Emergency abroad: What does the health insurer pay?

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Vacation – the best part of the year! But what if, just then, you're ill or you have an accident? Not only is this unpleasant, but it can also become expensive.

Anyone can have an accident or be ill, suddenly and without warning. In Switzerland, we know where to seek medical help and what our basic insurance or supplementary insurance will pay for. But what's the situation in Portugal, Vietnam, or the Maldives? What should you do if you're seriously ill when you're abroad? What benefits are covered?

Emergency abroad: What should I do?

It's best to contact your health insurer directly. Firstly, to avoid financial surprises, and, secondly, to get answers to questions about a different health system and to get advice on what to do next.

As an AXA Healthcare customer, you can get round-the-clock assistance in the event of an emergency abroad by calling +41 58 218 11 11. Our partner Medicall will immediately start the necessary measures and, if necessary, organize transportation back home.

The key is to stay calm in the event of illness or accident.

When does health insurance pay out in the event of accident or illness abroad?

Basic insurance covers the costs that are incurred in the event of an emergency abroad, regardless of which insurance model you have chosen. It is considered an emergency, for example, if you are temporarily staying abroad and require medical treatment, but returning to Switzerland for this treatment would not be appropriate. However, if you deliberately travel abroad for medical treatment, basic insurance will not cover the costs. The law excludes planned treatments abroad.

Accidents abroad are covered by health insurance if you have taken out accident insurance as part of your health insurance. As a rule, if you work more than eight hours per week, you are automatically insured against accidents by your employer.

What costs are paid for by basic insurance abroad? 

In the event of an emergency abroad, mandatory basic insurance will generally cover the costs for medical treatment. Whether medically necessary transportation abroad is covered cannot be definitively answered. In Switzerland, basic insurance covers 50% of the costs up to a maximum amount of CHF 500. Rescue missions outside of Switzerland or transportation to Switzerland (repatriation) is definitively not covered.

What costs are paid for by supplementary insurance abroad?

The benefits of supplementary insurance vary from provider to provider. Supplementary health insurance from AXA covers, for example, rescue missions, repatriation, or visits by a relative or close friend. You also receive other compensation if the cost of a hospital stay isn't covered in full by mandatory basic insurance.

Travel insurance stumbling blocks

The benefits of travel insurance are concentrated on cancellation costs and vehicle/personal assistance, but not on medical expenses. You should always make sure you know what benefits are covered by the insurance you've taken out so that you also benefit from the protection that's important to you.

Is basic insurance enough to cover accident or illness or accident abroad? 

If you require emergency medical care within an EU/EFTA country, you're entitled to the same benefits as the insured residents of the respective country.

In other countries, i.e. in countries outside the EU/EFTA, the cost contribution made by basic insurance in the event of an emergency is a maximum of twice the cost of the same treatment in your canton of residence. For countries with high health costs such as the USA, Canada, Australia, or Japan, twice this amount is often insufficient to cover the costs of treatment. This means that you must pay the costs not covered by basic insurance out of your own pocket. 

In this instance, you're not covered for costs relating to an accident or illness, such as recovery, search operation, or transportation to the hospital. You need supplementary insurance for this.

How does transportation back home from abroad work?

First an assessment is made as to whether transportation back home or repatriation is "medically necessary" or "medically advisable". In selecting the means of transportation, the distance to Switzerland is usually the decisive factor. An ambulance is deployed if its operating range is up to 750 km; an airplane is required for any greater distance.

If you're flown back home, your medical condition is taken into account. If you no longer have to go into hospital when you return home, your return flight is booked for you by Medicall, but you travel back independently on a scheduled flight. If you need to be taken to hospital when you return home, you'll be accompanied by a doctor from Switzerland. Depending on your condition, you'll normally travel back seated or on a stretcher. A stretcher is an area separated by a curtain in which you lie on a couch. If you're transported as an intensive patient or if transportation back home is vital despite a high risk of infection, you'll travel in an ambulance jet.

This is the procedure if you have supplementary health insurance with AXA. Other insurers may do things differently.

How much does return transportation to Switzerland cost?

The cost of return transportation within Europe can be more than CHF 20,000, particularly if you're flown back home in an ambulance jet. The cost of a scheduled flight with medical support is much lower at less than CHF 10,000 in Europe, but not exactly insignificant for petty cash.

There are other costs again if the situation is intercontinental. For instance, the cost of return transportation from Bangkok by ambulance jet currently ranges from CHF 80,000 to CHF 100,000.

The key issue here is that these costs are not covered by basic insurance. In this instance, you need supplementary insurance or specific foreign health insurance for optimum insurance cover.

What happens after return transportation to Switzerland?

If you have to go back into hospital after being transported home, you'll be taken directly to a suitable hospital in your canton of residence by your medical support crew. In this instance, "suitable" means that the hospital can treat your injury or illness. If you're flown back to Switzerland on a scheduled flight, an ambulance will be waiting at the airport for you and your medical support to take you to hospital. If you're flown by ambulance jet, the rescue vehicle will be waiting for you directly on the tarmac.

However, if you've already been discharged and no longer need to go into hospital, you can go home directly. It's possibly a good idea to visit your own doctor. Our Medicall partners will also make a recommendation here.

Takeaway: Supplementary insurance for abroad is worthwhile

To avoid receiving a horrendous bill following emergency treatment on your vacation, it's worth taking out supplementary insurance before you leave home. You must always check that your supplementary insurance will cover all costs of emergency treatment abroad. Costs of rescue missions and transportation home as well as search and recovery missions should also be covered. This ensures that you're fully covered in worst case scenarios.

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