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Old 26.01.2010, 13:27
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accident insurance - is there a franchise for this?

my wife had ski accident 2 days ago, we were told everything should be ok, but it didn't look good... but we decided not to go to doctor, but today she started having strong pain in the eye, and we would like to use our accident insurance to cover her treatment

but in my insurance they say that i have 2000 chf franchise and i have to pay first 2000 by myself.

is it true ? i thought accidents are exempt from franchise and insurance will cover it from the first franc

we are insured in Group Mutuel with SanaTel option
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Old 26.01.2010, 13:29
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Re: accident insurance - is there a franchise for this?

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my wife had ski accident 2 days ago, we were told everything should be ok, but it didn't look good... but we decided not to go to doctor, but today she started having strong pain in the eye, and we would like to use our accident insurance to cover her treatment

but in my insurance they say that i have 2000 chf franchise and i have to pay first 2000 by myself.

is it true ? i thought accidents are exempt from franchise and insurance will cover it from the first franc
Accident is covered by your employer if you are employed. For your wife if she doesn't work then (if its like mine) your wife will be paying a little extra each month for your standard basic health insurance to also cover accident.

With us when its an accident there is no excess. I thought the excess only came into play when it is maladie (sickness).
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Old 26.01.2010, 13:31
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Re: accident insurance - is there a franchise for this?

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With us when its an accident there is no excess. I thought the excess only came into play when it is maladie (sickness).
Same with us.

I think the important thing is that you have to report any trauma within a given period of the accident, otherwise the insurers will (potentially) view this as illness and you would be liable for the excess.
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Old 26.01.2010, 13:31
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Re: accident insurance - is there a franchise for this?

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Accident is covered by your employer if you are employed. For your wife if she doesn't work then (if its like mine) your wife will be paying a little extra each month for your standard basic health insurance to also cover accident.

With us when its an accident there is no excess. I thought the excess only came into play when it is maladie (sickness).
exactly, but they say something different... And yes, she is paying more and she has accident insurance

ok, i will deal with them later, does it matter if she will now go to eye doctor or to a emergency room? will accident insurance cover visit to eye doctor?
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Old 26.01.2010, 13:32
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Re: accident insurance - is there a franchise for this?

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Same with us.

I think the important thing is that you have to report any trauma within a given period of the accident, otherwise the insurers will (potentially) view this as illness and you would be liable for the excess.
do you know what is this period?
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Old 26.01.2010, 13:35
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Re: accident insurance - is there a franchise for this?

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do you know what is this period?
nope but it'll be more than 2 days i would bet.
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Old 26.01.2010, 13:35
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Re: accident insurance - is there a franchise for this?

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do you know what is this period?
The only time I came across this was when I had a car accident in August. The paramedics checked me over road side and I was fine so didn't go to hospital for further checks.

They told me to go over the next 48 hrs. In the end I went after 24 hrs due to chest pains (which the doc told me was normal, i.e. delayed pain) and didn't have any problems with (company) accident insurance.
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Old 26.01.2010, 13:38
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Re: accident insurance - is there a franchise for this?

Actually, also had an issue with daughter's two front teeth (milk luckily) - killed/damaged the nerves in a slide accident.

We had to go to the dentist and register the accident with the insurance provider and this was much longer than 2 days after the event as we didn't get to see the dentist until about a week later... But there must be an official window - this is CH after all!
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Old 26.01.2010, 13:58
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Re: accident insurance - is there a franchise for this?

so should i threat them with lawyer or what?

and, does it matter if i go to emergency room or normal eye doctor?
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Old 26.01.2010, 14:04
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Re: accident insurance - is there a franchise for this?

Disclaimer: I'm no expert, so this is just my opinion.

Check with lawyer or insurance broker (the latter is a cheaper option!) that you are indeed covered in the way you think you should be and check with Dr that s/he thinks the symptoms are related to the accident.

Write full letter explaining what happened, detail why the eye pain is related to the accident (with Dr's explanation/report if possible). Specifically ask why they are not covering this and why they think it is illness rather than accident. I am guessing that they don't see a link between the accident and your wife's current symptoms. Send by registered mail.

Wait for reply. If negative, follow-up with phone call and second letter detailing phone call and asking for re-assessment.

If still not resolved go to lawyer...

Last edited by Carlos R; 26.01.2010 at 14:21. Reason: added: or insurance broker (the latter is a cheaper option!)
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Old 26.01.2010, 16:47
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Re: accident insurance - is there a franchise for this?

Quote:
Dear Mr.

For all treatments which are covered by your health
insurance you have to pay the Franchise and the 10% of share (Art. 1 +
Art. 64 KVG - Krankenversicherungsgesetz) for illness and accident the
same.

Regards

Claudia Ducret
Leistungen & Managed Care
Sacharbeiterin

Tl. 058 758 38 39
Fax 058 758 38 59
www.groupemutuel.ch
this is what they wrote me! i don't get it, they claim that i have to pay for accidents the same as for illness...

can i quote her something from swiss law, that i don't have aby franchise for accidents? is it guaranteed by law?
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Old 27.01.2010, 09:30
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Re: accident insurance - is there a franchise for this?

and now they wrote this

Quote:
We can't send you a "Unfallschein UVG", your wife isn't insured UVG (UVG
is the obligatory insurance of accident when you have en employer). When
you are insured UVG, you don't have to pay any franchise or share.

But your wife is insured for accidents KVG, so she has to pay the legal
fixed contribution (franchise / 10% of share).
well, it seems insurance against accidents is also with franchise, at least for people that are not working but are insured separately

can you confirm this?

Last edited by juice99; 27.01.2010 at 09:51.
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Old 27.01.2010, 15:38
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Re: accident insurance - is there a franchise for this?

If you are employed and your accident insurance goes through your employer then you have no deductible on there.

If you are not employed (or independent etc.) and accidents are covered as part of your personal medical insurance then yes, the deductible/franchise applies.

Unfortunately, the mail you received from the Groupe Mutuel is correct.

Hope this helps
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Old 04.05.2010, 11:24
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Re: accident insurance - is there a franchise for this?

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If you are not employed (or independent etc.) and accidents are covered as part of your personal medical insurance then yes, the deductible/franchise applies.
So, Jenny, in the case where a student sprains her ankle and has accident coverage under her personal medical insurance, is there then any point in reporting the accident?
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Old 04.05.2010, 11:49
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Re: accident insurance - is there a franchise for this?

If the accident is not reported and the bill not sent to the medical insurance firm, then it will not be set against the franchise. This doesn't make any difference now, but if you have several bills during the year which together add up to more than the franchise, then it will.
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Old 04.05.2010, 11:53
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Re: accident insurance - is there a franchise for this?

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If the accident is not reported and the bill not sent to the medical insurance firm, then it will not be set against the franchise. This doesn't make any difference now, but if you have several bills during the year which together add up to more than the franchise, then it will.
I keep all my medical bills in a bulldog clip until the year end, to see if it's worth sending them off. Last year, for example, I had around 150chfs of medical bills (which I'd already paid) against an insurance franchise of 2500chfs, so that saved me form filling and a trip to the post office.
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Old 04.05.2010, 12:55
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Re: accident insurance - is there a franchise for this?

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my wife had ski accident 2 days ago, we were told everything should be ok, but it didn't look good... but we decided not to go to doctor, but today she started having strong pain in the eye, and we would like to use our accident insurance to cover her treatment

but in my insurance they say that i have 2000 chf franchise and i have to pay first 2000 by myself.

is it true ? i thought accidents are exempt from franchise and insurance will cover it from the first franc

we are insured in Group Mutuel with SanaTel option
I thought the same until I had a (thank god) little accident last year while I was on unpaid vacation to take care of my daughter and I found out that my accident insurance is not separated from the illness insurance. I am with ASSURA and they won't pay a cent of the medical bill because I haven't reached the franchise. I can't understand why the Swiss can possibly support this system.
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Old 04.05.2010, 19:43
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Re: accident insurance - is there a franchise for this?

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So, Jenny, in the case where a student sprains her ankle and has accident coverage under her personal medical insurance, is there then any point in reporting the accident?
I think this has been pretty much answered by Longbyt, Kodokan and Suzagna.

She can report the accident/send the bills off if she wishes to but she will only be reimbursed once she's gone over her franchise.

If your friend is a foreign student then she qualifies for student insurance and she may only have a 100.- annual deductible. So in this case it's a no brainer.
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Old 04.05.2010, 19:52
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Re: accident insurance - is there a franchise for this?

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I am with ASSURA and they won't pay a cent of the medical bill because I haven't reached the franchise. I can't understand why the Swiss can possibly support this system.
It doesn't matter who you're insured with as the basic health insurance is actually a law and every single company has to cover the exact same amount (or not) according to that law.

I'm not saying it's the best system in the world (I'm not sure that any country has found the best system to be honest) but there are a lot of things that the Swiss don't understand about how things work in the UK e.g. waiting months for an operation, lack of hospital beds etc.

As a lot of people on here know, I have RA (rheumatoid arthritis) which is what first got me interested in this insurance malarky over here.
Within a matter of months, I went from hardly being able to walk to having the whole thing under control thanks to the brilliant Swiss specialist I was referred to and the fact that she could get me on the most suitable medication for me right away.

My Mum's friend has the exact same thing as me in the UK and since the early 90s they still haven't found the best solution for her with regards to medication etc. She suffers really, really badly and when I told her what I was on (Enbrel injections) she told me she'd never heard of it....

Could it be that the NHS are not willing to talk about a treatment which costs the equivalent of 2'000.- a month?

Again, I'm not saying it's the best system in the world but it does have it's advantages...
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Old 04.05.2010, 20:14
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Re: accident insurance - is there a franchise for this?

Hi,

I don't know in general but I also took out insurance with Mutuel. The franchise is something you choose (I chose CHF 500) and in my case there was no difference between accident or illness.

It always makes sense to send in every bill (all you need to do is post them the bill with the policy number) because as soon as you reach the level of the franchise they start to pay out the cost (less the 10% contribution).

Sorry I couldn't be more helpful. I didn't bother trying to work out the difference on the premium between high and low franchise - it certainly doesn't take much to run up CHF 500 in medical bills and medicines - and with a monthly premium of about CHF 400 each it's best to claim for everything - there's no no claims bonus here.
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