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Old 05.06.2018, 17:30
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SwissCare after exemption ran out - will they still pay?

Hi all. I used to be a PhD student in Zurich. I have seen many topics on this forum with questions about what happens once someone is not eligible for SwissCare insurance anymore but does not convert to a "proper" insurance immediately. Usually the answer was that nothing happened even for people who delayed the change of insurer by a year or so.

But my question is, did anyone actually use SwissCare insurance after he/she was not eligible for exemption anymore? To my understanding, SwissCare doesn't really care about the exemption, who cares is the Switzerland (or Zurich City). Therefore, if I am not eligible for SwissCare anymore and Zurich City finds out, I can get in trouble. But if I still paid the SwissCare insurance after my exemption ran out and I get sick and want then to cover the bills, will they do it, or is the fact that I am not eligible for insurance exemption anymore an excuse for them to not pay anything anymore?
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Old 05.06.2018, 17:40
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Re: SwissCare after exemption ran out - will they still pay?

Might depend on the goodwill of the insurance.

You are without doubt obligated by the T&C to tell them about relevant changes. Failing to do so might result in claims not being taken up by them.

Now if the they will just pay up for all and give you a big fine for breaking the rules or if they will go as far to also not pay your bills is unknown to me.

Nonetheless you want to save some money by deliberate breaking the rules, Switzerland is a country where such things can have harsh and expensive repercussions and you should not do it.
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Old 05.06.2018, 17:46
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Re: SwissCare after exemption ran out - will they still pay?

If you still have a valid SwissCare insurance, and it's usually valid till the end of the calendar year, they will pay, but if you don't, they won't and you become personally liable for any health care you may need. You won't be refused treatment if it's essential, but you will have to pay and they will pursue you.
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Old 05.06.2018, 21:07
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Re: SwissCare after exemption ran out - will they still pay?

I got dematriculated in January and I pay SwissCare bills every quarter. I just received a new one and that's why I again remembered about the problem... I would say that if they keep sending me bills and I keep paying them, they should remain responsible for covering medical bills, but this is true that probably T&C are violated by now so they probably can interpret it the way they want...
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Old 05.06.2018, 23:19
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Re: SwissCare after exemption ran out - will they still pay?

I also had a Swisscare insurance during my student time and I kept it even after my permit and work situation changed. Actually, at that time I did not know I was no longer exempted and should change my insurance plan. I only found out when the Gemeinde asked me to send a copy of my health insurance and was told the Swisscare is not allowed. So I had to take a new insurance dating back to the time when the permit was changed (6 months). The agent from my present insurance provider was nice and gave the cheapest option for those six months. Then I sent those copy to SwissCare explaining the situation and they paid back the premium.
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