Hello everyone,

I am in the process of applying for the supplementary health insurance (private) with the same company I have the basic insurance. I have recently undergone a treatment, which was clearly a fertility test, as we are trying for a baby. I have not mentioned this test in the form, but then received a letter, that stated the date of the treatment (no details) and asking to clarify. I did not mention the test in the first place because no issues were found.

Should I tell all the details explicitly in the application form? Do they actually know already what kind of treatment was it? Can a potential pregnancy be considered as a reason for rejection?

Thanks and have a nice weekend

- Yes they can reject you if they please, they can do so for pre-existing conditions or simply because they feel like it due to bad weather on a Friday.

- Pregnancy and labour is covered under basic insurance (unless you want luxury extra's).

- Don't lie on insurance forms, better to not answer at all if so.

I don't think a potential pregnancy is a reason for rejection, however insurance companies make up a million reasons not to cover you.

In this case, they might be concerned you have a pre-existing condition of some kind that needs to be excluded or would be grounds for denying a supplemental policy.

Most supplementary insurances exclude pregnancy coverage for roughly the first year anyway.

This is a contract of the utmost good faith meaning that you are obliged to disclose everything that could result in a claim, even if not asked. Failure to do so will render the insurance invalid.

Hi Jim2007, 3Wishes and EdwinNL

Thanks a lot for your replies!

That's the thing, that there is nothing related to my health that could be a reason, no history, smoking or weight, other than a bad Friday weather.

The test showed that everything is fine, but the fact of it itself means that I could potentially end up in the hospital giving birth. So having the privacy after it is the only reason I want this insurance, and besides, my husband's employer pays for it.

So would you recommend go full blast about the baby planning, or just not comment on it?

Are you applying for private Maternity insurance?
If so, it only kick in after a certain amount of time, so you need to acquire it before you get pregnant.

As for the test itself, I don’t believe it’s the result that counts, it’s the fact that you may have had voluntary treatment and that that specific test/appointment thus might not be covered by the insurance.

Best is to ask your doctor on how to correctly handle the form.

Rest assured that once you are pregnant, your care is covered by basic health insurance in a cantonal hospital (very good hospitals).

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"Il mondo è fatto a scale, chi le scende e chi le sale"

If you don't comment, then potentially everything to do with pregnancy, they don't have to pay out for any supplementary cover.

No comment = No cover

Not pregnancy/fertility related, but along those lines: One of the several reasons I was rejected for supplementary insurance was that back home I had done screening tests for certain illnesses, typical preventative medicine in the US. The tests came back negative, so I have 'proof' that I was, indeed, free of those conditions. However, simply having such tests done was enough to disqualify me for Swiss supplementary insurance, as it meant that I might be in a higher risk group.

I don't know if this approach is standard across supplementary insurers, or specific to the one I applied for.

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If Lle27 does not qualify for supplementary insurance for future pregnancies, if privacy is important to her could she instead pay out of pocket to upgrade her hospital stay? Is that option typically available for maternity care?

(I have twice upgraded to a single room for hospital stays here, while treatment remained at the level covered by basic insurance. A fairly inexpensive option at our local hospital to provide the privacy I prefer. At some hospitals one can upgrade the room only, at others one must upgrade both room and level of treatment together. Policies seem to differ by hospital, price as well.)

Do you really need supplementary insurance for a pregnancy ?

Standard care is excellent here and medically speaking there is zero difference between private and standard.

Also you may meet another new mother in exact same situation you could chat with and exchange notes

Either way there are terms when taking up a new contract for when some coverages become active.

If all you want is a private room to recover than even an insurance is no warranty that a private room is available, and the other way around could also happen, we are on basic and my wife got a private room since the shared rooms were full.

Most hospitals offer you the option to pay yourself for a private room if any available without any involvement of the insurance, Triemli Zürich charges 350,- a day for such.

As for your question, they asked why you did a certain test, just tell them why you did it and that all was good. Or you have to tell them that you refuse to answer the question which also means you get no additional insurance.

My wife was pregnant when we moved here so we also had standard care. I can't say that we really missed something as the hospital was excellent.

I didn't read the OP to mean that the Supp Insurance was wanted for reasons related to the potential pregnancy, just concerned that it might exclude her.

Your question is still valid without that clause though - Do you really need supplementary insurance at all?

One of the key (for some people) benefits would be the ability to have a private room if you're hospitalised, but it's often possible to simply pay the hospital directly for the single room upgrade, which is going to be a lot cheaper than the extra annual premiums unless you're in for a very long period of time.

For pregnancy, labour and aftercare the answer is very easy.

NO.

If you want free choice of doctor, more luxury and such: Yes. (Tho a lot can be directly paid for towards the hospital)

As already stated, failure o disclose a potential risk will render the policy invalid. You are dealing with professional loss adjusters who have seen and heard it all before, so the chances are high that it will be detected. And if there is an issue you can expect the policy will be canceled.

Since your husband’s employer is paying for the policy they would be informed that the policy was canceled. Only you can know how that will look to his employer.

Also, I think when applying for insurance, you are required to disclose if you have had a policy canceled or were refused insurance in the past.

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"There is no passion to be found playing small - in settling for a life that is less than the one you are capable of living." - Nelson Mandela

If the main reason for get the insurance is to have a private room for recovery then it probably is not worth it.

- In an emergency, you’ll have to take what ever is available at the time

- There are some situations where your medical condition means they will not put you in a private room in any case

- Your local hospital may physically have private rooms, some only have doubles

It would probably be cheaper to just pay for the room at the time.

Depending on the nature of the test, why not say you had routine testing as part of your considerations on whether or not to start a family?

I'm a bit puzzled though. OP uses the word treatment first and then says it was a test.

A treatment implies there's a condition that needs to be treated. A test implies you don't yet know whether there's a condition that needs to be treated.

Hi 3Wishes,

the thing is, that in the letter the insurance company sent me for clarification, it is been referred as "Behandlung", not as a test. But this was actually a fertility test, which is, however, hardly a routine test. So if the insurance knows what exactly the test was, I can't say it's a routine.

Ideally, I don't want to lie or conceal things. But if these guys can really see pregnancy as a complication, it's just unfair. Then any woman in a fertile age is potentially discriminated from getting a complementary insurance, without explanation. I know they calculate their risks, but....

You mean if I fail to disclose that we plan to start a family, then even after this year or so period they can render the contract invalid?

It's kind of both. I mean I would prefer to have it for pregnancy, but if it happens before the policy starts, it's also fine.
But yes, since the baby planning is in my medical records now, I am afraid that I'll be rejected because of it.

I essentially get the private insurance for free, as the employer pays. If I don't have it, then I would need to pay for upgrades out of my pocket.

Pregnancy is not the issue, although it may be covered only after a certain period of time. Not disclosing a Behandlung will probably lead to exclusion of that.

See Jim2007´s post

Private health insurance is not just about having a private room.
It also means having a right to have the woman’s Obstetrician present during delivery. Since a large % of doctors with private practices only operate/deliver/work in private clinics, the patient needs to have some kind of private healthcare to be cared for by her own doctor.
Otherwise, the expecting mother with basic insurance goes to the cantonal hospitals (which are excellent by the way).

Though I’m a firm believer is private health insurance, I prefer cantonal, teaching university hospitals because if something goes wrong they have everything needed (like a neo-nat ward).

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"Il mondo è fatto a scale, chi le scende e chi le sale"

Thanks for fast reply roegner,

If we forget about the test and Behandlung, thing.

Let's say, I apply for the complementary insurance, and tell the insurer (for whatever reason) that I will probably be giving birth in 1.5 years (being perfectly healthy otherwise, no records), the baby fact itself would not be a reason for rejection?

That's another reason why I care about the private insurance.
I have no idea how the things would go, but if I have the opportunity, and don't have to pay for it myself, I would prefer to have extra perks.