Your future Health Insurance [2023 edition]

From me (Ticino) my CSS has gone to 330chf, while the most convenient one is Aquilana, which however honestly has many limits, all only in German, I tried to contact them and they treat me as if they were almost doing me a favor and telling me that I have to do everything in German. The desire to change is almost gone. Among other things, if I do both the LAMAL and complementary with CSS (I would need it for the gym reimbursement) there should be a sort of “365” app that allows you to recover up to 600chf. Have any of you ever done it? Does it really work? Do you advise me to insist with Aquilana?

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I would not. Price is one thing but I’d avoid doing business with companies that do not want to do business with me every time it’s realistically feasible.

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You might consider alerting the canton’s officials about that. It might be illegal from their side. Also why they have an offer in Ticino if not in italian? Maybe there is an hidden agenda (sharing zones between insurances?)

After a few queries on priminfo.admin.ch, I noticed that not all insurance companies are operating in the whole country.

What happen if I sign with an insurance but then move in a canton where they do not operate? Will they kindly request me to switch to another company?

Yes, if you move out of a coverage area of one insurance you simply switch to a different one mid-year. Happened to my family one time and was no big deal at all.

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They will also automatically adapt your premium if you switch zones (at least it happened for me when moving from Zurich to Aargau. got some money back, about 1-2% in that specific case)

Hey all, helpful discussion!

On the subject though, I have been contacted by a customer rep from Swica informing me the insurance premium will raise by 30-50% in my case (wtf? maybe I misunderstood) and he recommends to switch to a new model in which you are still Telemed but further restricted on the choice of doctor and specialist from their own network.

Few questions:

  • Does anyone have experience with this “in-network” model? How restrictive is it? So far my HA is included but not one of my routine specialists
  • How challenging is to switch to another insurer if you have pre-existing conditions?
  • Can an insurer refuse to have you as customer, or refuse to cover something in a way that it’s given to a very wide interpretation? (see below)

I agree with some of the comments above, the lack of focus on preventive care in Switzerland is quite perplexing, examples:

  • 90 % of costs up to CHF 500 every 3 years = hardly anything more than blood tests
  • gynecology visits every 3 years

P.S.:
For stats, I have Swica in ZH3 with:

Basic:
for CHF 245.45/m a 2’500 excess (thanks to this forum!) + 700 deductible, 10% co-pay and “call us first” Telemedicine, which in my experience is not enforced for simple visits to the doctor or e.g. known mandated yearly checks, but you need always someone (on phone or the family doctor) to refer you to a specialist. The “expert” on the phone almost always tells you to go to the family doctor instead of a specialist, so have to account for that additional (and non-trivial) cost.

Supplementary:
Another ~45 CHF
Honestly the only benefit I see here is emergency transport, repatriation, treatment abroad - which comes cheaper than a travel insurance last I checked.

The experience has been OK for me (as much as can be expected with Health insurances) but my S.O. had several major issues with them, some rejected claims and refusal of covering treatments for a pre-existing condition that was framed in such a way as to represent a blanket statement that could be applied to literally any future claim on any medical symptom based exclusively on their own assessment.

I think we all know what is the worth of such calls and “advices”.

I am taking the cheapest insurance with telmed and family doctor model, but I absolutely against a model with a medical network.

So check which health insurance is the cheapest with your parameters and just go for it.

For the basic insurance a company is obligated to take anyone applying. For complementary insurance, they can require whatever they want.

A travel insurance also covers other cases.

That’s when you are using your legal insurance to demand other insurance to pay what they refuse to pay AND show them the middle finger by cancelling.

same insurance and call received here :slight_smile: around begin October already.
except I don’t think the raise they mentioned per telephone was quite that high as on your call. In the end it was +12% (2023 to 2022, same conditions).
Made me consider my options.
On Telmed at the mo. (i.e. call to inform I’m going to a doctor, but no permission or discussion of details needed).
they sent me a quote for the Medpharm model, which requires call for permission incl. discussion with a swica telephone doctor or at a contract pharmacy. In addition i can only visit a doctor who is on their Medpharm list.
After looking more closely at the conditions and comparing, I find this is a difference I can live with:

  • short discussion with their doctor on the phone before i go to my Hausarzt
  • their Medpharm doctor list is very long, my Hausarzt is on there, including all specialists I’ve visited last years (ok, only 1 Dermatologist and 1 Gastroenterologist in my case, but still). If i search in my city there are many hundreds of doctors on the list. I would even dare to say, if a doctor is not on the list that may be a red flag for the doctor (unnecessary treatments, scammy billing?). Not implying that of your routine specialist though!

Cost savings:
Insurance base case / No restrictions 100
Telmed 88 (my choice till now)
Medpharm 75 (my choice for 2023)

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Unfortunately, there is no law that I can find which specifically requires insurers to provide services in the official language of the region they serve (It is a requirement for doctors in order for bills to be covered by mandatory health insurance).

The KVG law does state that insurers cannot discriminate against any group of residents, and language barriers could definitely be used as a tool for discrimination. But until that becomes a court case and gets a ruling, there’s no precedent to go on.

However, you can contact the Obudsman for health insurance about the issue:
https://www.om-kv.ch/it/domanda

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I never had the family doctor as base insurance.
How does it work if he is full busy or if that day is off?
With KPT win.win did someone understand if you can really call OR go to the doctor and if calling is free or you have to pay per minute?

To my best German understanding:

  • Yes, it’s either/or and the call (alone) can lead directly to a specialist
  • Yes, calling is free

Someone with previous KPT experience should confirm.

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I just had a call with a KPT representative, and win.win can offer more things than win.plus and for me it would be CHF 30 less.
I asked several times, but he said that with win.win you can decide to call, go to a doctor or go to a medical center, while with win.plus you can chose just a medical center and it costs more.
He said that is related to the canton, since you can get more discount for win.win just in some of them.
In addition you can potentially change the doctor every time.
With other insurances, the same options would cost like CHF 150/200 more.

Did you get the same information?

Given that every insurer has slightly different names and conditions for the different models, I’m having a hard time making an apples-to-apples comparison.

Does anyone know which insurance models are equivalent to CSS’s “Callmed” among KPT, Assura, Swica, Vivao, Aquilana, etc?
(Sorry if this has been discussed already)

My understanding of the conditions CSS’s callmed are:

  • Free choice of doctor
  • Have to call or use the app before going to a specialist, but then can pick any specialist
  • Can buy medecine in any pharmacy

they use different names which contain words like callmed, telmed, sana tel, etc.
you maybe be able to filter them using comparis.ch or go to their individual websites.

be careful, there are also some Callmed+HMO or Callmed+Hausarzt mixed models offered that comparis will show

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Fineprints are analyzed for you here

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Thanks, these documents comparing all of the models in consistent terms are super helpful!