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Old 07.11.2019, 21:48
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Doctor eligibility

Hello,

I am working in Switzerland and recently I had a knee trauma. I have had a slight knee pain before, but now it's getting really bad. My question is if insurance is paying for orthopedist or do I have to pay myself? I have a very basic plan insurance, but to be honest I don't understand what am I allowed to do with it. If in the end I need to pay myself, what would be aprox price for a visit, x-ray etc?
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Old 07.11.2019, 22:03
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Re: Doctor eligibility

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Hello,

I am working in Switzerland and recently I had a knee trauma. I have had a slight knee pain before, but now it's getting really bad. My question is if insurance is paying for orthopedist or do I have to pay myself? I have a very basic plan insurance, but to be honest I don't understand what am I allowed to do with it. If in the end I need to pay myself, what would be aprox price for a visit, x-ray etc?



It's an accident, not a health issue, if you are working you are insured via your employeur, if you are not working then you should have accident insurance attached to your health insurance.
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Old 07.11.2019, 22:19
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Re: Doctor eligibility

Depends what OP means by knee trauma? How did it happen. Just pain getting worse, or have you had some accident?
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Old 07.11.2019, 22:19
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Re: Doctor eligibility

If the accident occurred after you started living in Switzerland, the treatment, as already mentioned is covered by accident insurance. You need to report it to your employer and they will give you paperwork for the doctor. (Start with your GP and they will refer you.) This is better than health insurance as there is no excess to pay.

If it happened before you moved to Switzerland, I believe your normal health insurance has to cover it.
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Old 07.11.2019, 22:53
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Re: Doctor eligibility

Well to be honest it happened to me after I was hiking. I didn't have a real accident, but I just fel pain which now developed into 'I can't walk upstairs' pain, because I think I tore apart one of my muscles. I waited over 2 weeks, because I thought the pain will go away, but it gets worse. My employer is a family, since i am au-pair. The way they explained me about my insurance, is that I have a basic plan with franchise (?) of 2000 €. They told me that if my treatment is cheaper and not considered as first aid, I would have to pay everything myself. Technically they would have to pay, but of course they're not happy about it l... I just don't know how much that woyld cost, if let's say I need x-ray and then physiotherapy or in the worst case a surgery?
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Old 08.11.2019, 00:06
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Re: Doctor eligibility

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Well to be honest it happened to me after I was hiking. I didn't have a real accident, but I just fel pain which now developed into 'I can't walk upstairs' pain, because I think I tore apart one of my muscles.
That counts as accident!

They are full of it, they have to pay, not you.

My daughter recently sprained her ankle while walking, that was immediately covered by SUVA!

Tom
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Old 08.11.2019, 00:09
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Re: Doctor eligibility

Just to check, you are covered under standard Swiss health insurance, aren't you? (As in, not EHIC or some other type of arrangement. Your comment if not "considered as first aid" prompted the question )

Assuming Swiss health insurance:

When you say 'basic plan', there are more than one type of basic insurance models.

One is traditional - that is, you can decide on your own to see a doctor, even a specialist. (That is, if a specialist will see you on your own, but that's another topic) This type of plan is often a bit more expensive.

There there are variations of managed care models.

One is the Hausarzt model, where you have chosen a GP, and that GP must be your first point of contact. In this type of model, no matter what the issue, see your GP first. (Exceptions for gynecology and ophthalmology.)

Another is a TeleMed model, where you are required to first call a medical hotline and discuss your concern. The medical professional on the call then decides what the next step would be.

There might be other managed care models as well, I am not au fait with all that is offered today. The managed care models generally have less expensive premiums - that is the trade off.

If you have one of the non-traditional models and you don't follow the procedure you signed up for, you could end up having to pay more than you expected. So first, find out which of the 'basic plan' models you have.

---

Were it me, I would start with a GP (assuming you are not on TeleMed) for a first look at what is going on. A GP might decide that specialist referral is needed after initial examinations - and the GP can help arrange those appointments.

---

If you have a franchise of 2000, that means that the first 2000 in bills per year comes out of your pocket - and once that threshold is met, another 10% of the next 7000, for a total of 700 out of pocket possible.

---
Now comes the question of accident coverage. If your employers have taken out accident insurance for you (and they should have!), in that case you do not have the deductible to pay.

---

HOWEVER - not every 'accident' as we understand the word is deemed an accident for insurance coverage purposes.

(My torn ACL and other assorted broken bits, the result of a fall, were ruled an illness, not an accident. But then, I am an ancient old crone, already on the way to turning to dust...)

---

Just so you know:

MRI of the knee - most of mine have run in the neighborhood of 800, although IIRC one was less, maybe CHF 5-600

Physiotherapy - ca.CHF 65 for 25 minutes - with a doctor's Rx insurance will usually cover 9 sessions. Sometimes additional sessions will be covered, on doctor's order.

Surgery would depend on what needs to be done - but in any case, you can ask for a cost estimate from the surgeon/hospital before deciding what to do.

Then there are the cost of the doctor visits, which will depend on what is done. Budget 100-200 per appointment.


---

Bottom line - first you need more information as to exactly what type of plan you have - and make sure you know who your accident insurer is! - and then, get thee to a GP (or call TeleMed) as soon as you can.

Do you have a copy of your insurance policy? If not ask your employers for it. Or if you have your insurance card (and you should have one), call the insurance company and ask them for a copy of the policy.

---

By the way, a good overview of Swiss health insurance can be found on the Comparis site - you might browse around a bit to help you understand how the system works:
https://en.comparis.ch/krankenkassen/default


Good luck - I hope you get the treatment you need, and that you start to feel better soon.



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Technically they would have to pay, but of course they're not happy about it l...
This statement worries me a great deal. Your employers have a responsibility to ensure that you have appropriate medical insurance accident insurance - please do not let them discourage you from getting treatment!

Last edited by meloncollie; 08.11.2019 at 00:36.
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Old 08.11.2019, 00:13
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Re: Doctor eligibility

Why should they pay? Is that what is stated in your contract?

If your franchise is 2000 CHF then any treatments up to that comes from your pocket. Over that you pay 10% of cost for out patient treatments.

How much will it cost you? How long is a piece of string? Count minimum 300 CHF for first visit then add 200 to 300 for any second visit. Physio 400 or so in total. Surgery; sky is the limit.


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Well to be honest it happened to me after I was hiking. I didn't have a real accident, but I just fel pain which now developed into 'I can't walk upstairs' pain, because I think I tore apart one of my muscles. I waited over 2 weeks, because I thought the pain will go away, but it gets worse. My employer is a family, since i am au-pair. The way they explained me about my insurance, is that I have a basic plan with franchise (?) of 2000 €. They told me that if my treatment is cheaper and not considered as first aid, I would have to pay everything myself. Technically they would have to pay, but of course they're not happy about it l... I just don't know how much that woyld cost, if let's say I need x-ray and then physiotherapy or in the worst case a surgery?
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Old 08.11.2019, 00:21
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Re: Doctor eligibility

Why is it the employers responsibility? Are there special rules on this for AuPairs? (I'm referring to health and not accident)

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Just to check, you are covered under standard Swiss health insurance, aren't you? (As in, not EHIC or some other type of arrangement. Your comment if not "considered as first aid" prompted the question )

Assuming Swiss health insurance:

When you say 'basic plan', there are more than one type of basic insurance models.

One is traditional - that is, you can decide on your own to see a doctor, even a specialist. (That is, if a specialist will see you on your own, but that's another topic) This type of plan is often a bit more expensive.

There there are variations of managed care models.

One is the Hausarzt model, where you have chosen a GP, and that GP must be your first point of contact. In this type of model, no matter what the issue, see your GP first. (Exceptions for gynecology and ophthalmology.)

Another is a TeleMed model, where you are required to first call a medical hotline and discuss your concern. The medical professional on the call then decides what the next step would be.

There might be other managed care models as well, I am not au fait with all that is offered today. The managed care models generally have less expensive premiums - that is the trade off.

If you have one of the non-traditional models and you don't follow the procedure you signed up for, you could end up having to pay more than you expected. So first, find out which of the 'basic plan' models you have.

---

Were it me, I would start with a GP (assuming you are not on TeleMed) for a first look at what is going on. A GP might decide that specialist referral is needed after initial examinations - and the GP can help arrange those appointments.

---

If you have a franchise of 2000, that means that the first 2000 in bills per year comes out of your pocket - and once that threshold is met, another 10% of the next 7000, for a total of 700 out of pocket possible.

---
Now comes the question of accident coverage. If your employers have taken out accident insurance for you (and they should have!), in that case you do not have the deductible to pay.

---

HOWEVER - not every 'accident' as we understand the word is deemed an accident for insurance coverage purposes.

(My torn ACL and other assorted broken bits, the result of a fall, were ruled an illness, not an accident. But then, I am an ancient old crone, already on the way to turning to dust...)

---

Just so you know:

MRI of the knee - most of mine have run in the neighborhood of 800, although IIRC one was less, maybe CHF 5-600

Physiotherapy - ca.CHF 65 for 25 minutes - with a doctor's Rx insurance will usually cover 9 sessions. Sometimes additional sessions will be covered, on doctor's order.

Surgery would depend on what needs to be done - but in any case, you can ask for a cost estimate from the surgeon/hospital before deciding what to do.

Then there are the cost of the doctor visits, which will depend on what is done. Budget 100-200 per appointment.


---

Bottom line - first you need more information as to exactly what type of plan you have - and make sure you know who your accident insurer is! - and then, get thee to a GP (or call TeleMed) as soon as you can.

Do you have a copy of your insurance policy? If not ask your employers for it. Or if you have your insurance card (and you should have one), call the insurance company and ask them for a copy of the policy.

---

By the way, a good overview of Swiss health insurance can be found on the Comparis site - you might browse around a bit to help you understand how the system works:
https://en.comparis.ch/krankenkassen/default


Good luck - I hope you get the treatment you need, and that you start to feel better soon.





This statement worries me a great deal. Your employers have a responsibility to ensure that you have appropriate medical insurance - please do not let them discourage you from getting treatment!
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Old 08.11.2019, 00:28
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Re: Doctor eligibility

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Why is it the employers responsibility? Are there special rules on this for AuPairs? (I'm referring to health and not accident)
Now that you've brought up the question I did a bit of googling rather than going from memory, and I think you are right - domestic employers are required to provide accident insurance, but I see no mention of health insurance.

(I was going on the recollection of a few friends who are Au-pairs whose families paid their health insurance, maybe that was just an individually negotiated item.)

So the mystery deepens.

Betruewhatyoudo, could you further explain your comment about the family being required to pay?


But no matter who pays what - get to the doctor!


ETA:

Found the Canton ZH Merkblatt für Au-pairs, which says

Die Quellensteuer, die Arbeitnehmerbeiträge für AHV / IV / EO / ALV / BVG, die Hälfte der Prämie für die Krankenversicherung sowie die ganze Prämie für die Nichtberufsunfallversicherung dürfen vom Lohn abgezogen werden.

Which would imply that the family pays half the KK premium... Can anyone confirm?

https://awa.zh.ch/internet/volkswirt...r+Kroatien.pdf

Last edited by meloncollie; 08.11.2019 at 00:54.
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Old 08.11.2019, 01:12
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Re: Doctor eligibility

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Just to check, you are covered under standard Swiss health insurance, aren't you? (As in, not EHIC or some other type of arrangement. Your comment if not "considered as first aid" prompted the question )

Assuming Swiss health insurance:

When you say 'basic plan', there are more than one type of basic insurance models.

One is traditional - that is, you can decide on your own to see a doctor, even a specialist. (That is, if a specialist will see you on your own, but that's another topic) This type of plan is often a bit more expensive.

There there are variations of managed care models.

One is the Hausarzt model, where you have chosen a GP, and that GP must be your first point of contact. In this type of model, no matter what the issue, see your GP first. (Exceptions for gynecology and ophthalmology.)

Another is a TeleMed model, where you are required to first call a medical hotline and discuss your concern. The medical professional on the call then decides what the next step would be.

There might be other managed care models as well, I am not au fait with all that is offered today. The managed care models generally have less expensive premiums - that is the trade off.

If you have one of the non-traditional models and you don't follow the procedure you signed up for, you could end up having to pay more than you expected. So first, find out which of the 'basic plan' models you have.

---

Were it me, I would start with a GP (assuming you are not on TeleMed) for a first look at what is going on. A GP might decide that specialist referral is needed after initial examinations - and the GP can help arrange those appointments.

---

If you have a franchise of 2000, that means that the first 2000 in bills per year comes out of your pocket - and once that threshold is met, another 10% of the next 7000, for a total of 700 out of pocket possible.

---
Now comes the question of accident coverage. If your employers have taken out accident insurance for you (and they should have!), in that case you do not have the deductible to pay.

---

HOWEVER - not every 'accident' as we understand the word is deemed an accident for insurance coverage purposes.

(My torn ACL and other assorted broken bits, the result of a fall, were ruled an illness, not an accident. But then, I am an ancient old crone, already on the way to turning to dust...)

---

Just so you know:

MRI of the knee - most of mine have run in the neighborhood of 800, although IIRC one was less, maybe CHF 5-600

Physiotherapy - ca.CHF 65 for 25 minutes - with a doctor's Rx insurance will usually cover 9 sessions. Sometimes additional sessions will be covered, on doctor's order.

Surgery would depend on what needs to be done - but in any case, you can ask for a cost estimate from the surgeon/hospital before deciding what to do.

Then there are the cost of the doctor visits, which will depend on what is done. Budget 100-200 per appointment.


---

Bottom line - first you need more information as to exactly what type of plan you have - and make sure you know who your accident insurer is! - and then, get thee to a GP (or call TeleMed) as soon as you can.

Do you have a copy of your insurance policy? If not ask your employers for it. Or if you have your insurance card (and you should have one), call the insurance company and ask them for a copy of the policy.

---

By the way, a good overview of Swiss health insurance can be found on the Comparis site - you might browse around a bit to help you understand how the system works:
https://en.comparis.ch/krankenkassen/default


Good luck - I hope you get the treatment you need, and that you start to feel better soon.





This statement worries me a great deal. Your employers have a responsibility to ensure that you have appropriate medical insurance accident insurance - please do not let them discourage you from getting treatment!
Thank you for informative answer. Judging by what you just said, I guess I have TeleMed insurance? I wrote email to my insurance and they told me that I should call their special line and consult them explaining what happened to me. I was just not sure if I can wait to get appointment as it becomes a bit of emergency. However I will make this call tomorrow.

And regarding health coverage, it is part of the contract. Normally the family should provide au-pair with insurance, that is stated in the rules of au-pairing in general, as well as it is a must in Basel Kanton. Without it I would not have allowance to live and work here. However I was not informed enough before, that this insurance might not cover simple medical checks. Or maybe it was also my mistake, because as a EU citizen I didn't do a proper check on how it works here and expected it to be more simple.
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Old 08.11.2019, 01:43
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Re: Doctor eligibility

That document is really poorly written as it is ambitious! This one is better:

https://www.google.ch/url?sa=t&rct=j...42EkPxikKWfgeq

It looks like the family has to pay 50% of the insurance premium. Nowhere is it however said that they have to pay anything else. So franchise etc would be the Aupair unless contract states something different.



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Now that you've brought up the question I did a bit of googling rather than going from memory, and I think you are right - domestic employers are required to provide accident insurance, but I see no mention of health insurance.

(I was going on the recollection of a few friends who are Au-pairs whose families paid their health insurance, maybe that was just an individually negotiated item.)

So the mystery deepens.

Betruewhatyoudo, could you further explain your comment about the family being required to pay?


But no matter who pays what - get to the doctor!


ETA:

Found the Canton ZH Merkblatt für Au-pairs, which says

Die Quellensteuer, die Arbeitnehmerbeiträge für AHV / IV / EO / ALV / BVG, die Hälfte der Prämie für die Krankenversicherung sowie die ganze Prämie für die Nichtberufsunfallversicherung dürfen vom Lohn abgezogen werden.

Which would imply that the family pays half the KK premium... Can anyone confirm?

https://awa.zh.ch/internet/volkswirt...r+Kroatien.pdf
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Old 08.11.2019, 11:16
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Re: Doctor eligibility

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That document is really poorly written as it is ambitious! This one is better:

https://www.google.ch/url?sa=t&rct=j...42EkPxikKWfgeq

It looks like the family has to pay 50% of the insurance premium. Nowhere is it however said that they have to pay anything else. So franchise etc would be the Aupair unless contract states something different.
Well I just opened my contract again, it says that they take care on any medical expenses in the case of sickness or accident.

However I also googled what states regulations about insurance coverage in Switzerland and you're right, it says that health insurance must be paid 50/50.
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Old 08.11.2019, 11:24
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Re: Doctor eligibility

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Well I just opened my contract again, it says that they take care on any medical expenses in the case of sickness or accident.

However I also googled what states regulations about insurance coverage in Switzerland and you're right, it says that health insurance must be paid 50/50.
I would ask the family for exact details of any insurances they have taken out for you.

If you are working over a certain amount of hours they should be paying for at least your accident insurance and this would be classed as an accident. It doesn't need to have happened while you were working, it counts also if you are outside of work.

Another point is that presumably with your knee in a bad way, you can't fully perform your duties so it would be in their best interests, too, to get you treated.

Also the fact that it has got worse over the last couple of weeks is quite normal for knee injuries, too. Sometimes you can walk them off immediately and it's fine for a few days then the damage starts to become apparent after that.
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Old 08.11.2019, 11:34
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Re: Doctor eligibility

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My daughter recently sprained her ankle while walking, that was immediately covered by SUVA!
You may recall earlier this year my daughter tore ligaments on both sides of her ankle while doing the police assessment course. SUVA disputed it was an accident until we quote the relevant OR.

@OP - if the contract gives better benefits than the rules/laws, then the contract takes precedent. For accident insurance paid for by employer, (usually?) there is no excess. If a franchise does apply the maximum for you will be CHF2'600. It's not clear, but your contract seems to indicate your employer pays.

Just in case you need it, there is a walk (hobble!) in clinic near Basel SBB - https://www.medix-toujours.ch/en/ I've been twice and never had to wait. You don't need an appointment - just your insurance card. Open early until late 7 days a week.
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Old 08.11.2019, 11:36
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Re: Doctor eligibility

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Well I just opened my contract again, it says that they take care on any medical expenses in the case of sickness or accident.

However I also googled what states regulations about insurance coverage in Switzerland and you're right, it says that health insurance must be paid 50/50.

The MINIMUM requirement is 50/50 however if the employer wishes to cover at 100% that is also allowed.


As you contract states they take care, well it is fairly open/shut case.


Sounds like accident insurance anyway where their is no franchise
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Old 12.11.2019, 18:01
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Re: Doctor eligibility

Ok, so a quick update:

Last week I called Medgate, who gave me a consultation on the phone and reffered me to Universitätsspital, as it is an emergency. I took an accident report from my employer and went straight to Notfall in the hospital. However, the doctor told me that I might have knee pathology, because my patella links are moving, so she gave me a prescription for physiotherapy. Now I have to go there for 9 times and I have appointment with a surgeon in a month, who should tell me, whether it helped me or I need to plan a surgery.

I found a physiotherapist, registered, but since its not an accident after all, that is causing the problem, I don't get what can I expect from my insurance? I understood that the franchise of 2000chf means, that I have to pay for physiotherapy and everything else myself and insurance will cover everything that exceeds the limit?

I know that the full price of physio course will cost around 500-600chf. What concerns me is the fact that the law says I have to cover 50% of medical treatments (unless my hosts would be kind enough), where am I supposed to get this money, when my monthly salary as au-pair is already less than 500eu/month? I know its more just a rhetorical question, but it's ridiculous...
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Old 12.11.2019, 18:19
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Re: Doctor eligibility

Insurance covers 90% of that which exceeds your franchise, until you have paid 700 above the franchise.

Tom
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Old 12.11.2019, 18:22
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Re: Doctor eligibility

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Insurance covers 90% of that which exceeds your franchise, until you have paid 700 above the franchise.

Tom
No franchise for accident !!

The law states the MINIMUM requirement, your contract takes precedence as it is above the minimum requirement so employer pays, but as it is under accident insurance, it’s a mute point anyway.
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Old 12.11.2019, 18:28
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Re: Doctor eligibility

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No franchise for accident !!
I know, but:

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its not an accident after all.
Tom
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