FAQ – Frequently asked questions
Our answers to the most frequently asked questions
You can find here the answers to our insured members’ most frequently asked questions.
Simply click on your subject of interest.
If you only have basic insurance, you can be admitted to the clinic providing you stay in a general ward and that the hospital is listed by your canton of residence (Art. 41, para. 1bis LAMal/KVG).
If not, you must have supplemental insurance to cover the costs of a semi-private or private room.
You are reimbursed for standard hospital care in a general ward up to the rate applicable for this treatment in a hospital listed by your canton of residence (Art. 41 para. 1bis LAMal/KVG). There will be no additional charges if the hospitalisation is due to an emergency or medical necessity (i.e. if the benefits cannot be provided in the canton of residence).
However, if you wish to be hospitalised in another canton for personal reasons, the difference between the reference rate of your canton of residence and that of the facilities where you were hospitalised is entirely at your expense or at the expense of a possible supplemental insurance policy.
As a reliable insurer and in order to protect your interests, we negotiate rates by establishing partnerships with the hospitals and clinics that provide benefits under supplemental insurance. Despite our efforts to find an advantageous rates’ agreement with the Luzerner Kantonsspital (LUKS), the agreement with this medical facility has unfortunately not been renewed.
You may still be admitted to the Luzerner Kantonspital. However, this may involve some administrative and legal complications for you, particularly in relation to invoicing. If this is the case, we will provide you with assistance and the invoices will be covered in accordance with your current insurance contract (except in the event of a possible request for a deposit submitted by the LUKS).
We would encourage you to discuss the matter with your doctor to see whether an alternative is possible, such as staying in another medical facility.
Expenses that are usually refunded (outside of the deductible amount) and according to your current insurance contract will be covered by Groupe Mutuel. However, invoices may be sent directly to you, since you are the liable debtor. This is why we recommend that you assign your rights to us as a debtor (a letter will be sent to you by Groupe Mutuel as mentioned in the next question) so that Groupe Mutuel becomes liable for the invoices issued by the LUKS.
If you are hospitalised in a private or semi-private ward at the Luzerner Kantonspital, we will send you an explanatory letter and a form that you will have to fill out in order to assign your rights and responsibility as a debtor to us. Groupe Mutuel will then become the liable debtor, pay any invoices due and represent you in the event of a dispute.
The medical interest is paramount and we suggest that you choose a medical facility together with your doctor. You can contact us by phone on 058 758 44 44 to check whether the medical facilities chosen have a partnership agreement with us or not. Groupe Mutuel has agreements with most hospitals and clinics in the canton of Lucerne and in Switzerland.
No, this situation should not affect our usual reimbursement deadlines. We will make every effort to refund any amounts as soon as possible and notify you in the event of a significant delay.
Yes, the hospital is entitled to ask you for a deposit.
The deposit remains payable by the insured person. Groupe Mutuel will provide the hospital with a guarantee of coverage. In most cases, this will prevent the insured person from having to pay a deposit.
We are currently negotiating new agreements with several partner hospitals and clinics. Your entitlement to benefits will remain the same under your current insurance contract.
No, termination is only possible under the terms and conditions of your current insurance contract. Any changes in partner facilities do not allow the insured person to terminate the supplemental hospitalisation insurance contract outside of the terms and conditions of the said contract.