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Old 19.05.2017, 17:43
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Beware of Cigna!

I recently moved to Zurich with my husband and have been doing a lot of research into Health Insurance. I applied for Sanitas Basic and Supplemental (as we spend a fair amount of time in the US) and I was accepted for both but my husband was rejected for Supplemental - I assume because he is taking low dose meds for cholesterol and blood pressure. Sanitas did not specify and only wrote that he did not meet their profile risk for Supplemental insurance.

I saw an ad for Cigna International and thought I would give them a try. I thought I would caution those who contact Cigna as the agents use some high pressure sales tactics to sell their insurance. I am sure their product itself is very good EXCEPT that unless one applies for and is granted an exemption from the Gemeinde/canton, the Gemeinde may not recognise Cigna and in effect, make you take out a basic policy on top of the International/Worldwide insurance you have with Cigna (basically double insurance!)

The Cigna agent with whom I spoke, assured me that the exemption would be granted as a formality. I told him I would not sign on until I had the exemption in hand. Flash forward... and I submit the Exemption form and cover letter to the Gemeinde (my husband meets the criteria as he is 55 and can obtain better healthcare for his condition than what Sanitas offered (since we are in the US 4-6 weeks during the year).

The Gemeinde asked me to have Cigna sign and complete a form "H" which basically lists the services they would provide my husband (they would issue his insurance worldwide with no exclusions), fee choice of hospitals, doctors, prescription meds etc... The only problem is, when I asked Cigna to sign the form/declaration, they refused to do so. They said, via phone, they cannot sign anything until I pay for the insurance upfront (which I have no guarantee that the Gemeinde will recognise/approve). And so I am left in a Catch 22...

I wasted 4 weeks and a lot of time with a company (Cigna) who refused in the end to cooperate. I ended up taking Basic insurance with Sanitas for my husband and me and just obtained Allianz for private annual medical travel insurance when we travel overseas. Interesting in that I saved quite a bit on the Premium by going this route as well.

Wish I had known this information from the outset but wanted to caution those who may contemplate using Cigna going forward. Their product may be very good once approved but their service/help in terms of assisting in the approval process leaves a lot to be desired!
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Old 19.05.2017, 19:31
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Re: Beware of Cigna!

If you' asked here before you started your research you would have been told that very few non-Swiss insurances are accepted by the cantons here. Also that people with pre-existing conditions are unlikely to get supplementary cover, though they can't be refused for basic. The basic cover is very good and as you say you saved money by getting that and the travel insurance separately.
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Old 19.05.2017, 19:51
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Re: Beware of Cigna!

Thanks for your comment! As I wrote, I wasted too much time with an insurance company/agent who said they would assist me but did not do so in the end. Who knows, maybe if I purchased Cigna's insurance the Zurich canton would have granted the exemption but why take the risk?

At the end of the day, I paid a lot less for the basic coverage with a good company, Sanitas, and opted to go with the Allianz Private Medical Travel Insurance to meet our needs. It is a lesson for me and a win/win (despite the time wasted!)

Just wanted to give others a view as to my experience as there may be former expats here now on local packages...
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Old 20.05.2017, 08:11
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Re: Beware of Cigna!

While I appreciate you bringing out the formalities involved in taking international insurance providers, I feel Cigna is unnecessarily getting a bad rap here. I can understand why they will not sign something unless they have a contract with you.

Long back we were covered by Cigna and it was accepted by our Gemeinde (possibly because I was on an international contract). And I had very good experience with Cigna.
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Old 20.05.2017, 10:26
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Re: Beware of Cigna!

May I ask why it is necessary to get separate medical travel insurance? I understand that the basic enforced cover here covers international medical for non-optional things. Even if it's just to go to the doctor because you have the flu or some such. As long as you are 'sick' it is covered. Or so I understood from my insurance company when I talked to them.
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Old 20.05.2017, 10:29
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Re: Beware of Cigna!

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May I ask why it is necessary to get separate medical travel insurance? I understand that the basic enforced cover here covers international medical for non-optional things. Even if it's just to go to the doctor because you have the flu or some such. As long as you are 'sick' it is covered. Or so I understood from my insurance company when I talked to them.
Because your basic coverage may not cover everything in f.e. the US and you´d end up with a huge bill
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Old 20.05.2017, 10:44
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Re: Beware of Cigna!

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Because your basic coverage may not cover everything in f.e. the US and you´d end up with a huge bill
So you mean even of unavoidable things where you are ill and need attention while travelling? And is that only US? I have discussed this at length with an English speaking consultant at CSS and I had felt comfortable that absolutely everything was covered without any suggestion that it depends on the country.
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Old 20.05.2017, 12:04
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Re: Beware of Cigna!

I'd check the policy very carefully. What about hospital care?
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Old 20.05.2017, 12:45
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Re: Beware of Cigna!

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I'd check the policy very carefully. What about hospital care?
Online it says for CSS: 'Cover for costs incurred in emergencies for outpatient or inpatient treatment in the general ward up to a maximum of twice the tariff of the canton of residence in Switzerland.Special conditions apply in EU States (incl. Iceland, the Principality of Liechtenstein and Norway) as determined in the Bilateral Agreements'

When I visited in person, the person I talked to said that for a very small extra sum I could include all 'voluntary' doctor expenses as well, ie not just 'emergency' where 'emergency' includes all feeling sick and needing a doctor.

As I was going to be away for 5 months, forced to keep paying my Swiss health insurance, it seemed reasonable to me that I should get the same benefits as I would at home in Switzerland.
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Old 20.05.2017, 12:49
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Re: Beware of Cigna!

Did you get a special card to carry with you? I alway's get additional insurance from my provider for countries outside of Europe, it costs little and gives me peace of mind, especially for the USA.

Last edited by Oldhand; 20.05.2017 at 14:00.
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Old 20.05.2017, 12:56
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Re: Beware of Cigna!

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Did you get a special card to carry with you? I alway's get additional insurance from my provider for countries outside of Europe, it cost little and gives me peace of mind, especially for the USA.
I didn't pay the extra for voluntary, even though it was very small, but I think then I would have got an extra card. But my understanding has always been that compulsory Swiss health insurance covers international travel for the same things you get ordinary health travel insurance for. Downside is having to pay upfront and getting a refund which you don't have to do with proper travel health insurance.
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Old 20.05.2017, 13:53
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Re: Beware of Cigna!

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Online it says for CSS: 'Cover for costs incurred in emergencies for outpatient or inpatient treatment in the general ward up to a maximum of twice the tariff of the canton of residence in Switzerland.Special conditions apply in EU States (incl. Iceland, the Principality of Liechtenstein and Norway) as determined in the Bilateral Agreements'...As I was going to be away for 5 months, forced to keep paying my Swiss health insurance, it seemed reasonable to me that I should get the same benefits as I would at home in Switzerland..
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But my understanding has always been that compulsory Swiss health insurance covers international travel for the same things you get ordinary health travel insurance for.
I've no idea of figures involved as I've never been to the US, but I've read before that US hospital charges are very high, so I wonder if the limit of 'twice the tariff' (in bold above) would be enough if one had to be hospitalised. Like Oldhand, we, too, took extra insurance from our normal health insurance provider when we went to NZ, just in case. Maybe Meloncollie, MathNut or one of the other US members, could help us here.
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Old 20.05.2017, 14:06
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Re: Beware of Cigna!

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...But my understanding has always been that compulsory Swiss health insurance covers international travel for the same things you get ordinary health travel insurance for. Downside is having to pay upfront and getting a refund which you don't have to do with proper travel health insurance.
Swiss health insurance will cover emergencies abroad (not routine care) subject to the conditions you already quoted.

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Online it says for CSS: 'Cover for costs incurred in emergencies for outpatient or inpatient treatment in the general ward up to a maximum of twice the tariff of the canton of residence in Switzerland...
Let's say you needed emergency heart surgery in the U.S. Your Swiss medical insurance would cover up to 2x the tariff in your canton. Whether that's enough to cover the whole bill in the U.S. or not is debatable. You could be left out-of-pocket.

Here's a nice blog post about the difference between travel insurance and travel medical insurance: http://www.hccmis.com/blog/insurance...-a-difference/

Swiss medical insurance might not cover things like evacuation, or repatriation of remains if the worst happens. In that case it's not a bad idea to have travel medical insurance.
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Old 20.05.2017, 14:11
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Re: Beware of Cigna!

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Swiss health insurance will cover emergencies abroad (not routine care) subject to the conditions you already quoted.



Let's say you needed emergency heart surgery in the U.S. Your Swiss medical insurance would cover up to 2x the tariff in your canton. Whether that's enough to cover the whole bill in the U.S. or not is debatable. You could be left out-of-pocket.

Here's a nice blog post about the difference between travel insurance and travel medical insurance: http://www.hccmis.com/blog/insurance...-a-difference/

Swiss medical insurance might not cover things like evacuation, or repatriation of remains if the worst happens. In that case it's not a bad idea to have travel medical insurance.
Unfortunately, it's hard to estimate because costs in the US are non transparent and it depends where you have any treatment and how the treatment is coded. It also depends on how well you (or someone acting for you) can negotiate.

For evacuation, etc, lots of people have a membership in rega.
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Old 20.05.2017, 14:26
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Re: Beware of Cigna!

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Unfortunately, it's hard to estimate because costs in the US are non transparent and it depends where you have any treatment and how the treatment is coded. It also depends on how well you (or someone acting for you) can negotiate.
So true. With my recent mishap, I paid a sum at the urgent care center, but was told that was a "preliminary" payment and I'd get another, "final" bill within a month. I'd also receive separate bills from the doctor, the radiologist, and the company that sells the crutches.

My Swiss insurance applied some weird formula to each bill that I can't quite sort, but they covered most of the expense so I can't complain.

In terms of Cigna, it is odd they refused to provide information to the municipality, and wanted OP to sign for the policy before she knew if the Gemeinde would approve it. I can imagine the messy thread we'd have from that!
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Old 20.05.2017, 18:59
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Re: Beware of Cigna!

I worked on a Radio 4 holiday programme back in the late 70s through the 80s and the recommendation then for travel insurance for the US was minimum cover of $1 million. These days it's probably nearer 2 million. I doubt any Swiss health insurance is going to come near to covering that sort of cost if it's needed.

I haven't experienced US health care as a tourist (thank goodness), but I've heard that you can get charged for really silly things like having an extra pillow if you want one. And it's a daily charge?

In any case I'd want an insurance where they pay directly rather than me paying and then claiming it back. Yes, it may be a pain to have to ring them to get approval first, but still likely to save you paying thousands out of your own pocket. Difficult to do if you don't have the cash on hand and your credit cards are maxed out. What are you supposed to do then, bearing in mind that most US banks don't have things like SWIFT or IBAN numbers to do international transfers with.
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Old 20.05.2017, 19:18
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Re: Beware of Cigna!

My insurer told me that everything would be covered everywhere, apart from the States, Canada, and, a recent addition to the list, Australia. He said that I should take out a supplementary insurance for travelling in these countries.

As I am going to Australia next year, can anyone with Oz experience comment on this?
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Old 20.05.2017, 22:02
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Re: Beware of Cigna!

To give you an idea of how costs vary between the the US and CH:

I was worried because the surgeon at the local CH hospital has a poor reputation, so I toyed with the idea of having an operation done in the US. I got a quote from a well-known Chicago hospital so I could compare the cost estimate from the local Swiss hospital.

Bearing in mind Edot's comment about less-than-transparent costs at US hospitals, and bearing in mind that this would be a planned hospitalization. An emergency op in the US would likely be far more expensive:

US hospital: High 90Ks - mid 120Ks, 24 hour stay.
Swiss hospital - 20K, estimated 5-7 day stay
(Only stayed 2 days, so far costs are quite a bit less than the estimate, and I think most of the bills are in...)

So the US estimate was 5-6x the Swiss estimate, difference against actual even more astounding. Coverage of max 2x the Swiss costs could leave you hundreds of thousands in debt. I shudder to think what an emergency heart attack would cost in the US.

So no guesses where I had the op done.

But an inexpensive solution would be travel medical insurance. I, too, have CSS for my basic insurance and took out a travel medical policy with them (not a supplemental KK policy) that covers emergencies (and only emergencies) in the US. IIRC it's something like 200/year, and that includes some level of flight insurance as well.
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Old 20.05.2017, 22:21
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Re: Beware of Cigna!

Thanks Meli. That is exactly what I meant in post 12.
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Old 21.05.2017, 17:25
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Re: Beware of Cigna!

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I worked on a Radio 4 holiday programme back in the late 70s through the 80s and the recommendation then for travel insurance for the US was minimum cover of $1 million. These days it's probably nearer 2 million. I doubt any Swiss health insurance is going to come near to covering that sort of cost if it's needed.

I haven't experienced US health care as a tourist (thank goodness), but I've heard that you can get charged for really silly things like having an extra pillow if you want one. And it's a daily charge?

In any case I'd want an insurance where they pay directly rather than me paying and then claiming it back. Yes, it may be a pain to have to ring them to get approval first, but still likely to save you paying thousands out of your own pocket. Difficult to do if you don't have the cash on hand and your credit cards are maxed out. What are you supposed to do then, bearing in mind that most US banks don't have things like SWIFT or IBAN numbers to do international transfers with.
As a former banker, it is very easy to execute international wires/transfers to US banks as they use a Swift/BIC code which is recognised/accepted by the international banking community. They do not use IBAN numbers however. We have lived the last 30 years overseas (Europe and Asia) and I have never had any issues transferring money to our accounts in the US
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