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Old 16.03.2017, 10:21
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Wife Pregnant - Insurance question

Hi My Fellow English Forum Mates,


My wife is 12-13 weeks pregnant this week yipppeeeee......Exciting times.


We have a few bills from the doc for the initial examination and tests for HIV and other sorts of tests. One bill 1000chf (from another company that did the tests) for the blood tests and the other 469chf for the ultrasound etc.


Wife phoned up Assura and they said they only pay after the 13 weeks mark.


I was under the impression that 3 or 4 ultrasounds and all the other bills associated with the pregnancy is fully covered. Did I misunderstand something?


Cheers


Gee
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  #2  
Old 16.03.2017, 10:52
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Re: Wife Pregnant - Insurance question

I cannot remember for sure, but i think Assura paid everything when my wife was pregnant 6 years ago, outside the franchise
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Old 16.03.2017, 11:18
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Re: Wife Pregnant - Insurance question

The relevant laws for medicine are here,

https://www.admin.ch/opc/de/classifi...073/index.html

I have had a quick look and can find no clause exempting the first 13 weeks.
-----------------------------------------------------------------
Assura: http://de.assura.ch/gcse-search?sear...ger&gsc.page=1

on their web page, Assura state that you are entitled to 7 check ups starting between the 6th and 10th week of the pregnancy.

It also states: after the 13th week and until 8 weeks after the birth, the customer does not pay any deductible money nor franchise.

Artikel 10
Mutterschaft
Die Assura übernimmt neben den Kosten für die gleichen
Leistungen wie bei Krankheit:
a) die Kosten ohne Franchise und ohne Selbstbehalt für
7 Kontrolluntersuchungen während der sowie 1
Kontrolluntersuchung zwischen der 6. und 10.
Woche nach der Schwangerschaft;
b) die Kosten für die Geburtshilfe durch einen Arzt oder
eine Hebamme im Falle einer Entbindung zu Hause
sowie für das hierzu benötigte Material;
c) einen Betrag für Geburtsvorbereitungskurse (Einzeloder
Gruppenkurs), welche von Hebammen
durchgeführt werden;
d) die Kosten für maximal 3 notwendige
Stillberatungssitzungen;
e) die Kosten für die Behandlung und den
Spitalaufenthalt des gesunden Neugeborenen,
solange es sich zusammen mit seiner Mutter im
Spital aufhält.
Ab der 13. Schwangerschaftswoche bis acht Wochen nach
der Niederkunft sind Frauen auf den allgemeinen
Leistungen bei Krankheit von der Kostenbeteiligung befreit.
---------------------------------------------------------------------
Article 10
maternity
The Assura takes besides the cost of the same
Benefits like illness:
(A) the costs without franchise and without deductible for:
7 Check - ups during and 1
Control examination between the 6th and 10th
Week after pregnancy;
(B) the cost of obstetrics by a doctor or physician;
A midwife in case of delivery at home
As well as for the material required for this purpose;
(C) an amount for maternity preparatory courses (single or
Group courses), which are of midwives
be performed;
(D) the cost of a maximum of 3
Nursing consultations;
(E) the cost of treatment and treatment
Hospital stay of the healthy newborn,
As long as it is together with his mother in the
Hospital.
From the 13th week of pregnancy to eight weeks after the pregnancy, women are exempt from the participation in the general sickness benefits.
--------------------------------------------------------------------
Summarising:
you are entitled to refunds of the costs, less the deductible (10%) and subject to the franchise (CHF 300,- ??) for the first 13 weeks. After 13 weeks all costs are free of charge, up to 8 weeks after the birth.

Send the claim in again, or go round there and smack 'em!

You should insure the newborn soon. They will only start charging a premium after the birth, but if there are birth complications (Maybe the newborn baby needs oxygen, as mine did) the baby has to have it's own insurance, as the mother's insurance will not cover it...!
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Old 16.03.2017, 11:23
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Re: Wife Pregnant - Insurance question

Sbrinz, Thank you very much, this is great help. Appreciate it.
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Old 16.03.2017, 11:25
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Re: Wife Pregnant - Insurance question

Quote:
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The relevant laws for medicine are here,

https://www.admin.ch/opc/de/classifi...073/index.html

I have had a quick look and can find no clause exempting the first 13 weeks.
-----------------------------------------------------------------
Assura: http://de.assura.ch/gcse-search?sear...ger&gsc.page=1

on their web page, Assura state that you are entitled to 7 check ups starting between the 6th and 10th week of the pregnancy.

It also states: after the 13th week and until 8 weeks after the birth, the customer does not pay any deductible money nor franchise.

Artikel 10
Mutterschaft
Die Assura übernimmt neben den Kosten für die gleichen
Leistungen wie bei Krankheit:
a) die Kosten ohne Franchise und ohne Selbstbehalt für
7 Kontrolluntersuchungen während der sowie 1
Kontrolluntersuchung zwischen der 6. und 10.
Woche nach der Schwangerschaft;
b) die Kosten für die Geburtshilfe durch einen Arzt oder
eine Hebamme im Falle einer Entbindung zu Hause
sowie für das hierzu benötigte Material;
c) einen Betrag für Geburtsvorbereitungskurse (Einzeloder
Gruppenkurs), welche von Hebammen
durchgeführt werden;
d) die Kosten für maximal 3 notwendige
Stillberatungssitzungen;
e) die Kosten für die Behandlung und den
Spitalaufenthalt des gesunden Neugeborenen,
solange es sich zusammen mit seiner Mutter im
Spital aufhält.
Ab der 13. Schwangerschaftswoche bis acht Wochen nach
der Niederkunft sind Frauen auf den allgemeinen
Leistungen bei Krankheit von der Kostenbeteiligung befreit.
---------------------------------------------------------------------
Article 10
maternity
The Assura takes besides the cost of the same
Benefits like illness:
(A) the costs without franchise and without deductible for:
7 Check - ups during and 1
Control examination between the 6th and 10th
Week after pregnancy;
(B) the cost of obstetrics by a doctor or physician;
A midwife in case of delivery at home
As well as for the material required for this purpose;
(C) an amount for maternity preparatory courses (single or
Group courses), which are of midwives
be performed;
(D) the cost of a maximum of 3
Nursing consultations;
(E) the cost of treatment and treatment
Hospital stay of the healthy newborn,
As long as it is together with his mother in the
Hospital.
From the 13th week of pregnancy to eight weeks after the pregnancy, women are exempt from the participation in the general sickness benefits.
--------------------------------------------------------------------
Summarising:
you are entitled to refunds of the costs, less the deductible (10%) and subject to the franchise (CHF 300,- ??) for the first 13 weeks. After 13 weeks all costs are free of charge, up to 8 weeks after the birth.

Send the claim in again, or go round there and smack 'em!

You should insure the newborn soon. They will only start charging a premium after the birth, but if there are birth complications (Maybe the newborn baby needs oxygen, as mine did) the baby has to have it's own insurance, as the mother's insurance will not cover it...!
Presumably the baby can not be uninsured & there is 3 months time to get insurance which is backdated, just like people who arrive in Switzerland.
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Old 16.03.2017, 11:41
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Re: Wife Pregnant - Insurance question

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Presumably the baby can not be uninsured & there is 3 months time to get insurance which is backdated, just like people who arrive in Switzerland.
I thought I had explained. The unborn baby is insured by the parents, and until it is born, it is not legally a person and no premiums are charged. Once it is born alive the insurance can charge the premium, and pay for any after-birth treatment. My newborn son needed oxygen to recover as he had a difficult time.

No back dating is done.
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Old 16.03.2017, 11:48
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Re: Wife Pregnant - Insurance question

Quote:
View Post
The relevant laws for medicine are here,

https://www.admin.ch/opc/de/classifi...073/index.html

I have had a quick look and can find no clause exempting the first 13 weeks.
-----------------------------------------------------------------
Assura: http://de.assura.ch/gcse-search?sear...ger&gsc.page=1

on their web page, Assura state that you are entitled to 7 check ups starting between the 6th and 10th week of the pregnancy.

It also states: after the 13th week and until 8 weeks after the birth, the customer does not pay any deductible money nor franchise.

Artikel 10
Mutterschaft
Die Assura übernimmt neben den Kosten für die gleichen
Leistungen wie bei Krankheit:
a) die Kosten ohne Franchise und ohne Selbstbehalt für
7 Kontrolluntersuchungen während der sowie 1
Kontrolluntersuchung zwischen der 6. und 10.
Woche nach der Schwangerschaft;
b) die Kosten für die Geburtshilfe durch einen Arzt oder
eine Hebamme im Falle einer Entbindung zu Hause
sowie für das hierzu benötigte Material;
c) einen Betrag für Geburtsvorbereitungskurse (Einzeloder
Gruppenkurs), welche von Hebammen
durchgeführt werden;
d) die Kosten für maximal 3 notwendige
Stillberatungssitzungen;
e) die Kosten für die Behandlung und den
Spitalaufenthalt des gesunden Neugeborenen,
solange es sich zusammen mit seiner Mutter im
Spital aufhält.
Ab der 13. Schwangerschaftswoche bis acht Wochen nach
der Niederkunft sind Frauen auf den allgemeinen
Leistungen bei Krankheit von der Kostenbeteiligung befreit.
---------------------------------------------------------------------
Article 10
maternity
The Assura takes besides the cost of the same
Benefits like illness:
(A) the costs without franchise and without deductible for:
7 Check - ups during and 1
Control examination between the 6th and 10th
Week after pregnancy;
(B) the cost of obstetrics by a doctor or physician;
A midwife in case of delivery at home
As well as for the material required for this purpose;
(C) an amount for maternity preparatory courses (single or
Group courses), which are of midwives
be performed;
(D) the cost of a maximum of 3
Nursing consultations;
(E) the cost of treatment and treatment
Hospital stay of the healthy newborn,
As long as it is together with his mother in the
Hospital.
From the 13th week of pregnancy to eight weeks after the pregnancy, women are exempt from the participation in the general sickness benefits.
--------------------------------------------------------------------
Summarising:
you are entitled to refunds of the costs, less the deductible (10%) and subject to the franchise (CHF 300,- ??) for the first 13 weeks. After 13 weeks all costs are free of charge, up to 8 weeks after the birth.

Send the claim in again, or go round there and smack 'em!

You should insure the newborn soon. They will only start charging a premium after the birth, but if there are birth complications (Maybe the newborn baby needs oxygen, as mine did) the baby has to have it's own insurance, as the mother's insurance will not cover it...!
Important correction: your entitled to those things between 6 and 13 weeks WITHOUT deductible. I.e free, no excess, no 10%. A normal pregnancy does not cost you one franc here. Complications are under maladie but otherwise, even before 13 weeks it's totally covered, no deductible.

We've had three kids here. Always assura, multiple scans and the like from 6 w eke on. Nothing to pay.
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Old 16.03.2017, 11:53
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Re: Wife Pregnant - Insurance question

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Important correction: your entitled to those things between 6 and 13 weeks WITHOUT deductible. I.e free, no excess, no 10%. A normal pregnancy does not cost you one franc here. Complications are under maladie but otherwise, even before 13 weeks it's totally covered, no deductible.

We've had three kids here. Always assura, multiple scans and the like from 6 weeks on. Nothing to pay.
That was my understanding, but I quoted the Assura website which states up to 13 weeks the mother is treated as a normal patient. But it also states that after 6 weeks the investigations are free.

I cannot find anything in the governments regulations, so perhaps Gee10 should ask Assura under which clause of the Swiss law they are with holding payments...
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Old 16.03.2017, 12:35
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Re: Wife Pregnant - Insurance question

I am currently pregnant and my health insurance is also with Assura. Had my first Ultrasound at 10th week and till date Assura has been paying everything. You just need to pay the bills you get at home and than invoice them.

Though HIV test and other blood test were done later than 12th week of pregnancy. Also we payed the 1000 chf from our pocket for blood test for Non Invasive Prenatal testing and did not bother to bill it to Assura since they pay only when you are above 35 or if you are a high risk pregnancy.

Hope that helps and Congratulations
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Old 16.03.2017, 13:00
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Re: Wife Pregnant - Insurance question

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I am currently pregnant and my health insurance is also with Assura. Had my first Ultrasound at 10th week and till date Assura has been paying everything. You just need to pay the bills you get at home and than invoice them.

Though HIV test and other blood test were done later than 12th week of pregnancy. Also we payed the 1000 chf from our pocket for blood test for Non Invasive Prenatal testing and did not bother to bill it to Assura since they pay only when you are above 35 or if you are a high risk pregnancy.

Hope that helps and Congratulations


Ahhh ok so we pay the bills and then send them in. I thought we just send them the bills.


In regards to the 1000chf bill for the blood tests, this is mandatory for pregnant woman so why is this not covered? I do not understand. I may test the waters with this one
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Old 16.03.2017, 13:13
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Re: Wife Pregnant - Insurance question

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In regards to the 1000chf bill for the blood tests, this is mandatory for pregnant woman so why is this not covered? I do not understand. I may test the waters with this one
There are different types of blood tests some of which are voluntary and those are not necessarily reimbursed.
The most common voluntary one is the Harmony test which looks at foetal cells in the mother's blood for abnormalities. At the moment it is only covered by insurance if the earlier blood test and/or nuchal scan come back with a high risk or the mother is over 35.
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Old 16.03.2017, 13:14
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Re: Wife Pregnant - Insurance question

There are various kind of blood tests. Some are mandatory and some are self willing. I don't know which one was yours. We had both and as mentioned by me earlier the Prenatal Non Invasive Blood Testing ( somewhat Genetic Testing) is not mandatory. We did it for our self assurance . And it is only reimbursed by Health Insurance if you are high risk or above 35. May be you just had the usual one ( checking for Iron and other stuff) we had that too and so definitely you can invoice them. As you will get further along in your pregnancy there will be more tests coming, if these tests are suggested by your doctor you can invoice them all gladly.
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Old 16.03.2017, 13:21
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Re: Wife Pregnant - Insurance question

The docter suggested we do the tests as we were travelling in Mexico and Cuba. The ones he recommended were the HIV and the Zika Virus. So i think I will send this nice bill to Assura and see what they say
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Old 16.03.2017, 13:58
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Re: Wife Pregnant - Insurance question

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I thought I had explained. The unborn baby is insured by the parents, and until it is born, it is not legally a person and no premiums are charged. Once it is born alive the insurance can charge the premium, and pay for any after-birth treatment. My newborn son needed oxygen to recover as he had a difficult time.

No back dating is done.
To that point, set up baby insurance immediately. That way you won't have any insurance issues "on arrival" of your baby.

For the record all our costs were covered from first visit, so not sure where the 13 weeks cap is from, but this was a while ago for us.

As for the ultrasound "limit". This is mildly amusing. Drs know this and simply state that there's a medical need for any exta checks...

Good luck!
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Old 16.03.2017, 14:11
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Re: Wife Pregnant - Insurance question

I had similar question when my wife was pregnant.

How it works is
1. Insurance does not immediately pay costs incured before 13 weeks of Pregnancy (they consider Pregnancy as "not confirmed" until you cross 13 week mark
2. as soon as you cross 13 weeks, you can send all bills to Insurance company and they will pay even costs incured even during initial 13 weeks

I did this without any issue with my Insurance (it was Helsana at that time, but basic coverage is same with all insurance providers).
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Old 16.03.2017, 14:33
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Re: Wife Pregnant - Insurance question

Up to 13 weeks treatments that are outside of a 'normal' pregnancy checkup have to be paid out of your franchise. It could be that some of your blood tests fall outside of anything considered 'normal'. Also if you are not a high risk pregnancy only 3 ultrasounds are covered. If more than 1 is taken before 13 weeks it is also possible you have to pay it out of your own pocket. After 13 weeks you shouldn't have to pay anything.
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