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-   -   Health Insurance FAQs (https://www.englishforum.ch/insurance/2198-health-insurance-faqs.html)

heather 06.11.2006 22:11

Health Insurance FAQs
 
Can you recommend a Health Insurance Company?

No, what works for one will not work for someone else. One of the best places to start looking for health insurance is Comparis but it is worth bearing in mind that companies which are highlighted are not necessarily better or cheaper, merely that they have paid for advertising. This site is available in English and apart from showing comparisons between various insurance companies it also provides lots of other useful information about health care in Switzerland.


What is a 'franchise'?

This is an amount of money that you elect to pay before claiming on your health policy, similar to 'excess' or 'deductible' on car insurance in order to reduce the cost of the premium.

It is worth bearing in mind that the franchise operates on an annual basis and not on a per-case basis. Therefore should you have a claim that crosses two financial years then you will pay two separate amounts even if it is for the same illness or accident.


What is a 'retention'?

This is the amount you must pay towards the cost of your health care. Typically it is 10% of the cost of treatment/medication. First you must pay your franchise and then once the cost of health care exceeds your franchise then you pay 10% of the costs up to a maximum of 700 CHF. Ie – you get 90% of your bills refunded until you reach 700 CHF and then you get 100%. Read more about retention here or see examples of calculations here [comparis.ch].


Is having health (medical) insurance compulsory?

If you intend to live in Switzerland for longer than 3 months, yes, it is.


What about accident insurance?

If you are employed for more than 8 hours per week then your employer will cover your accident insurance costs but any dependants must be covered separately through the insurance. If you are self-employed or
registered as unemployed you are responsible for paying for your own accident cover. Read more about accident insurance here [comparis.ch].


What is the difference between health (medical) insurance and accident insurance?

Health (medical) covers the costs resulting from illness including hospitalization, medication and GP care. With your health (medical insurance) you may elect to pay a franchise and you will have a retention payment. Accident insurance covers everything that arises from an accident, including sporting injuries, car accidents, accidents at work, etc.

What is important to remember is that if you are employed for more than 8 hours per week then your employer will cover the premium for your accident cover but if you are unemployed or self-employed then you will be responsible for your own cover. It is wise to speak to your employer about how their particular accident insurance operates and what you need to know. For instance, some will require you to inform them within 24 hours of the accident. You may also wish to have some supplementary accident coverage if your employer has only basic coverage – i.e. for a private room.


Can I get temporary insurance cover?


Not exactly. However, if you leave Switzerland permanently during the period of cover then you only need to provide evidence of deregistering with your local government office and your insurance will be cancelled with any advance monies. paid being returned to you.


What happens if I don't bother getting health insurance?


If the government discover this then they will assign a health plan to you and will not necessarily consider relative costs so you may end up with a very expensive plan. It will be back-dated to when you entered the country.


What is 'basic insurance'?

Basic insurance is what you are required to have in Switzerland. No one can be refused basic health insurance regardless of their medical history. The element of choice is quite restrictive because you may only be treated in your canton of residence (apart from emergency treatment when you are away from home). It is worth noting that there is a vast difference in the price of basic insurance from the different providers so it is worth 'shopping around' especially since what is provided by the basic insurance is identical regardless of which company you purchase from. Age, gender and location can affect premiums. Women will generally have higher premiums. You can read more about basic insurance here or read about what is covered here [comparis.ch].


What is 'supplementary insurance'?

This is anything you require beyond the basic insurance. You are not obliged to have supplementary insurance cover but it will broaden your choice and can include home-care, vaccinations, glasses and contact lenses, for instance. Supplementary insurance will allow you a greater choice of doctors and hospitals and will mean you can be treated outside your own canton. If you live on the border of a canton then this can be quite important because your nearest cantonal hospital may be some distance from your home and it could be easier to travel to a hospital in a neighbouring canton. Unlike the basic insurance it is possible to reject applicants for supplementary insurance because of previous illness, age, location, etc. It is possible to have your basic insurance with one company and your supplementary insurance with another company. You can read more about supplementary insurance here [comparis.ch].


How do I change insurers/terminate my existing policy?

If you leave Switzerland and have evidence that you have deregistered with your local government office then you may terminate a policy at any time. If you merely want to change your policy then there are only certain dates in the year when you may change. If there have been no changes to the cost in your policy then you will have to give 3 months notice for leaving at the appropriate time (December/June). This means that you will have to have given notice in writing by the end of September or March. If the company has increased costs then you need give only one month's notice and must cancel in writing by the end of November. There are sample letters on the above link.

Please note that if you have light, GP or HMO model you may only change providers at the end of the calender year in December.

If you have supplementary insurance then it is worth ensuring that you have been accepted by an alternative company before terminating your agreement with your existing provider.

It would be sensible to discuss the arrangements for terminating different policies during your search for a provider. These are merely broad guidelines. You can read additional important information on this subject here [comparis.ch].


What do all the different models mean?


GP Model

This form of health insurance (as is the case with HMO), obliges the policyholder to always contact his GP (gatekeeper) first in case of illness. Emergencies are exempt from this rule.

The selected GP is responsible for the policyholder's treatment. If necessary, he may refer his patients to a specialist.

It is expected that restricted access to specialists will generate less costs than traditional health insurance. This is why premiums for GP health insurance products are 5 to 15% less than those of traditional basic health insurance. Your insurance company will give you a list of family doctors who participate in this model.


HMO (Health Maintenance Organisation)

HMO is a health insurance model. The policyholder is required to consult a certain physician practising in an HMO centre, if he falls ill. This doctor is called a "gatekeeper". Emergencies are exceptions to this rule.

The HMO doctor is paid a flat monthly rate for all treatment his registered patients might need. This flat rate covers all costs for treatment provided either by himself, by specialists or during a hospital stay.

The gatekeeper principle enables the HMO doctor to coordinate his patients' treatment. The flat rate forces him to restrict treatment to what his patient needs. Thus, superfluous services are no longer lucrative. HMO premiums are up to 25% lower than traditional basic health insurance rates for the same extent of benefits.

In case of emergencies:

HMO policyholders must always consult their HMO doctor first. Should he not be available or if the patient is away from his place of residence or work, he must seek out the nearest available emergency physician. After the emergency treatment, the HMO policyholder must contact his HMO physician to discuss further procedures.

Here is a list of HMO practices:


TELMED.


With each new health problem (except for emergencies or gynaecological routine examinations), policyholders must call an information line before consulting a physician. They will either receive information about how to deal with the problem or will be advised to consult a doctor or the hospital for treatment.

Such telephone consultations aim to cut costs. Holders of the Telmed insurance model pay lower premiums than holders of traditional basic health insurance (up to 15%).

The general terms of contract envision various procedures for dealing with policyholders who consult a doctor without having called the telephone helpline. These range from coverage of the costs to demotion to the traditional basic insurance (Exclusion from the Telmed model).
A telephone consultation before seeing a doctor is unnecessary for the following benefits:
  • Emergencies
  • Annual gynaecological preventative check-ups
  • Examinations by an eye specialist (in some cases only for children)
  • Other services (depends on insurance company)
Details of providers of TELMED


Will the TELMED/HMO/GP models give adequate coverage?


Every basic insurance policy, regardless of provider, will cover the same procedures and health services. It is only the access to these services which is different.

Here is a list of what is covered with basic health insurance.


Will my health insurance cover dental care?

Not unless you request it in your supplementary cover but this will be very expensive.


I am still uncertain about choosing insurance. Can you help me?


You can use the services of an English speaking insurance broker who will help you to find an insurance suitable for you although it is worth bearing in mind that many brokers will have ties to certain companies and may not necessarily get you the cheapest deal. There are some English Forum members who have assisted people in the past, such as jenny, who are insurance advisers. English Forum has no connection with these people other than they use this forum.


How do I make a claim on my insurance?

Obviously each company will have methods specific to their administration, but it is normal for you to be billed by your health provider/GP/hospital direct and you will then claim the money direct from your insurance company. It can take a couple of months for you to receive a bill from your health provider and it can take up to a couple of months for you to receive payment from the insurance company.

Some companies are billed directly from your health provider and the insurer will bill you for any franchise or retention payments arising. Discuss this with your chosen insurer.


I need medical treatment but haven't sorted out my policy yet. What can I do?


Your Swiss insurance policy will be applied from the date you entered the country. Most doctors won't bill you for several weeks after consultation so your cover will eventually be in place. There is an interesting thread that deals with this issue here.

Prescription Drugs - costs.

Normally your insurer will make a direct payment to the pharmacy or GP for your drugs but you will need to provide evidence of cover (most health insurance companies provide you with a card similar to a credit card and this should be used in the pharmacy, GP practice etc). Your insurance company should then deal directly with you regarding any costs arising out of your franchise agreement. Depending on your franchise arrangement with your individual provider will determine what co-payment, if any, you will be responsible for. Most prescribed drugs should be covered but in case of doubt check with your individual insurance provider. Some providers may require you to pay for your drugs on collection and will then reimburse you.

I have a question that isn't listed here.
Try looking through the comprehensive list linked above and see if that helps or search the forum and if you still cannot find an answer post on the relevant thread. You can also find a glossary of terms here [comparis.ch].

eireann 22.05.2007 23:48

Re: Health Insurance FAQs
 
Can we make a sticky of this? Thanks Heather, it is really well put together and would have been useful to find when I first started trying to get to grips with the Swiss health insurance system.

mark 22.05.2007 23:50

Re: Health Insurance FAQs
 
I can't believe it wasn't sticky - I've made it sticky now.

Tubbies-Mummy 10.06.2007 08:28

Re: Health Insurance FAQs
 
this is very helpful thnaks but can you give me some names of companies that provide cover please
also what happens if we dont add dental insurance - can we just go to a dentist and oay that day??:D

ChrisW 10.06.2007 08:53

Re: Health Insurance FAQs
 
Going to the comparis website, which is mentioned in the first sentence of this FAQ, is the best way to find out which insurance companies might be good for you (i.e., it will give you a list with company names and prices). On that site, click "En" for English in the top left, then click "Health Insurance" in the panel on the left, then fill in the details requested.

Regarding dentists: Yes, they are quite happy for you to go there and pay them directly for whatever work they do.

Tubbies-Mummy 10.06.2007 09:22

Re: Health Insurance FAQs
 
many thnaks i did this but it just gave me a calculaor to comapre policys and did not bring any up maybe i will try again x:)

Guest 27.06.2007 17:44

Re: Health Insurance FAQs
 
Very helpful. Thanks Heather!
Now only if someone could makes a dummy guide for all the taxes/contributions.

jenny 30.06.2007 18:18

Re: Health Insurance FAQs
 
Quote:

Originally Posted by heather (Post 20652)
How do I change insurers/terminate my existing policy?

If you leave Switzerland and have evidence that you have deregistered with your local government office then you may terminate a policy at any time. If you merely want to change your policy then there are only certain dates in the year when you may change. If there have been no changes to the cost in your policy then you will have to give 3 months notice for leaving at the appropriate time (December/June). This means that you will have to have given notice in writing by the end of September or March. If the company has increased costs then you need give only one month's notice and must cancel in writing by the end of November. There are sample letters on the above link.

Please note that if you have light, GP or HMO model you may only change providers at the end of the calender year in December.

If you have supplementary insurance then it is worth ensuring that you have been accepted by an alternative company before terminating your agreement with your existing provider.

It would be sensible to discuss the arrangements for terminating different policies during your search for a provider. These are merely broad guidelines. You can read additional important information on this subject here [comparis.ch].

This is almost right….

For BASIC insurance :

- If you have a « franchise ordinaire » (ordinary deductible – i.e. 300.- for adults, 0.- for children) then you can change companies twice a year but only by giving a 3 month notice period. i.e. your insurance company must receive a registered letter by the 30th of March for the 1st of July or the 30th of September for the 1st of January.

- When you receive your new policy by the end of October (all companies have to send it to you by law by the 31st of October) then you have the right to change for the 1st of January as long as they receive the letter by the 30th of November. You can do this even if they haven’t changed the price or have reduced the price !

For COMPLEMENTARY/SUPPLEMENTARY insurance :

- You can add on complementary/supplementary insurance whenever you like for the 1st of the following month.

- You can only cancel this insurance once a year (for the end of the year)

- Most companies require 3 months notice i.e. they must receive the letter by the 30th of September, however some companies require 6 months and must receive the letter by the 30th of June.

- Once you have taken out complementary insurance, there is a period for which you have to keep it. For most companies this is 1 year, however, there are companies who require that you stay with them for 5 years (e.g. All 14 companies under the Groupe Mutuel ; Assura ; Supra etc.) These are usually the same companies who ask for a 6 month notice period.

Hope this helps !

Jenny
:)

nyexpat 30.06.2007 19:14

Re: Health Insurance FAQs
 
This is extremely helpful. Thank you!

caninecounselor 17.09.2007 17:52

Re: Health Insurance FAQs
 
Hi Jenny,

Any pointers in the right direction would be most appreciated: in the case of my mother, still living in the EU, planning to move to CH. She is looking for an insurance plan that will cover her pre-existing condition of an arthritic knee, due to knee surgery. I read that no one can be refused insurance in Switzerland, does this include pre-existing conditions of seniors??

Thank you in advance for your help.

Blonaybear 17.09.2007 17:57

Re: Health Insurance FAQs
 
Quote:

Originally Posted by caninecounselor (Post 105135)
Hi Jenny,

Any pointers in the right direction would be most appreciated: in the case of my mother, still living in the EU, planning to move to CH. She is looking for an insurance plan that will cover her pre-existing condition of an arthritic knee, due to knee surgery. I read that no one can be refused insurance in Switzerland, does this include pre-existing conditions of seniors??

Thank you in advance for your help.

Yes, if your mother takes up residence here she will be excepted irrespective of pre-existing conditions.

caninecounselor 19.09.2007 19:24

Re: Health Insurance FAQs
 
Jenny,

Thanks a million for the reply!!

Cheers

muze7 19.09.2007 19:47

Re: Health Insurance FAQs
 
Does anyone know a company that has no waiting requirement for someone who is not yet pregnant? I am referring to a zusatzverschicherung (optional insurance), as Visana for example has a 365 waiting period, meaning the birth should not fall within this time.

Ok I found some companies that have 270 days. KPT is one of them.

rmaunder 24.10.2007 12:26

Re: Health Insurance FAQs
 
Thanks very much for this - an excellent and comprehensive summary - most helpful!

Bell 25.10.2007 09:26

Re: Health Insurance FAQs
 
That's very helpful information you've all provided here. I've also been to comparis and had a look around and it's certainly handy!

Just to clarify one more thing...

If I had supplementary insurance, I should wait for acceptance from the new company I'm applying to before I terminate my current plan.

But

If I have only basic, I can do these simultaneously?

muze7 14.11.2007 03:14

Re: Health Insurance FAQs
 
Quote:

If I had supplementary insurance, I should wait for acceptance from the new company I'm applying to before I terminate my current plan.

But If I have only basic, I can do these simultaneously?
Yes, although be aware the old basic insurance will not officially be terminated until your new insurance has send confirmation to the old company.

On another note, the detailed comparisons on Zusatzverschicherungen (supplementary insurance) seems to have disappeared from Comparis! Only hospital cover is left now. This is a shame...:eek:

jenny 14.11.2007 12:36

Re: Health Insurance FAQs
 
Quote:

Originally Posted by muze7 (Post 132270)
On another note, the detailed comparisons on Zusatzverschicherungen (supplementary insurance) seems to have disappeared from Comparis! Only hospital cover is left now. This is a shame...:eek:

I think it was hard for them to compare the complementary. It's far too complex to have a table with comparisons. I think it really depends on what you're looking for in a company. Some people are more sporty, some more into alternative treatments, some need good cover abroad, some need good cover for teeth, glasses, everything gynaecology etc. etc.
Then there are those companies who are more expensive for women etc. etc. You really need to shop around and know what you want more or less.

hopeful hiker 21.01.2008 11:41

Re: Health Insurance FAQs
 
As we are considering relocating more permanently to Switzerland we found this post extremely helpful.Have also followed up the links .Many thanks Heather .
Hopeful.

muze7 21.01.2008 12:54

Re: Health Insurance FAQs
 
I think once you reach an X number of post, there will appear a 'thanks' button below right, you can use that to thank her :)

hopeful hiker 22.01.2008 14:58

Re: thanks for Health Insurance FAQs
 
I did look for that button but it seemed to have gone AWOL although I have used it before and it reappeared with your post.Does it depend on frequency of contact with the Forum ?I have been away for a while.
Hopeful


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