility that you can have a bit of bleeding in the brain, which presents as headache). Everything was fine. However, since it wasn't due to the pregnancy, it wasn't covered and I had to pay. A friend also had the same issue with a UTI, which you're of course more prone to during pregnancy but isn't strictly due to the pregnancy. Complications due to the pregnancy are of course covered.

Still, over several years, I've come out way ahead by keeping the deductible high and generally not needing to visit the doctor often, and most pregnancies won't have such an unlucky coincidence.

I think it's worth it to save the money you'd spend on lowering the deductible and use it to upgrade to a semi-private or private room in the hospital once you've delivered. I really liked having the calm to get to know my daughter after she was born-you'll have enough interruptions with the aftercare and the neonatal care without listening to someone else's phone conversations and seeing their visitors!

Oh, one odd bit is that I've had the insurance work both directly through the doctor (ie, I get a record of the visit and the cost, but no bill) and through me (I get the bill, pay, and get reimbursed). This depended on the doctor, not the insurance. As the visits + labs are quite expensive, you may want to find a practice that handles billing directly (as, for example, the Triemlispital did during my first pregnancy) or be prepared to have about 1000-1500 CHF available to pay your bills. You'll get the money back, of course, but it may take a couple of months and you will need to make sure you've kept good records-it can happen that early labs or visits won't be reimbursed because the insurance doesn't see that it is pregnancy-related. It will be your responsibility to follow up on this, call, explain and wait for a few more months.

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Hi there,

Thanks for the explanation. I found your post very informative.
Would like to share my experience with the pregnancy bills and perhaps you have something to add....

For a normal pregnancy and checkups I find that the insurance does not pay for certain things like: Pflichtmedikamente, hilfsmittel migel, verbandmaterial etc. I am not sure what these are but I have only had normal checkups at my OBGYN so far. These and more are mentioned on the bill from the doctor and the insurance has excluded them from payment, meaning that I am paying for these.

Did you have a similar experience with the basic insurance coverage for pregnancy??

Would like to understand more about these...

Thanks

I had a similar experience with my second pregnancy-I went for checkups at my OB-GYN and they weren't all being paid (I was denied coverage). We called, and it turns out that it wasn't totally clear that they were pregnancy related (these were the early checkups and the first labs) so the insurance didn't cover them. However, once we told them it was pregnancy-related, they paid. They didn't fight it, so it seemed like an honest mistake.

Basically, I found that you need to keep track of your bills and what the insurance has paid, and let them know if you think they're mistaken about something.

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Question: If you have a medical problem, pregnancy related or not, are the insurance companies not obligated to pay for it under basic coverage?

It depends. If you have a deductible (franchise) that has not been met for the year, then no, you pay. If you have a strictly-pregnancy-related issue, then the medical costs are not applied to your franchise.

Beware, though, since pregnancy-related is very very strictly defined!

Pregnancy also has no deductible, non-pregnancy 10% is paid by you.

2x now I have had retained placenta after giving birth and guess what - not classed as pregnancy because my baby was born a week earlier

A hospital stay after pre-term labor I also paid 10%.

A therapy after a birth defect was also fully paid by us. I would gladly do away with paying premiums every month and just pay for care ourselves.

May I ask what health insurance carriers you all have??

thank you!

I have basic insurance with Sanitas. They've been very good about handling billing and fixing things when they make mistakes.

I agree with MarieZug. Complications during pregnancy that are not part of a 'normal' pregnancy are treated like a non-pregnancy illness. You have to pay these bills up to your deductible plus 10% of bills over this up until you have paid 700CHF more.

well, yes and no. I had a pretty complicated first delivery-my daughter's head was stuck because her fist was pushed up next to it. She failed to progress, and they discussed an emergency c-section before she finally moved down and they were able to use the head suction thingy.

100% covered, including consultations by all the head doctors and the epidural.

Second pregnancy, with the migraine, an emergency c-section was considered and would have been covered (though the tests, head scans, and hospital stay prior to delivery were not covered).

So, it really depends on how linked to the pregnancy the problems are.

Also, if you sign up for coverage prior to the birth, supposedly insurance providers cannot deny coverage for "preexisting conditions." I'm not an expert here, maybe MarieZug can clarify what this means since she has some experience, but I that's what I remember. Also, at least Sanitas gave us the first month free (not so great for daughter no. 1, born on the 24th, but pretty good for no. 2, born on the 2nd!)

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Congratulations

I had semi-private insurance, had a miscarriage and then applied for private insurance and it was declined due to the fact that I had the miscarriage so I had to stay with semi-private (or only have basic).

With the birth of my first child, I shared a room with another lady during my hospital stay. It sucked. I had the room all to myself for 3 days and nights during the hospital stay of my second child and it was great!

IMO, if you can afford to, go private. It was really miserable getting woken up by my roommates baby (and her and her visitors... and the hospital staff taking care of her) whenever I had a couple of hours to rest in between feeding my baby. Plus, not cool sharing a bathroom. Each time one of us would use it, we'd ask the other if they needed to use it first.

Maybe I should clarify and say during pregnancy rather than during delivery. Our problems were with the placenta so couldn't be more pregnancy related if we tried and we had to pay the deductible still. I checked this out with the insurance ombudsman and they said the insurance was correct so there are definitely pregnancy related complications that you still have to pay the deductible for.

This is from a previous thread:

I contacted the insurance Ombudsman to clear it up. They said there are 2 areas of pregnancy cover under basic insurance, Special benefits for maternity (covered 100% by basic insurance and not included in franchise) and Complications of pregnancy (included in franchise +10% with a max of 700CHF per year above the franchise).

Special benefits for maternity includes:

• 7 normal controls before birth,
• hospital stay for birth (up to 5 days -more than 5 days the hospital needs to justify the longer stay),
• midwife after birth (up to 10 days total incl. number of days in hospital ie. 4days in hospital +6midwife visits),
• 1 after birth control

Complications of pregnancy includes:

• (some) prenatal vitamins,
• DVT stockings,
• hospital stay/special procedures before birth,
• extra (>7 ) controls for complicated pregnancy
• extra (>1) after birth control

(Some of these can be covered by supplementary/extra insurance)

He also said that once you leave hospital after birth, if you need to go back it will come under the franchise so don't leave until you are sure everything is ok (doesn't matter if you have a low franchise or have paid it already)

(If I have got anything wrong here, feel free to correct me, I took notes while I was talking to the man but can be I mixed something up)

More detailed info is here (in german): Articles 13 to 16 of the Health Care Benefits Ordinance

Just bumping this thread back up after I did a search. A heads up to anyone who suffers a miscarriage that you will have to pay and it goes toward your deductible. Miscarriage is apparently classified as a sickness.

I hope that you didn't learn this through first-hand experience, and if you did, I'm very sorry.

What's interesting is that it's pregnancy-related if it comes out alive, but not if it comes out dead. Harsh but true. Unless the rules are different for stillbirth?

I'm sorry, I'm not sure I understand. Pay for the doctors visit associated with the miscarriage?

Yes. It's not considered pregnancy-related. It's considered a sickness.