New family doctor or pay more?
Insured people are hit again and again: they suddenly receive a letter from their health insurance company stating that they have to look for another family doctor. The doctor chosen so far can suddenly no longer be found in the family doctor model. An alternative to this is to pay higher premiums, which can be 13 percent and more. If it is not just an insured person, but a couple or even a whole family, the change is money.
Many insured people would prefer to switch to health insurance because they want to stay with their doctor and still want to take advantage of the family doctor model. The health insurance companies want to prevent this and do not dismiss their members. You may offer them to switch to the phone model and then the higher premium will have to be paid. A change of health insurance is only allowed when the insurance year is over. The insurance thus excludes extraordinary termination and insists on the proper termination of the insurance contract. Very annoying for all insured persons who have to pay more money by then.
Change of health insurer legally prevented?
This raises the question of whether preventing an extraordinary termination is even lawful. After all, the performance of the health insurance changes and then the insured should be granted a right of termination! Far from it, because the corresponding conditions are in the small print. These state that by choosing the family doctor model, the insured also agree to the applicable insurance conditions and these in turn include the refusal of the extraordinary right of termination because a doctor has left the family doctor model.
The health insurers argue that there are always changes and that doctors could give up their practice or retire. Perhaps the doctor has not adhered to the applicable guidelines on quality of treatment and must therefore be removed from the list of general practitioners. If the insured were to terminate each time, it would not only be a financial disaster for the insurance company, but also in terms of administrative effort.
A common reason GPs disappear from their health insurance list is related to the costs they billed. In the eyes of the insurance company, the doctor causes excessive costs that have to be borne by the health insurance company. As a precaution, the Santésuisse health insurance association checks annually whether the doctors are not overcharging. Anyone who becomes conspicuous has to explain himself, in the worst case even a court case may be pending because of these costs. For the insurance companies, on the other hand, there is no must, they can choose who they want to put on their family doctor's list. This in turn harbors a certain risk for the insured, as Morena Hostettler Socha also knows, her character as an ombudswoman for health insurance. If a doctor is struck from the family doctor list, the insured persons concerned have to switch to the standard basic insurance, which gives them the freedom to choose a doctor. That sounds good, but the costs involved are so high that switching to another health insurance policy is worthwhile by the end of the insurance year at the latest.
Conclusion: No right to extraordinary termination if the family doctor is excluded
If the previous family doctor is removed from the list of family doctors by the health insurance, this is bad for the insured. You have to switch to the more expensive basic tariff and until the end of the insurance year you have no option to switch from one insurance to another. But they have to pay more for this, because the basic tariff is usually significantly more expensive than the family doctor model. This change will be expensive for families, but they have no legal remedy.
