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If the statute of limitations has been reached, the supplementary insurance does not have to pay any claims for reimbursement. However, she could.
Bruno W. noticed that his godfather had obviously lost track of things. He has only recently taken on the administrative side of his godfather after he moved into a retirement home.
When arranging old bills, Bruno W. noticed: His godfather, who is suffering from dementia, has paid the Spitex bills since 2018, but has not claimed them back from his supplementary insurance. That’s why Bruno W. subsequently submits the invoices for the last 4 years to Sanitas. The goddess has had supplementary insurance there for 40 years.
Sanitas shows no goodwill
The disillusionment follows with the benefit statement: Sanitas will reimburse the amounts up to June 2020, but not the amounts before that. Sanitas refers to the limitation period of 2 years at that time. The health insurance does not want to pay 12,500 francs.
Bruno W. contacts Sanitas customer service several times because he does not understand this response. But his efforts are unsuccessful. So he goes directly to the head of customer service, Alex Friedl, and describes his godfather’s difficult situation in a letter. But the answer from the management does not bring any change either. Sanitas does not want to accommodate.
There is a leeway
“Kassensturz” confronts Sanitas and asks why one of the largest health insurers is showing no goodwill in this case. Sanitas does not want to comment in front of the camera. In writing, however, one communicates: “The statute of limitations was asserted in accordance with the Insurance Contract Act. Our general insurance conditions and instructions do not allow any leeway here.»
The fact that there is some leeway is shown in the same case. W.’s godfather has additional insurance with Concordia. A phone call is all it takes and they will reimburse you for the insured costs up until 2018. She does not insist on the limitation period of 2 years.
Change in law from 2022
The Insurance Contract Act in Switzerland was revised on January 1, 2022. The statute of limitations for reimbursement claims under supplementary insurance is now 5 years. However, this only applies to invoices from 2022. The old statute of limitations of 2 years therefore still applies to the repayment of the Goddess by Bruno W. Bruno W. comes to the conclusion: “Legally, Sanitas has the upper hand, but I have the idea that when I’ve been with an insurance company for 40 years, I can count on goodwill.”