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  #21  
Old 22.04.2017, 04:20
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Re: Health problem and question about insurance

Hi there

As the health insurance is obligatory in Switzerland,
any healthinsurance company is obliged to insure you both with the basic insurance.

However, the basic insurance is not always enough and you should sign up for some additional coverage. In this case the companies can do whatever they want and with a chronical problem they might refuse. Try it anyway.

If you are in good health go for the highest self-risk. If you visit the doctor a lot, get the lowest.

Don't sign with the cheapest insurance, but make sure someone is there to help you if needed.

Good luck👍🏻
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Old 22.04.2017, 14:51
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Re: Health problem and question about insurance

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2)How would you described the Swiss healthcare(good,bad,very good) and are you satisfied with it(not that there are some weaknesses),but generally looks good(from outside):
-affordable price(for the income there)
-great quality
-maximum amount of money that you can pay for the majority of the cases
As i said,there are some weaknesses but generally looks good.
What is your opinion as a resident there ?
Personally, I find the Swiss healthcare excellent and affordable. Yes, it felt odd to pay CHF 300 per month per person when I arrived (previously in EU, with State healthcare covered by social security deductions). But the availability of services, speed of treatment, cleanliness of hospitals, nurse to patient ratios, waiting time in ER, coverage of physiotherapy / physical rehabilitation ..... all far above my experiences elsewhere.

Mr HH has an ongoing serious condition (already existing when we arrived here). His basic insurance has paid every bill without question, including major surgery, weeks in hospital, 3 weeks residential physical rehabiliation, drugs galore. And all has been swiftly available, even the expensive drugs were approved within 2 days. I did think initially that this is possibly because his health is so bad....also in my home country really sick people get most of what they need.

My health is better than Mr HH's, but can also say access to not so serious services has been good. An example...minor burn while cooking on a Saturday night. Went off to ER as it was blistering, but by no means "serious" burn....seen within 10 minutes.
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  #23  
Old 22.04.2017, 16:47
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Re: Health problem and question about insurance

From experience, I would also agree that the basic insurance will be fine. A 'typical' doctors' appointment with some labs will cost around 200-250 chf. If appointments every couple months are necessary, then a lower deductible may be worth it, otherwise the higher deductible is cheaper long-term. I've also found that using a "Callmed" or "Telmed" plan is cheaper and works better because you speak to someone on the phone and explain what you need (and they will have an English option), and if you can clearly explain what your situation is and what services/lab tests you need, they generally will just let you go straight to the necessary specialist without seeing a 'gatekeeper' first, and that is faster and cheaper.
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Old 26.05.2017, 14:49
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Re: Health problem and question about insurance

Sorry that i answer you just know,but i was a little busy.
Big thanks to everyone -now i am full aware of the capabilities of the Switzerland health -the strong and weak sides of it and this because all of you.

meloncollie
It is a huge privilege to read your posts.
As i said,there is no perfect health system and Swiss health system is not an exception.
But we are looking for good price-performance ratio because we have a lot of examples of health systems which have very good price(but weak performance) and vice versa-good performance(but very high price).
The last year i made a report about a health system for one of my clients(i didn't remember the country ) and i remember i have a quick look of US health system.
Yes,if you have platinum or gold package payed of your company.........you are fine-if you not(and the majority of the US population don't)...........you are totally screwed.
The prices can be skyrocketing to absurd high levels.
And when you see spending of healthcare as a % of the GDP ............it is one big bubble than soon will burst.
And this is not only my opinion -i find this US healthcare-bubble/
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Old 26.05.2017, 15:13
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Re: Health problem and question about insurance

To add to the above. In your case go only for the standard model as otherwise you will always be stuck with the necessity of getting a reference to the specialist first (i.e. it is pretty much to your GP whom you go to), which can be a LOT of hassle, because even finding a GP, let alone a good (read competent and willing to cooperate on such matters) GP, takes time here. Do make sure that you get this option, go through the small print. I cannot stress enough the importance of this.
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Old 26.05.2017, 15:18
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Re: Health problem and question about insurance

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To add to the above. In your case go only for the standard model as otherwise you will always be stuck with the necessity of getting a reference to the specialist first (i.e. it is pretty much to your GP whom you go to), which can be a LOT of hassle, because even finding a GP, let alone a good (read competent and willing to cooperate on such matters) GP, takes time here. Do make sure that you get this option, go through the small print. I cannot stress enough the importance of this.
I had an HMO model with an amazing group practice, nothing was ever a hassle & they did everything + more instantly. Best Dr I ever had in over 50 years. I even booked specialists myself & just informed the Dr, not complicated at all.
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  #27  
Old 26.05.2017, 17:10
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Re: Health problem and question about insurance

It's great that you had a good experience, but the OP should also be aware of the "rules" as they are written (I mentioned the problem of cooperation in my earlier post).

https://www.comparis.ch/krankenkasse...ossar/hmo.aspx

The Gatekeeper Principle (google translated)

HMO model is an alternative insurance model in compulsory health insurance, in which insured persons undertake to consult a specific HMO practice in case of illness. Due to the limited physician's choice, insured persons benefit from a premium discount of up to 25% compared to the standard model.

Excluded from this obligation are emergencies, the annual gynecological preventive examination as well as control examinations at the ophthalmologist. These exceptions vary from health insurance to health insurance and are defined in the general insurance conditions of health insurance funds.
HMO practice

An HMO practice is a group practice in which not only general practitioners but also specialists as well as therapists of various disciplines are active. Depending on the size of the practice, a great medical performance is offered. HMO practices have entry areas. This means that every practice has a local area of ​​activity.
HMO doctor

The HMO doctor is referred to as a "gatekeeper". He receives a monthly lump sum for the medical care of insured persons inscribed with him. From this, all the services which the HMO insured will take internally with him, with specialists and hospital stays, are paid. The gatekeeper principle allows the HMO doctor to coordinate the treatment of his patients. The lump sum compensation for the medical services allows the HMO physician to restrict himself to the provision of services which are right for his patients. The premiums of the HMO insurance companies are accordingly up to 25% lower than the premiums of the standard basic insurance, with the same scope of benefits.
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  #28  
Old 26.05.2017, 17:44
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Re: Health problem and question about insurance

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It's great that you had a good experience, but the OP should also be aware of the "rules" as they are written (I mentioned the problem of cooperation in my earlier post).

https://www.comparis.ch/krankenkasse...ossar/hmo.aspx

The Gatekeeper Principle (google translated)

HMO model is an alternative insurance model in compulsory health insurance, in which insured persons undertake to consult a specific HMO practice in case of illness. Due to the limited physician's choice, insured persons benefit from a premium discount of up to 25% compared to the standard model.

Excluded from this obligation are emergencies, the annual gynecological preventive examination as well as control examinations at the ophthalmologist. These exceptions vary from health insurance to health insurance and are defined in the general insurance conditions of health insurance funds.
HMO practice

An HMO practice is a group practice in which not only general practitioners but also specialists as well as therapists of various disciplines are active. Depending on the size of the practice, a great medical performance is offered. HMO practices have entry areas. This means that every practice has a local area of ​​activity.
HMO doctor

The HMO doctor is referred to as a "gatekeeper". He receives a monthly lump sum for the medical care of insured persons inscribed with him. From this, all the services which the HMO insured will take internally with him, with specialists and hospital stays, are paid. The gatekeeper principle allows the HMO doctor to coordinate the treatment of his patients. The lump sum compensation for the medical services allows the HMO physician to restrict himself to the provision of services which are right for his patients. The premiums of the HMO insurance companies are accordingly up to 25% lower than the premiums of the standard basic insurance, with the same scope of benefits.
The reality is that a HMO practice in ZH has about 6 Dr's, 2 Nurses, physiotherapist, a Lab & possibly X-rays on site. You always see your own DR if you make an appointment, however if your ill & turn up you will be seen very quickly by the first available DR. Of course if you don't like your DR, 5 others you can try......

Tell me any normal Dr Surgery that has a lab on site, huge advantage is you get blood & urine tests 15 minutes before seeing the Dr & he has the results when you see him, he can request further tests on the spot. No need for multiple appointments.

Anything to do with Eyes, Heart etc you can go where you want as there are no restrictions. I even was allowed to go to any Dr in GE the following week for a follow up blood test as I would be there working there.

What EXACTLY was your problem?
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Old 26.05.2017, 17:48
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Re: Health problem and question about insurance

fatmanfilms, you speak from your experience, I speak from mine. Have a good weekend.
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Old 26.05.2017, 17:52
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Re: Health problem and question about insurance

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Anything to do with Eyes, Heart etc you can go where you want as there are no restrictions. I even was allowed to go to any Dr in GE the following week for a follow up blood test as I would be there working there.
You trying to persuade us you got a heart now
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Old 26.05.2017, 17:57
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Re: Health problem and question about insurance

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fatmanfilms, you speak from your experience, I speak from mine. Have a good weekend.
You refuse to elaborate on what the problem is, so it sounds to me like a patient problem rather than a problem with the HMO system.
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Old 26.05.2017, 18:23
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Re: Health problem and question about insurance

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You refuse to elaborate on what the problem is, so it sounds to me like a patient problem rather than a problem with the HMO system.
The OP mentioned a preexisting medical condition that requires regular attention. It is a patient problem indeed. I speak from my experience as a person with an inborn condition that requires regular attention and taking meds until I kick the bucket so as it influences my life as little as possible. I like to have freedom to consult my specialist at any time without dropping by the GP first. I am tied essentially to him, not to my GP. I hope this explains it.
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Old 28.05.2017, 13:23
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Re: Health problem and question about insurance

I read the pdf file that one of the members here has posted(about Swiss Health system) and i am wondering is it possible when you make a health insurance,the company without a notice or some major event to start to increase your monthly premiums and what you do in this situation-negotiate or go to other company ?
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  #34  
Old 28.05.2017, 13:27
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Re: Health problem and question about insurance

You can change basic insurance yearly and the insurance premium depends on where you live, how old you are etc.

Supplemental insurance depends on your contract
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  #35  
Old 28.05.2017, 14:11
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Re: Health problem and question about insurance

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You can change basic insurance yearly and the insurance premium depends on where you live, how old you are etc.

Supplemental insurance depends on your contract
Basic insurance premiums only depend on age up to the age of 25, after that it stays the same. The premiums do change substantially depending on where you live.
Supplementary premiums can depend on a whole host of different things which can also vary between different insurers.

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I read the pdf file that one of the members here has posted(about Swiss Health system) and i am wondering is it possible when you make a health insurance,the company without a notice or some major event to start to increase your monthly premiums and what you do in this situation-negotiate or go to other company ?

The basic premiums can only be increased once per year and you are free to change insurers if you are not happy with the new premiums but you must cancel your existing insurance by 30th November at the latest ( written cancellation by recorded delivery is the recommended way)
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Old 28.05.2017, 16:24
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Re: Health problem and question about insurance

Are you sure about that regarding basic Belgianmum? Because looking back over our insurance costs we started out at a monthly figure of 369 including a bit of complementary for the two of us back in July 1999 and now we pay 898.30. We were both well past 25 when we arrived and although I suspect our complementary has gone up I'm not sure you could say it's increased by over 500 francs. Basic insurance for us now is 388 each a month or 776 for both of us which I make a monthly increase on the basic of 407 in the time we've lived here. It certainly hasn't stayed the same. I'm sure there have been increases imposed by the canton along the way, especially in recent years, but we've lived in exactly the same commune/canton the whole time.
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Old 28.05.2017, 16:56
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Re: Health problem and question about insurance

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Are you sure about that regarding basic Belgianmum? Because looking back over our insurance costs we started out at a monthly figure of 369 including a bit of complementary for the two of us back in July 1999 and now we pay 898.30. We were both well past 25 when we arrived and although I suspect our complementary has gone up I'm not sure you could say it's increased by over 500 francs. Basic insurance for us now is 388 each a month or 776 for both of us which I make a monthly increase on the basic of 407 in the time we've lived here. It certainly hasn't stayed the same. I'm sure there have been increases imposed by the canton along the way, especially in recent years, but we've lived in exactly the same commune/canton the whole time.
100% certain. The premiums can increase every year but not based on age, the premium would be the same whether you were 27 or 87 assuming everything else ( live in the same commune) was the equal.
The ages ranges for the different premium rates for basic insurance are 0-18, 19-25 and 26+.
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  #38  
Old 28.05.2017, 16:57
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Re: Health problem and question about insurance

I think the point made was that it is not the age of the person being insured which makes the premium increase regularly but rising health costs in general which need to be covered.

BM is quicker. Must be old age...
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Old 28.05.2017, 16:58
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Re: Health problem and question about insurance

About HMO and the GP's job as "gatekeeper"... it seems to me to vary a great deal from HMO to HMO, or from GP to GP within the HMO. Some trust their patients' common sense and allow them to make their own appointments and see whomever they need, also in another canton, as fatmanfilms experienced. Other HMO-GPs are more determined to do that gatekeeping. They strive harder to lower the costs per patient, either because it positively affects their own earnings, or because they regard it as their ethical duty to keep the country's medical costs from spiraling.

I know of a tragic case where the patient repeatedly asked her HMO GP to do certain tests, but he deemed them unnecessary. He also turned her down when she asked to see a specialist in that field. Because she could not afford to pay for a specialist doctor here in Switzerland, she waited till she next needed to attend to essential family matters in her home country, and paid for a specialist consultation there. That specialist immediately did those tests, and cried out: "Why didn't you get this care earlier?"
When she brought the results back to Switzerland, her GP conceded that perhaps he should have run those tests, after all. But the damage was done, and her condition was too far advanced.

Another friend had an HMO set-up just as fatmanfilms describes it, and loved the efficiency of it all. Worked fine while he had no serious medical conditions, and only occationally needed appointments. One day he had something that looked like it would become chronic, but arrived at the HMO to find out that his GP had left, and had been replaced with the severe gatekeeper type. Nothing he could do, then, but he did change his model of insurance the following year, away from HMO.
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Old 28.05.2017, 19:11
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Re: Health problem and question about insurance

Quote:
I know of a tragic case where the patient repeatedly asked her HMO GP to do certain tests, but he deemed them unnecessary. He also turned her down when she asked to see a specialist in that field. Because she could not afford to pay for a specialist doctor here in Switzerland, she waited till she next needed to attend to essential family matters in her home country, and paid for a specialist consultation there. That specialist immediately did those tests, and cried out: "Why didn't you get this care earlier?"
When she brought the results back to Switzerland, her GP conceded that perhaps he should have run those tests, after all. But the damage was done, and her condition was too far advanced.
And how you cant prevent this ?
Because in this case,my relative needs every month casual tests.
Yes,it can be every two or three months,but it is better to be every month.
If the HMO refuse you tos end you to specialist,what you can do ?
And when i read your post,it means to stay away from HMO and GP model and to choose the free one(can go where he/she wants before any notice) ?
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