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Old 07.09.2019, 13:01
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Insurance cover for sports injuries

Hi all

I arrived in Switzerland a month ago and I'm trying to decide what health insurance to go with. I do a lot of running, cycling and swimming and pick up the odd minor injury every now and then so the main thing that I'd like my insurance to cover are consultations and treatments related to these injuries.

In the past this has meant going to see a physiotherapist or a consultant that specialises in sports injuries. When I have seen a consultant I generally need to get an MRI and some form of treatment (e.g. steroidal injection, rehab program). The SportClinic Zurich (sportclinic.ch) has been recommended to me as a one stop shop for sports injuries but I'm not sure what supplemental would cover this or if it might be covered by a basic health insurance package.

Does anyone know what insurance I would need take out to cover some or all of the cost of this?
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Old 07.09.2019, 18:01
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Re: Insurance cover for sports injuries

Hi Kafka and welcome,

I only have the basic insurance (Lamal/KVG) and so can speak of my limited experiences with that.

However, if your injury is from an accident and you are working, any care will be covered by your employers insurance - this isn't just work related accidents, but skiing injuries, falling off the bike etc. So you can check the level of your employers policy.

For complaints that don't arise from accidents, I've not had a problem with the basic insurance. Provided a doctor considers treatment or investigation necessary it should be covered, including physiotherapy (though there are limits to the number of sessions per year), what's important is you see the doctor and get a prescription for physio etc.

In my case I saw the doctor one day, had prescription for physio and saw the physiotherapist the next.

Be aware that the supplemental insurance requires a medical questionnaire and so could exclude any pre-existing injuries - one reason I didn't bother with it myself.

Hope that helps!
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Old 07.09.2019, 23:16
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Re: Insurance cover for sports injuries

Thanks sct, that is very helpful. I'm struggling to see how supplemental cover would be worth the additional cost. Out of interest have you had any say in who you are referred to for complaints that don't arise from accidents or is this restricted under basic insurance?
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Old 07.09.2019, 23:51
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Re: Insurance cover for sports injuries

If you are working more than an average of 8 hours per week, then your employer must insure you for accidents which occur at work, and also in your free-time. They are known, in German, as BU (Berufsunfall) and NBU (Nichtberufsunfall) Versicherung, respectively.

If you work for an average of less than 8 hours per week, then your employer must insure you only for BU, and you must buy insurance for NBU.

In any case, it can be very convenient to have a top-up insurance that gives you free choice of doctors throughout Switzerland, and doesn't limit you to your home canton, or to your one GP or medical centre. I'd guess that for you, as an active person, this would be a good idea.

In addition, I'd recommend joining REGA. It is not an insurance, so there's no guaranteed help, but it is a collective. So many people in Switzerland pay in the very low annual contribution (Fr. 30 p.a. for a single person), that REGA owns helicopters and employs emergency rescue staff and will organise someone to fetch an injured or stranded patron as needed (and according to their resources at the time).
https://www.rega.ch/en/home.aspx
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Old 08.09.2019, 21:18
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Re: Insurance cover for sports injuries

Thanks for the suggestions, I'll look into joining REGA.

In terms of basic cover I'm assuming that the accident insurance would cover medical costs outside of the canton if it was an emergency e.g. broken leg while skiing.

I also take your point that it could be useful to have access to a particular specialist outside of my canton but I'm not sure what supplemental covers this - do you have any suggestions? I was looking at AXA's options but this seems to be either covering complementary therapy or private/semi-private rooms during a hospital stay. Quite possible that I'm missing something here though.
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Old 08.09.2019, 23:11
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Re: Insurance cover for sports injuries

Have a look here
https://www.axa.ch/health/kranken-zu...6-a8e49e4852a4
and scroll down to "freie Arztwahl", which means "free choice of doctors".

Freie Arztwahl might be possible without upping your general level of care, i.e. still basic (Grundversicherung).
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Old 09.09.2019, 13:23
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Re: Insurance cover for sports injuries

If you qualify, this might be a reason to at least look into supplemental insurance.

A stoooopid fall was ruled to be an illness, not an accident, and so I am now paying for physiotherapy out of pocket, as the limited number of sessions allowed under basic non-accident coverage was not enough to get me walking again. Also had to pay for a customized knee brace as the standard was not appropriate for my injury.

On the other hand, I'll be ca 5K out of pocket for things that might have been covered under supplemental insurance - which I think is less than the difference between basic and supplemental for one year's premium.

So unless you are at risk for regular accidents that are likely to not be considered accidents, you might still be better off with just basic coverage.

It's always a question of 'Where is your pain point?'. Some are more comfortable paying more upfront and then having fewer worries about the potential cost of treatment down the road, others are happier to save on the known costs, putting the difference aside against a rainy day. (Of course if you don't qualify for supplemental that option is off the table.)
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Old 09.09.2019, 17:41
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Re: Insurance cover for sports injuries

Seems a bit harsh that a fall wouldn't be considered an accident. Is it always the case that basic non-accident cover will only allow one course of treatment per illness and if it doesn't work you're on your own?
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Old 09.09.2019, 18:01
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Re: Insurance cover for sports injuries

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Seems a bit harsh that a fall wouldn't be considered an accident.
Yes, it is harsh. A fall is an accident when it happens "out of nothing", as it were, or from the force of something unexpected "from the outside". Unfortunately, a fall is classified as an illness when it is deemed that a basic, underlying medical condition is responsible for the fall-ability of the person.

I say "unfortunately" because - as meloncollie set out - in general the medical cover and benefits for accidents are superior to those for illness. This, I believe, is why insurance companies have come up with this sly trick of first trying to see whether any accident can be neatly re-classified as an illness or at least due to an illness.

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Is it always the case that basic non-accident cover will only allow one course of treatment per illness and if it doesn't work you're on your own?
No, that's not always the case. Physiotherapy typically is prescribed in sets of 9 appointments of 30 minutes each, to be taken once or possible twice a week. If, after that, the doctor deems that a further batch of 9 appointments is needed, he/she may prescribe them. Sometimes the doctor doesn't deem them necessary. Sometimes, even when the doctor does, the medical insurer refuses them. Sometimes one can fight with the medical insurer to get that next set of 9 covered, after all, but this doesn't always work.

As to fighting: one of the key principles to succeed in this is when the doctor's motivating report sets out not just: "I say my patient isn't quite better yet, so we must push on," but explains in detail What Is To Be Feared if the treatment were to end, and why, in detail, ending treatment would lead to that consequence. One has more chance of getting the treatment continued as soon as it can plausibly set out that the medical consequences of stopping early would end up causing the insurer greater medium- and long-term costs.
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Old 09.09.2019, 19:03
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Re: Insurance cover for sports injuries

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Seems a bit harsh that a fall wouldn't be considered an accident. Is it always the case that basic non-accident cover will only allow one course of treatment per illness and if it doesn't work you're on your own?

Yep, if there is anything in your medical history that could possibly have been a factor in a fall it could be classified as an illness.

This thread where someone fought the illness classification might prove illuminating:

https://www.englishforum.ch/family-m...-accident.html


---

As to challenging the insurer to cover more therapy: Fighting the insurance company would have taken time, and break in the PT would have undone the progress I had made to date. I felt I needed to continue uninterrupted if I was ever going to get off crutches.

I suppose I could have pushed, but honestly - at the time I was in too much pain to gear up for that fight.

Sometimes you just have to pick your battles...
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Old 10.09.2019, 01:18
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Re: Insurance cover for sports injuries

Your employer will contract an accident insurance for you.
Then you need to be lucky with the provider.

I've been really happy with some (declaration never challenged) while others never paid a cent.
I hurt my back falling at a football match, they did not want to cover it. I torn up my cornea when putting my lenses (that hurts!), they did not want to cover it...

I would suggest to take a low franchise if you get regular sports issues.

The law definition of accident is quit short, but some insurers will try take advantage of it so be careful when you declare it (from memory, it needs to be an external and exceptional cause. So for example if you just get some pain while you run, an insurance provider might not cover it. If not, then there needs to be a lesion. But in my example, they did not consider a cornea tear a lesion...)
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Old 10.09.2019, 20:07
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Re: Insurance cover for sports injuries

Thanks for all the information everyone, I'm getting a better picture of how the health insurance system works here. I think I will try to find an insurer with a reputation for not fighting claims (if they exist), even if the cover costs a bit more I would rather have the peace of mind. Not much point in paying less if the insurer is going to exploit some loophole to justify refusing cover.

@patrickk what providers were you happy with?

Would it be unheard of for people to take out their own accident insurance if they weren't happy with the provider that their employer had selected?
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