Hi all
We are insured with SWICA and have several supplemental insurances. Today we had to go and see a doctor for the first time and I have a couple of questions on how the health insurance actually works.
Let say the doctors rate is CHF 150 per hour and our supplemental insurance says it will cover 90% up to CHF 50 per consult. Does this mean we will have to pay the remaining CHF 100 or does the basic insurance pay a certain percentage of this fee as well?
I must admit I find the whole health insurance quite complicated and difficult to understand
And then I must also find out about the SPA treatments....... that sounds too good to be true. I have 3 supplementals - each one stating +CHF 30 per day for spa treatment. Do I add all of them together with the basic insurance (comes to CHF120/day)?
Thanks for helping out
I suppose since this is the first time you are still under your yearly out of pocket deductible from basic insurance, therefore basic insurance won't pay. Not sure if supplemental can be used to cover that (looking at contract and T&C is probably the way to go here) but 90% up to 50 chf would mean that they only pay 50 chf.
If you have 3 supplementals you're likely over insured. I don't see why they wouldn't pay each for your spa treatment.
Thank you Meerkat33. I tend to agree with you about being over insured (think hubby got bamboozled into taking everything when he signed up) - we will relook at this for future changes.
Supplemental insurance covers the things that Basic Insurance don’t cover. Things like Dental, Eyeglasses, Single hospital rooms, etc. It doesn’t cover Basic Insurance Deductibles or co-share 10%. At least I’ve never heard of a policy that covered these, but there is no reason why the couldn’t be offered.
But the cost of covering these would not justify having such covering. The Insurance companies have to make a profit.
Use comparis and other comparison sites to give you an idea of whatever available. Worldwide coverage, is usually a very good choice and doesn’t cost a bomb.
Like Bowlie said .. Supplemtal is just that.. Going to the doctor for some parecetemol would be the basic insurance and you'd have to pay the deductible. Supplementary wouldn't come into it..
But if the doctor recommended something like acupuncture or a special massage to help your sore head, that probably wouldn't be covered under the basic and that's where your supplemental might kick in.. depending on the options you bought.. Or an ambulance is another example usually not covered in the basic insurance.. Private room at the hospital etc..
So you call an ambulance, get taken to hospital, get an operation, recover in a private room..Have aromatherapy to help you relax..
You can see how that's split, the operation would be under the basic, after the deductible, the rest would be under supplementary.
My supplementary covers a two-bedded room in a limited number of private hospitals and thats about it. It used to cover care in all of the 'normal' private clinics, but this is no longer the case. It doesn't cover dental or glasses.
I've never heard of a supplemental covering 90% rather than 100% though. The exclusion is for the basic insurance.
For basic insurance, you have to cover the deductible yourself plus 10% of the next 7k. That's the 10% bowlie talks about.
Your supplementary may be unnecessary. I may be wrong, or perhaps it's hospital-specific, but AFAIK you can "rent" (request to be moved and pay the additional cost yourself) a two-bed room in the hospital when you're there. And of course only when you actually want/need that.
On Swica, there's a supplemental that covers 90% of a psychotherapy session up to 50CHF, maximum 60 sessions per year.
Yup. The wife had supplementary insurance for many years and one day she had to go in for a few days for an emergency procedure. We thought, finally, the supplementary insurance will prove to be worth it. But no.... there were no private single rooms available that week.... They were all booked out
On the other hand, with supplementary insurance , we do get things like massages paid for, etc. We practically get our moneys worth from the massages alone.
With Swica beware - their supplementary insurance also has a franchise. Make sure you get the right option.
There's one franchise that applies to all you've got. Spend your franchise on basic, and you won't have any to pay on supplementary.
But for most non-Swica, you do not have to spend your franchise on the basic before your can claim from the supplementry.
Not sure if it is still the same now but I quit Swica for this reason. Swica's selling point at that time was that they were the only ones who let you burn your deductible on both Supplementary and Basic, so you will get full coverage much faster. So lets say I have a deductible of Fr.1500, of course I will hit it much faster if I claim on both basic and supplemantary. However, I almost never have a reason to claim anything on the basic, which means that I could not claim anything on the supplementary until I hit Fr.1500. With my previous and current insurer, I can claim the supplementary insurance immediately from Zero!
Swings and roundabouts - depends which model works for you. For years I claimed on neither. Now I hit the franchise every year - even if I went for max.
Agree.
In our situation, wife and I have been here almost 20 years and in that time we burnt the deductible only 3 times (all her). We are lucky.
We spend at least Fr.1000 every year on "prevention" (some people call it self-pampering) with almost everything paid by the supplementary. That 1 year with Swica was a shock as they paid nothing.
Basic insurance is something where I hope not to hit the deductible and with Swica I feel like I need to gamble and hope for my supplementary to be paid out. With other providers, the supplementary is a sure thing.
I have a long term underlying condition, so Swica model definitely works for me!