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Reader question: Can Swiss health insurance exclude me if I have pre-existing conditions?

Reader question: Can Swiss health insurance exclude me if I have pre-existing conditions?
Example of a card for compulsory health insurance. Photo by Federal Office of Public Health
Whether an insurance carrier in Switzerland can turn you down because of chronic illnesses depends on the kind of coverage you are seeking.

Say you are newly arrived in Switzerland and — as health insurance is compulsory here — you have to take out a policy.

Or maybe you are a permanent resident who wants to switch carriers.

But to complicate matters, you have some pre-existing health issues and are worried no insurance company will want to take  you on.

What can you expect?

Switzerland’s universal health care system is based on every resident’s obligation to buy a basic health insurance policy, which covers —though subject to annual deductibles and co-pays — all emergencies, doctor’s visits, prescribed medical treatments and tests, physiotherapy, occupational therapy, nutritional counselling, speech therapy, mental health therapy, chiropractic therapy, rehabilitation therapy, and medications.

Basically, anything your doctor orders, the insurance will pay for, with the exception of experimental drugs or treatments which have not been approved in Switzerland.

As this insurance (KVG in German  and LaMal in French and Italian) is mandatory for anyone living in Switzerland, any carrier you choose must provide you with this coverage — regardless of your medical history, age, or nationality.

The premiums will vary depending on your canton of residence and your age, but will never be based on your health status. And, under the Swiss law, insurance companies can’t make profit from KVG / LaMal or set their own costs — premiums are determined by the Federal Office of Public Health and are the same for all carriers.

This system is not cheap, but at least you can be sure that you will not be denied health care you need, or that it won’t be covered by your insurance.

However, in addition to the compulsory insurance, many people in Switzerland also take out supplemental policies that cover perks such alternative medicine treatments, glasses and contact lenses, medical accessories and devices, wellness services such as massage therapy, and psychotherapy performed by therapists without medical training. 

READ MORE: Should you buy supplemental health insurance in Switzerland?

Unlike the compulsory coverage, supplemental policies are far more restrictive; this is where insurance companies can — and do — cherry-pick their clients.

And this is where your medical history and current health are taken into account before coverage is given or withheld.

While you are not required to fill out a health questionnaire for the compulsory insurance (since you can’t be denied coverage under any circumstances), you will be asked to do so when applying for the supplementary one.

You will have to answer (truthfully) questions about any medical conditions and history of repeated treatments, including current ones.

If you are relatively healthy and have no chronic illnesses requiring regular treatments, you will not have a problem getting supplemental coverage.

But if you have health issues, you will be probably denied coverage. Or, you will be accepted, but only if your existing medical problems will be excluded from coverage.

This is an example of a typical health questionnaires for supplemental insurance coverage.

READ MORE: EXPLAINED: Why you need ‘legal protection insurance’ in Switzerland


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