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-   -   Insurance Runaround (https://www.englishforum.ch/permits-visas-government/296488-insurance-runaround.html)

videodude 31.01.2020 14:41

Insurance Runaround
 
Hi All, Sorry in advance for the long story. I need help and am not exactly certain where to turn. Hoping someone here can shed some light on my predicament.

I met a lovely Swiss woman in the States. After a year of back-and-forth I decided "Enough!" and got married to her in Switzerland. At about the same time we married I was granted a Swiss B-Visa. I received the Visa in September 2017.

Part of the process of receiving the visa required that I answer a list of questions at the village Gemeinde (municipal office). One of those questions was "Do you have health insurance?"... to which I answered "Yes" because I did in fact have health insurance.

The village official who collected this paperwork never asked me to provide any proof of that insurance, and I never thought to ask if she needed it.

Fast forward to mid-2019. I've decided that since I'm now living almost exclusively in Switzerland that I should just sign up for a Swiss health insurance plan. My U.S. coverage was still in current at the time.

Soon after my application for Swiss health insurance was approved we received a nasty-gram from a cantonal office saying that since I didn't have health insurance (not true) since my B-Visa was approved that I was in violation of the rules that make health insurance compulsory in Switzerland that I was subject to a penalty of several thousand Swiss Franc.

This only happened because the local Gemeinde administrator failed to collect proof of my existing U.S. insurance and then forward that proof along to a cantonal office that oversees insurance compliance.

My wife and I have gone back-and-forth with the Gemeinde, the cantonal office, and with the health insurer to resolve the fact that I did have coverage during the time they say I didn't, but we hit road-blocks at every turn.

We hired a lawyer to pursue this, but to the best of my knowledge he's just retracing steps that I've already taken. He seems as lost in this as I am.

Does anyone have any experience with this? Recommendations for who might help finally get this resolved. I'm not anxious to pay out several thousand Franc because a clerical omission.

Guest 31.01.2020 14:52

Re: Insurance Runaround
 
Quote:

Originally Posted by videodude (Post 3143179)
One of those questions was "Do you have health insurance?"... to which I answered "Yes" because I did in fact have health insurance.

The village official who collected this paperwork never asked me to provide any proof of that insurance, and I never thought to ask if she needed it.

Fast forward to mid-2019. I've decided that since I'm now living almost exclusively in Switzerland that I should just sign up for a Swiss health insurance plan. My U.S. coverage was still in current at the time.

Your US coverage almost certainly would not have been valid here, and although you maybe didn't realise, it was up to you to prove to the Swiss authorities that it was. It's very unusual that a foreign health insurance is acceptable, and certainly not by default, i.e. you'd have had to take some action to extend its validity to the satisfaction of the Swiss rules.

So I think you'll almost certainly just have to bite the bullet on this, painful as it may be. The fact was (almost certainly) that you weren't actually covered and (definitely) that you hadn't proven that you were, and although it's not nice, ignorance of the rules is no excuse.

grumpygrapefruit 31.01.2020 14:58

Re: Insurance Runaround
 
Did you notify your US insurance that you were not resident in the US and ask if they would cover you for Swiss Dr and Hospital visits? If they said yes and you have that in writing, you might be able to use this as a lever to get the penalty reduced. But as Ace has said, it's very rare for the Swiss to accept foreign health insurance once you are a resident here.

qwertz 31.01.2020 15:59

Re: Insurance Runaround
 
Everyone resident in Switzerland must take up Swiss health insurance within 3 months of their arrival no discussion.

Main exemptions:
- Foreign students (i.e. that came to Switzerland to study) can contract a cheaper insurance that provides for exemption of Swiss health insurance during their period of study up to 6 years maximum. Students from the EU/EFTA can become exempt upon producing their respective country’s European health insurance card
- Workers within the EU/EFTA that are resident in Switzerland (covered by the state they work in)

Everyone else must take up Swiss insurance within 3 months, else a pro-rated fine amounting to 30-50% of the premium and the number of days between the end of the 3 month period and the start of coverage will be charged. This fine can be contested directly to the insurance provider if it puts the insured person in financial difficulty and there are valid reasons why the insurance wasn’t taken up within 3 months of arrival in Switzerland.

You can read all the details under the relevant KVG law and ordinance but it will be up to the insurer to decide whether to levy the fine. I don’t think a lawyer is necessary.

aSwissInTheUS 31.01.2020 16:00

Re: Insurance Runaround
 
First, it is permit B. The visa you might got was a visa D ;) Permit B is a full fledged residence permit with all strings attached.

Next, Switzerland knows two concepts: Selberschuld and Bringschuld.

The first means, it is mostly always your fault (specially when you hurt yourself). The second, means the burden to provide and seek information is upon you.

All laws and regulation can be found here: https://www.admin.ch/opc/de/classifi.../national.html
the law regarding mandatory health insurance is here:
https://www.admin.ch/opc/de/classifi...073/index.html

So, Selberschuld if you did not read and understand the law. Selberschuld if you made a false statement on a government form. Selberschuld if you did not ask for clarification. Selberschuld if were not aware that if you get a permit B, register with the commune that you are proper Swiss resident and have certain obligations.

Next you might find out your Swiss tax might not be in order as you did not report all of your worldwide income and assets. At least with tax there is a literal once in a life time opportunity of self declaration w/ impunity (only valid if the tax authority does not already know about your misdeeds through other sources).

aSwissInTheUS 31.01.2020 16:08

Re: Insurance Runaround
 
Quote:

Originally Posted by qwertz (Post 3143224)
but it will be up to the insurer to decide whether to levy the fine. I don’t think a lawyer is necessary.

The insurance can not levy a fine. The maximum the insurance can do is to increase the monthly premium for a certain period. Based on Art. 5 KVG https://www.admin.ch/opc/de/classifi.../index.html#a5 and Árt. 8 KVV https://www.admin.ch/opc/de/classifi.../index.html#a8

If there is a fine, or even more likely a monetary penalty it will be based on Art. 92 KVG and will come from a criminal prosecutor or judge https://www.admin.ch/opc/de/classifi...index.html#a92

There will be a criminal record entry if it is a fine (Busse) of more than CHF 5000 or a if it is a monetary penalty (Geldstrafe) of any amount.

qwertz 31.01.2020 16:14

Re: Insurance Runaround
 
Quote:

Originally Posted by aSwissInTheUS (Post 3143231)
The insurance can not levy a fine. The maximum the insurance can do is to increase the monthly premium for a certain period. Based on Art. 5 KVG https://www.admin.ch/opc/de/classifi.../index.html#a5 and Árt. 8 KVV https://www.admin.ch/opc/de/classifi.../index.html#a8

If there is a fine, or even more likely a monetary penalty it will be based on Art. 92 KVG and will come from a criminal prosecutor or judge https://www.admin.ch/opc/de/classifi...index.html#a92

There will be a criminal record entry if it is a fine (Busse) of more than CHF 5000 or a if it is a monetary penalty (Geldstrafe) of any amount.


The fine and a potential levy or reduction is of the insurer’s competence as per Art. 8 of the KVG ordinance

https://www.admin.ch/opc/de/classifi.../index.html#a8

aSwissInTheUS 31.01.2020 16:22

Re: Insurance Runaround
 
Quote:

Originally Posted by qwertz (Post 3143240)
The fine and a potential levy or reduction is of the insurer’s competence as per Art. 8 of the KVG ordinance

https://www.admin.ch/opc/de/classifi.../index.html#a8

:confused: Exactly what I linked to :confused: But it is not a fine :msnmad: If we speak about laws and consequences the term 'fine' has a very certain distinct meaning given by the Art. 106 Swiss Criminal Code. Accordingly, the above is not a fine.

Guest 31.01.2020 16:23

Re: Insurance Runaround
 
Quote:

Originally Posted by qwertz (Post 3143240)
The fine and a potential levy or reduction is of the insurer’s competence as per Art. 8 of the KVG ordinance

https://www.admin.ch/opc/de/classifi.../index.html#a8

Fines are issued by the government, insurance can only raise the monthly premium for a limited period.

Just think of it: Which insurance should hand out a fine if somebody was here for let's say two year but never was insured?

qwertz 31.01.2020 16:28

Re: Insurance Runaround
 
Fine poor translation, not a ‘fine’ but an ‘insurance premium supplement’. In any case for OP futile to loop their town hall or canton in this, it is to be settled directly with the insurance provider

Guest 31.01.2020 16:35

Re: Insurance Runaround
 
Quote:

Originally Posted by videodude (Post 3143179)
This only happened because the local Gemeinde administrator failed to collect proof of my existing U.S. insurance and then forward that proof along to a cantonal office that oversees insurance compliance.

Just noticed this statement, which I missed earlier - made me laugh, it did.

You could apply the same logic to many other things if it were to hold water - e.g. sorry, officer, nobody asked me to prove I had a valid driving licence, I just assumed I could go on using a foreign one for ever and no-one told me otherwise, it's the fault of the system, I tell you!.

aSwissInTheUS 31.01.2020 16:53

Re: Insurance Runaround
 
Quote:

Originally Posted by qwertz (Post 3143255)
In any case for OP futile to loop their town hall or canton in this, it is to be settled directly with the insurance provider

No or maybe.
First, we do not know if the 'penalty' OP mentions is just an increased premium or an actual monetary penalty from the state attorney or court.

Second, the competent authority to grant an exemption from Swiss health insurance for residents in Schaffhausen is the SVA Schaffhausen.
https://www.bag.admin.ch/dam/bag/de/...efreiung-d.pdf

Third, the insurance will have issued a formal decision (Verfügung) about the increased premiums. This decision must also state where, how, when an objection can be lodged. This has normally be done at the cantons insurance court.

If there is indeed no formal decision from the insurance the first step is to request one and then formally object against it.

Guest 31.01.2020 18:23

Re: Insurance Runaround
 
I don't think the insurance send a bill for thousands, after 3 months the health insurances do no longer have to be retro-active, so it would make no sense for the insurance to send a bill of thousands.

qwertz 31.01.2020 19:25

Re: Insurance Runaround
 
Incorrect, it is the insurance provider that is mandated to charge the premium supplement.

The cantonal health insurance office never issues payment orders and only deals with granting exemptions, premium subsidies and controlling the population in their competence is insured as per the law. It is then up to the insurance company to discount premiums if a subsidy has been granted or charge supplements in case of late subscription to the insurance.

Guest 31.01.2020 20:23

Re: Insurance Runaround
 
Quote:

Originally Posted by qwertz (Post 3143318)
Incorrect, it is the insurance provider that is mandated to charge the premium supplement.

The cantonal health insurance office never issues payment orders and only deals with granting exemptions, premium subsidies and controlling the population in their competence is insured as per the law. It is then up to the insurance company to discount premiums if a subsidy has been granted or charge supplements in case of late subscription to the insurance.

Do you even read other postings in this topic or are you just randomly typing stuff?

As for your posting:

- Health insurance no longer is retro-active.
- Extra charge in premium is limited to 50%

Now tell us: According to what logic would an insurance send a bill of thousands.

Just makes no sense at all.

qwertz 31.01.2020 20:36

Re: Insurance Runaround
 
Just because it doesn’t make sense to you doesn’t mean things are done one way or another.

It is not up to me to question the logic of some procedures of the health insurance ordinance. It is very simple: the insurance company sends premium supplement bills in parallel to monthly premiums unless the insured person contests the supplement in writing to the insurance company.

Have you by any chance been charged with this premium supplement and can start adding value to the thread from first hand experience?

Guest 31.01.2020 20:53

Re: Insurance Runaround
 
Quote:

Originally Posted by qwertz (Post 3143326)
Just because it doesn’t make sense to you doesn’t mean things are done one way or another.

It is not up to me to question the logic of some procedures of the health insurance ordinance. It is very simple: the insurance company sends premium supplement bills in parallel to monthly premiums unless the insured person contests the supplement in writing to the insurance company.

Have you by any chance been charged with this premium supplement and can start adding value to the thread from first hand experience?

Such nonsense.

They don't send supplement bills in parallel, they can raise the monthly premium and just send one monthly bill for that.

You have not yet answered my question:

Quote:

Now tell us: According to what logic would an insurance send a bill of thousands.

From OP:

Quote:

Soon after my application for Swiss health insurance was approved we received a nasty-gram from a cantonal office saying that since I didn't have health insurance (not true) since my B-Visa was approved that I was in violation of the rules that make health insurance compulsory in Switzerland that I was subject to a penalty of several thousand Swiss Franc.
Health insurances can't issue penalties of several thousands.

aSwissInTheUS 31.01.2020 21:09

Re: Insurance Runaround
 
From federal court ruling BGE 129 V 267 we know that the premium supplement results in an increased monthly premium (in percents) and must not be billed otherwise, specially not in a single installment. Quite logically, as the future monthly premium is not known and the supplement is a percentage of the premium.

Guest 31.01.2020 21:15

Re: Insurance Runaround
 
https://www.admin.ch/opc/de/classifi...000/832.10.pdf

Art 92 defines the amount of the sanction when skipping the insurance duty due to not telling the truth at a maximum of 180 daily earnings :eek:

roegner 31.01.2020 21:29

Re: Insurance Runaround
 
Quote:

https://www.admin.ch/opc/de/classifi...000/832.10.pdf

Art 92 defines the amount of the sanction when skipping the insurance duty due to not telling the truth at a maximum of 180 daily earnings :eek:
Ouch


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