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Old 16.10.2020, 17:02
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Insurance models & diabetes & medication limitations

Hi all!
I've just arrived in Switzerland and I was searching for which insurance model to choose.

I am diabetic (mixed type for now - Type I according to the antibodies, but still under control with pills) and I was wondering if there is any other diabetic out there to propose which insurance model works better with this health condition (Multimed - Telemedicine & family doctor model combined, Family doctor model, Telmed - Telephone advice first, HMO - Contact your network doctor or group practice first, Standard - Free choice of doctor).

Also, apparently there are supplementary insurance called outpatience for medicine that they are not covered from the basic insurance or if the basic insurance only covers a limited amount of it.

So, I was searching in the http://www.listofpharmaceuticalspecialities.ch/ about my pills, but I can't understand if there is a limitation or not, as it's written for example 'Limit:
For the treatment of patients with type 2 diabetes mellitus.
For patients who cannot be adequately controlled with previous oral therapies and / or insulin or who cannot tolerate them.
Combination therapies with other oral antidiabetics, apart from sulphonylureas and / or insulin, require the insurance company to confirm the costs after consulting the medical examiner.'

In that case means that there is not limitation on the amount, so I don't need the supplementary insurance?

Thanks for your time Take care!
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Old 16.10.2020, 17:59
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Re: Insurance models & diabetes & medication limitations

Basic Insurance cannot exclude any pre-existing condition. But for supplementary cover, like private medicine, alternative medicine, etc- Insurance can refuse to take you on, due to age, pre-exisiting conditions, etc, without having to explain or justify this decision. We arrived in CH with pre-exisiting conditions, aged over 60- and we were refused for all supplementary cover. Nothing we could do about it- but probably saved us lots of money.


For Diabetes, normal treatment, be it via medication like Metformin, etc, or Insulin, or combination- is covered by basic insurance. But there is a list of treatments which are approved in Switzerland, and which will be covered- and others, that will not. If you are unable to use 'normal' treatment as above- then only a specialist with full knowledge of the treatment you are having instead of metformin/insulin combo- will be able to tell. Some medication prescribed in some countries are just not approved in CH.
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Old 16.10.2020, 18:41
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Re: Insurance models & diabetes & medication limitations

I am T1. I have the lowest franchise (CHF300) as the cost of my medicine alone is going to be much higher. I see my diabetaloge 4 times a year and I have other costs such as my FreeStyle libre which is f63 every two weeks or f1638 a year. Add in there the cost of test strips and Insulin.

All of the above is covered by the basic insurance.

Supplemental Insurance depends on your individual needs. The travel insurance is dirt cheap. Single room when hospitalised is debatable, Dental depending on your teeth and age ...

The first thing I would do would be to find a good diabetic specialist, and some of the insurance models could help you there.
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Old 16.10.2020, 21:34
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Re: Insurance models & diabetes & medication limitations

Husband is Type II diabetic and also has MS. We just have the standard basic health insurance and everything's been covered by it.
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Old 19.10.2020, 12:13
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Re: Insurance models & diabetes & medication limitations

I want to thank you all for your answers (as I am not able yet to do with the forum buttons )
Seems that the supplementary for diabetic medicine is not needed in my case, as I asked also in a pharmacy. The combination of the medicine I take though needs a 'special' explanation paper from the doctor.

So, the question is now to find a diabetologist - I guess though a GP?
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Old 19.10.2020, 12:17
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Re: Insurance models & diabetes & medication limitations

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I want to thank you all for your answers (as I am not able yet to do with the forum buttons )
Seems that the supplementary for diabetic medicine is not needed in my case, as I asked also in a pharmacy. The combination of the medicine I take though needs a 'special' explanation paper from the doctor.

So, the question is now to find a diabetologist - I guess though a GP?
Yes. Best way is to go to your GP and get a referral. They know the best person to send you to for what you need.
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Old 19.10.2020, 13:39
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Re: Insurance models & diabetes & medication limitations

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I want to thank you all for your answers (as I am not able yet to do with the forum buttons )
Seems that the supplementary for diabetic medicine is not needed in my case, as I asked also in a pharmacy. The combination of the medicine I take though needs a 'special' explanation paper from the doctor.

So, the question is now to find a diabetologist - I guess though a GP?
You probably would not be offered a supplementary policy in any case, either that or they would exclude diabetes from your supplementary offerings. Basic does a good job.

Many GPs manage diabetes, although as Type 1, your needs may be more complex. Your GP should refer you to an endocrinologist as needed.
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Old 19.10.2020, 13:47
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Re: Insurance models & diabetes & medication limitations

You can also ask your insurance company. They have a vested interest in you getting the best possible care. The side effects of T1 (your eyes, your kidneys, your feet, etc.) can be expensive. If you can stay in control (a1c below 7, time in target over 60%) they will love you.

If you donít have a freestyle libre, that should be your second question to your new diabetaloge. They have changed my life. (a1c 6.4; tit 68%).
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Old 19.10.2020, 13:53
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Re: Insurance models & diabetes & medication limitations

My GP practice now has a diabetes educator. One of the medical assistants is receiving special training and trains patients in the use of injectables and monitoring under doctor's supervision, of course. I don't know if this is Kanton wide (I'm in kt Zurich), or throughout the country or just my GP practice.
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Old 19.10.2020, 21:25
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Re: Insurance models & diabetes & medication limitations

I am type 2 . I go thee DAZ clinic. Veery good.

I started with metformin. Decided I dÓd not want to take it. So went on a big diet and lost 15 kilos. I have read about metformin and really not good for you.
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Old 19.10.2020, 22:46
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Re: Insurance models & diabetes & medication limitations

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I am type 2 . I go thee DAZ clinic. Veery good.

I started with metformin. Decided I dÓd not want to take it. So went on a big diet and lost 15 kilos. I have read about metformin and really not good for you.
And yet, it helps many other people.
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Old 19.10.2020, 22:56
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Re: Insurance models & diabetes & medication limitations

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Yes. Best way is to go to your GP and get a referral. They know the best person to send you to for what you need.

They probably will know or at least be able to ask someone else for someone to send you to, which might or might not be influenced by a monetary and/or insurance aspect.
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Old 19.10.2020, 22:56
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Re: Insurance models & diabetes & medication limitations

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And yet, it helps many other people.
In my experience (I'm no longer on it), the first few months are the worst in terms of the side effects. According to my doctor, this leads to patients not taking the medicine, taking it sporadically, thinking it doesn't work, or simply giving up entirely. It was a very rough few months and I hated it and couldn't see how it would make me any better. But I stuck with it, gradually made recommended changes, and no longer need it.

Also the extended release version was recalled in the States recently due to contamination. I got an email from my old pharmacy even though I haven't filled the script in years. However the media releases and the pharmacy email said not to stop taking any meds without first talking to your doctor.

Metformin is a tried and tested medicine that helps a lot of people for not a lot of money.
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Old 21.10.2020, 15:48
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Re: Insurance models & diabetes & medication limitations

Seems that supplementary insurance is not an option if you're diabetic, all companies have not offered any so far

Anyway, I'm still searching and probably will go for the GP model or GP plus phone model.

I wanted to ask, how you find a GP. Does the insurance give you a list to choose or I should find already one and tell the insurance who he/she is?
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Old 08.11.2020, 20:26
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Re: Insurance models & diabetes & medication limitations

I'm diabetic, T1. I've never made a claim relative to my diabetes on my supplemental insurance. It's all been covered by the basic insurance. I have a minimum self-pay of 300 CHF, as my costs over the year are way over anything I would get on an increased self-pay. Indeed, I go over the 10% limit of 700 CHF self-pay, usually in September each year, so currently I'm not paying anything until the beginning of next year (or else getting 100% refunds on bills I pay myself).
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Old 08.11.2020, 21:10
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Re: Insurance models & diabetes & medication limitations

I would ask about what supplemental insurance they will offer you. Things like dental shouldnít be affected (and if you want it). Iíve got the travel insurance for less than f50 a year and a couple of other things.
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