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Old 30.07.2015, 19:38
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Incorrectly denied supplementary health insurance - but complex background

Hello,

Not a new member but I wanted to anonymise a problem I have given the highly personal nature. I have Mod approval for this temporary duplicate account.

I am a bit surprised to have just been denied supplementary health insurance because I am deemed "high risk", even though I am in my late 20s and the truthful answer to all the questions on the questionnaire was that I lead a healthy lifestyle and have not required treatment for anything significant in the past several years. The insurance company has given the reason that my BMI is too low, which on paper, it is. Except this is my natural, healthy weight. Anyone who has met me knows that I am built like a bird, and I'm sporty and strong enough to go on 9 hour alpine pass hikes and (before I recently moved) do a good 6 hours of intensive exercise a week. If this were the full story, it would be easy and I would, as advised by the company, simply write a letter back explaining my current health is tip top. Which it is!

Except that's not quite the full story.

In my late teens I suffered from a severe eating disorder which involved hospital treatment. I have had confirmed recently that I have absolutely no lasting health effects from it. However, I have had a couple of scary relapses since (though neither led to health issues, just was close to the weight I know they could reemerge), and even though I have been completely well for a few years now, I would not be comfortable stating that it (needing treatment) could never happen again.

I am concerned that the possibility of an eating disorder is what the insurance company are alluding to. Even though, as I mentioned, the truthful answer is that my current BMI is completely natural and the questionnaire in the specified time horizon does not require me to disclose my past. However, I'm worried that if I ever present with a relapse again, or something that can be traced as being a consequence, I'll still be deemed to have lied by omission and have all my cover invalidated - against even anything unrelated. So I am wondering if I should volunteer the information.

Potential benefits:
- I was fully discharged from care at my current BMI. So lends proof to my claim that I am extremely healthy now
- I could argue for excluding the eating disorder as pre existing, but I should get supplementary cover for anything else - at least it's clear cut
- conscience

Potential issues:
- they don't buy my claim to be healthy today given my history and class me definitively high risk and I get nothing
- my current weight is unrelated to the history, even if it may be perceived as such

Does any of that even make sense? I am a bit worked up and a bit stuck. I'm not sure I'm thinking logically as this brings back memories I had archived. Advice would be appreciated.

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Old 30.07.2015, 19:46
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Re: Incorrectly denied supplementary health insurance - but complex background

Try a different insurer.

Tom
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Old 30.07.2015, 19:50
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Re: Incorrectly denied supplementary health insurance - but complex background

I can't figure out this supplementary insurance. My husband was turned down and all he had was an ACL sprain/reconstruction, which is covered by accident insurance not health insurance anyway
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Old 30.07.2015, 20:21
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Re: Incorrectly denied supplementary health insurance - but complex background

I understand the frustration that one can be denied when one is currently healthy, but past illnesses - even if no longer an issue - are part of a risk profile, and sometimes are enough of a reason for some insurers to deny coverage.

One of the reasons I was denied was that I had started early mammogram screening in the US, and continued that once I moved here. Every test was negative, meaning I actually had proof of not being ill - but falling into the broad risk profile that recommended preventative early screening (in the US we do tend to be over cautious wrt to screening) was enough for a rejection.

(Another reason I was denied was my age, I was an ancient crone of 40 at the time. But I suppose that taken all together I presented more of a risk than the insurer wished to take on.)

Basically, if you have a history of illness, or fall into a risk profile, some insurers could deny supplemental coverage.

As s2lemans suggests, try another insurer. However be aware that most ask if you have been denied before.

---

If you are looking for supplemental insurance in order to get better accomodation in a hospital, be aware that you can sometimes pay out of pocket to upgrade accomodation to a semi private or private room. This is subject to availablity, and one can be bumped should a 'real' private patient require the space. But some prefer to do this for a planned hospital stay.

---

So first, try another insurer, see what happens.

Good luck!
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Old 30.07.2015, 20:55
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Re: Incorrectly denied supplementary health insurance - but complex background

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I can't figure out this supplementary insurance. My husband was turned down and all he had was an ACL sprain/reconstruction, which is covered by accident insurance not health insurance anyway
The ACL reconstruction he had, means, in very basic terms, that he had a health problem sometime. Irrespective of who paid for treatment, his health was impaired at one point. Health insurance can, for VVG (supplemental) view this as a risk and due to this they have the right to turn him down.

Last edited by glowjupiter; 30.07.2015 at 23:42.
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Old 30.07.2015, 21:04
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Re: Incorrectly denied supplementary health insurance - but complex background

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The ACL reconstruction he had, means, in very basic terms, that he had a health problem sometime. Irrespective of who paid for treatment, his health was impaired at one point. Health insurance can, for VVG (supplemental) view this as a risk and due to this they have the right to turn him down.
Well.. not a health problem.. an accident. They have no problem differentiating between health and accident when it benefits them

I thought they might offer insurance excluding that injury, but no. Funny as he managed to get Tagesgeld insurance (self-employed) which excludes the knee/recon complications.... but if he snaps the reconstruction in a new accident... that is covered
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Old 11.10.2015, 18:48
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Re: Incorrectly denied supplementary health insurance - but complex background

I have just been denied supplementary insurance because I am on an L permit. The insurer said it was illegal to give supplementary ins. to individuals on an L permit. Illegal? Any comments? Thank you.
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Old 11.10.2015, 19:09
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Re: Incorrectly denied supplementary health insurance - but complex background

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I have just been denied supplementary insurance because I am on an L permit. The insurer said it was illegal to give supplementary ins. to individuals on an L permit. Illegal? Any comments? Thank you.
Yes the Swiss use that word all the time, often nonsense of course. They don't legally have to offer cover is the reality.
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Old 11.10.2015, 19:11
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Re: Incorrectly denied supplementary health insurance - but complex background

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I have just been denied supplementary insurance because I am on an L permit. The insurer said it was illegal to give supplementary ins. to individuals on an L permit. Illegal? Any comments? Thank you.

Wait for Glowjupiter and Medea.F.S. 's answers. They can tell us if this is true or not.

You may also want to try this.
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Old 11.10.2015, 19:57
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Re: Incorrectly denied supplementary health insurance - but complex background

Is it with the same insurer as your basic is with? Can't think why it would be illegal, not that I'm up on the insurance side of things. They may not want to provide it of course, but illegal? Maybe Glowjupiter knows more.
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Old 11.10.2015, 20:08
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Re: Incorrectly denied supplementary health insurance - but complex background

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Wait for Glowjupiter and Medea.F.S. 's answers. They can tell us if this is true or not.

You may also want to try this.


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I have just been denied supplementary insurance because I am on an L permit. The insurer said it was illegal to give supplementary ins. to individuals on an L permit. Illegal? Any comments? Thank you.
You can be refused supplementary for any reason, only basic insurance coverage cannot be refused. No matter the reason given, they are within their rights to not insure you for supplementary.

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The basis of basic Swiss health insurance (compulsory) is solidarity - people with few illnesses pay as high or low a premium as people with many illnesses, if they are within the same age bracket, live in the same city/vicinity and choose the same insurance model. This way, people pay for each other in a way.

Supplementary health insurance is just that - supplementary (noncompulsory) security. If you want to be sure that you have the possibility to choose doctors/rooms/care etc. in the case that you should you fall ill, take out supplemental insurance.

If you can live without that security and the fact that (I think) some hospitals do not offer the possibility of upgrading your care on a case by case basis, don't go for supplementary insurance and ask if you can pay extra when you fall ill. If you definitely want the "bells and whistles" when worst comes to worst, pay for them.

Also know that all insurances have to cover your basic insurance costs, but they are not obliged to accept you for supplementary insurance.
Link 1
Link 2
Link 3

You cannot demand supplementary health insurance coverage no matter how healthy you are, as they have neither a legal duty to accept you nor to provide you with a reason for their refusal accept you.


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Yes, tom_vn, fatmanfilms is right.

Basic health insurance (Grundversicherung) is mandatory from the date of taking up residence or from date of birth. That is federal law (Art. 5 paragraph 1 KVG).

Supplemental health insurance (Zusatzversicherung) can be taken out from whenever you wish, however - as opposed to basic health insurance - insurers are allowed to reject you.

Last edited by glowjupiter; 11.10.2015 at 21:06. Reason: formatting
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