SKKO Sales/misrepresentation

Situation:  I contacted a SKKO advisor May 2017, to assess the possibility of reducing my medical insurances expenses having the same services as my previous insurance provider which was HELSANA (insured from 2014 to 2017)

Throughout the first meeting we had discussed verbally the different possibilities. I make it clear that I would still want to have private insurance and which services I would like to maintain (the same services as I was having with Helsana) clarifying that I was happy with their services, but I just wanted to evaluate if there was a way to reduce expenses having the same services,  considering that I out of workforce for a while now. Therefore, I addressed the important points for me:

1.       Private insurance during pregnancy, as I was intended to have a second child including additional checkup as COMPLETA product in Helsana.

2.       Choose my doctor and the clinic where I can deliver my baby

3.       To have reimbursement on supplementary therapies as Lymphatic massage & gym

4.       To have the documentation in English-I can feel much more comfortable, especially contractual docs.

5.       To have the possibility of reducing the franchise

6.       The possibility of organizing medical treatments abroad

7.       To be flexible in changing insurances yearly and not be tied to 5 years contract as happened to me in the past when I recently landed in Switzerland.

During my firsts checkup I found out that not only I wouldn’t be covered by Group Mutuel under the private insurance policy that I’m paying for, but also the information provided was completely incorrect.

Facts related to his negligent advice:

1.       The 12 months waiting period was never mentioned. I recalled we talked about the 3 months waiting period as Helsana, and I raised the question of what happened if I’m pregnant before that? I clearly remember (my husband was also participating of the conversation) his answer was: “ I know people in Group Mutuel who I can talk with to make an exception as we are working with them and selling their products and I can find the way to maintain private coverage for you” – (I want to make it clear that my intention was never to down-grade after pregnancies, it was just a question raised to prevent) In fact, with my previous insurance I always been private covered.

The advisor offering me Group Mutual insurance didn’t take into consideration my objectives and needs, having same service as HELSANA. Group Mutuel is not offering a cheaper option and the same service as Helsana. I needed to go though additional checkups that I am liable for all out of pocket payments: For instance, I already paid out the following amounts:

a.       Prenatal Test: CHF1, 054

b.       Pregnancy checkups: more than CHF 300

(If you need specific data of the invoices I can also provide them)

In the case of prenatal test, I cannot consider as an alternative, the puncture test, since I have done it for the first pregnancy and I ended up with the lost of my baby during the last stage of the pregnancy. As any mother I wouldn’t put under risk the life of the baby. I needed to choose a non-invasive prenatal testing.

2.       Choose the doctor and deliver in Hirslanden Klinik. The advisor knew the importance for me of having the possibility of choosing the doctor. He was aware that this was and still is an extremely important point for me. Under a clinical and physiological point of view after loosing my daughter 2 weeks before the due date.

As a proof of this, he was the one submitting the insurance coverage in 2014 for by daughter and then he was the one finally cancelling that contract for me due to her loss.  He was totally aware of the importance of this point according to my clinical records.

3.         Reimbursement on supplementary insurance. Again, I am paying medical expenses on my own pocket. In addition, I cannot go through Lymphatic massage treatment which is known that pregnancy is often accompanied by poor circulation because of the constant medical expenses.

4.       Documentation in English. During our meeting it was mentioned the possibility of having the documentation in English and furthermore that the intranet platform it is also in English where I can easily interact with Group Mutuel. Even though platform is in English, important documentation it is only in D, F, I. Documentation it is typically sent in Italian and/or German., When I asked GM directly for an English version they answered

they got documents on official languages. Contract Letter, Certificate of Insurance was sent in Italian.

 Contract Signed at home: The advisor was carrying an iPad, pointing out were I do need to sign. Of course, he was explaining what the documentation said but I do not have any

proof of that. At this stage it is his point of view against what I am saying. I have no control of what he stated in the contractual documentation in his device.

Protocol: Should state customer assessment in relation to its needs and purpose. In GM protocol signed by SKKO and myself none of my needs were addresses.

My son’s insurance coverage. The advisor was also insisting in changing my son to GM. I answered that I would like to see how it works with me and then in any case, I would change him the following year. Here is a clear wrong approach from an adviser.

                I can provide copies of the documentation GM sent me signed by myself.

5.       Possibility of reducing the franchise. Another “error”, when I raised this questioned his replied was “you can change franchise whenever you want, specially if you reduce it which means a higher premium for the Insurer”. Again, this is not true. I found out I can only change it once a year.

6.       The possibility of organizing medical treatments abroad. N/A

7.       To be flexible in changing insurances. When we went through this point the advisor said I can change it yearly, but he didn’t clarify that supplementary insurance I am tied till 2020 having the possibility of termination only then. I recall that I emphasize this point referring to my previous experience when I first landed in Switzerland. I was tied to an insurance for 5 years, paying for something I was covered in another insurer. Paying double coverage because of the narrow flexibility in the terms and conditions of the policies- I found it totally unfair for the customer.

 As per these points mentioned above:  

I consider that the advisor acted in the advice provided with totally negligence, non-ethical way and not considering the obligation of good faith that should be in any commercial private contract.  

A reasonable and prudent advisor would have suggested me not to change insurances if those were my plans. Specially knowing the facts and circumstances involved in my case.

 He has the duty to disclose complete and not provide misleading information related to the products he is selling and to provide complete details of the product and services and, not just persuade me to sign the contract so he can achieve his objective, not mine. He had chosen a professional misconduct and negligence in his advisor procedure, at least in this case with me. For me the errors and omissions were clear and only intended me to creep me into a contract that now is bringing me stress and headaches in a moment where I should be calm and happy while waiting for my daughter.

 SKKO, [email protected], 044 503 71 00

·Responsible for not hiring adequate staff to carry it out contracts with international clients.

 When I raised the issue to the referred advisor he justified saying that everything was a complete misunderstanding, probably due to the language barriers- He should be able to provide the right advise in English language if we are discussing the terms and contractual aspects in English.

 GROUP MUTUEL:

As a Swiss resident, I have the responsibility of always integrate and improve my German knowledge, but I am not obliged to reach a legal level of the language as I have been told in Group Mutuel when I raised the issue.

 Action already taken:

1.       I first contacted the advisor and then Group Mutuel to assess the possibility of finding a solution together and resolve the issue. To reach a fair and reasonable outcome for all parties. Since none of the involved participants seemed to have an interest in finding a resolution I am now forced to submit this formal complaint.

2.       Since Feb 2018 we had discussed the issue on the phone as well as exchanged different emails (which I can provide later) where he addressed a misunderstanding to back himself. affirming in those emails things which were not true, basically putting responsibility on my side. He continued saying that probably I did not remember about the issues we had discussed which absolutely is not true. Why, being happy with Helsana, would I change if were not because of the price?

3.       Contacted Group Mutuel, stated they cannot do anything as a contract is signed and rules are equal for everybody.

4.       My doctor sent out a letter explaining my past records and the importance for keeping the same team for the pregnancy and to reconsider the situation as my due date is 2nd week of September 2018- Group Mutuel replied sending him a copy of the terms and conditions.

It is clear seen that none of them are understanding the situation under a customer’s point of view, as they already reached their objective: on one side SKKO seemed not to care because the policy was already sold (and commission pocked) and Group Mutuel because has already a customer tied to a contract and being in a weaker position, even though in an unfair scenario.

I can see clearly after what happened to me it seems like GM is not caring much about the best practices because pretty much it may know that the customer is not fully protected, taking therefore advantage from .  

 It has been a big surprise for me that in a country like Switzerland, situations like mine happened with no room to make a complaint against this sort of procedures. If we were provided with a protocol or a record of the conversation we could easily prove our point, but we were not given any document at all revealing the conversation contents.    

 It is important to stress that all those issues have been bringing me continuous stress, economic damage and steal of precious time of joy instead of being concerned about all mentioned.

 All this situation that SKKO put me through is generating me a chronic stress besides a depression. Already more than 7 months involved in this difficult situation.

 Other important details: I hope that the CONSUMER PROTECTION ASSOCIATION and THE SWISS OMBUDMAN OF INSURANCE are paying attention to this type of behavior from insurers, bringing a huge distress for customers. My role is not only stepping forward to raise my complaint but also alerting the public about such bad practices which damages the whole markets’ reputation.

I want to thank you for taking the time in reading the claim and specially for your prompt attention to this matter. I look forward to receiving your reply and support.

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