At the end of the renewal comparison there is the table, and one of the new offers looks better than the current contract: a wider network, more screenings, a more favourable premium. When deciding on a switch, however, there is one question that does not show in the table but that employees feel first-hand weeks later: continuity. Switching to a new insurer creates a new contract, and a new contract starts a new clock – with a waiting period, a fresh assessment of pre-existing conditions and new enrolment paperwork. In this article we go through what starts again when you switch, what this means for colleagues with chronic illnesses, and what takeover (continuity) terms HR should request already in the request for quotation, so that the better offer does not come with a gap in cover.
- Switching to a new insurer creates a new contract with a new start date of cover: under the conditions, the waiting period restarts for everyone – Alfa's conditions set 1 month, the UNION-Kompakt conditions 3 months; it varies by insurer.
- The reference date for assessing pre-existing conditions also moves: the Alfa clause excludes day surgery and high-value diagnostics related to an illness that developed or was diagnosed within 1 year before the start of cover, while the UNION-Kompakt conditions look back 5 years.
- Takeover (continuity) terms – waiving the waiting period for members already insured, crediting the earlier reference date for pre-existing conditions – can be requested through an individual agreement; they are not automatic and are only worth anything in writing.
Why does the clock restart? The contract and the insured person
Group health insurance is a contract between the company and the insurer; the employee is an insured person but not a party to the contract. When the company signs with a new insurer, the new insurer has no legal relationship with the old one: it does not take over the old contract but concludes its own, with its own start date of cover. And every time-based rule in the conditions – the waiting period, the assessment of pre-existing conditions, some of the exclusions – is tied to this start date, not to how many years the employee has been using company health insurance.
The waiting period is the most visible consequence. Alfa's group health insurance conditions (CSEB-SZ-250501, point 5.3) set a waiting period of 1 month for every insured person and every service, and the insurer provides no benefits for insured events occurring during the waiting period. Other conditions set other lengths: the special conditions of the UNION-Kompakt group health insurance (U26702), in force since 2014, stipulate a 3-month waiting period before benefit claims can be made, except for acute infectious diseases. So the length varies by insurer, but the logic does not: counting from the date of the switch, there is a period during which the team is formally insured but does not yet receive care. With a January switch, this means that some of the winter illnesses fall right into the gap. What exactly the waiting period means, and what it does not apply to, is explained in our glossary of policy terms.
Pre-existing conditions: what counts as new with the new insurer?
A major advantage of a group contract is that there is typically no individual underwriting: under most conditions, employees join without a health declaration – with a small headcount or high benefit limits, some insurers may depart from this. That does not mean, however, that earlier illnesses do not matter – the conditions deal with them through exclusions. Point 9.4 of the Alfa conditions treats as a pre-existing condition any symptom, illness, injury or permanent impairment that already existed before the start of cover; for day surgery and high-value diagnostics, the Doktor Plusz clause (CSOP-ASZF-Z-250601-PS, point 6) states that events related to a symptom or illness that developed or was diagnosed within 1 year before the start of cover are excluded. Alfa's product information document also removes from cover events related to permanent health impairment established before the start of cover. The UNION-Kompakt conditions (point 2.2) draw the line more strictly: there, an illness counts as one with no prior history if, in the 5 years before the start of cover, it caused no symptoms or complaints and did not require medical care, examination or treatment.
When you switch, this start date moves forward. Someone diagnosed under the old contract – say, last autumn with a thyroid or spinal problem – was insured with the old insurer with an illness that was already “inside” the contract, but arrives at the new one with a history dating back less than a year, and the conditions may exclude a day surgery or high-value diagnostic claim related to it. In practice, several insurers do not apply the pre-existing condition exclusion to outpatient specialist examinations, or apply it only more narrowly, but by the letter of the conditions – as with Alfa's point 9.4 – it may also be general; exactly which services the pre-existing condition exclusion extends to can only be told from the conditions in question. How group contracts generally handle pre-existing conditions is covered in a separate article of ours – a switch changes this picture only insofar as the start date for the calculation is rewritten.
Takeover (continuity) terms: what can you ask for?
The good news: the rules above are the defaults of the conditions, not laws set in stone. When taking over an existing group with a claims history, insurers may depart from them by individual agreement – what they agree to, and from what headcount, varies by insurer, and nothing is automatic. Three things are worth requesting by name in the request for quotation. The first is waiving the waiting period for members who were already insured under the old contract on the day of the switch – the normal waiting period can remain for new joiners. The second is aligning the reference date for the pre-existing condition assessment with the start of cover under the old contract, i.e. the new insurer crediting the period of continuous cover. The third is what happens to care in progress: with which service organiser an investigation already under way or an appointment already booked will be completed. Whatever of this makes it into the offer must be seen in writing in the policy or in a clause; when switching, a verbal promise is worth nothing.
Another lesson applies if you stay with your current insurer. Under point 7.6 of the Alfa conditions, when the contract is amended, the amended contract applies to new insured persons joining after it takes effect, while for existing insured persons the contract remains in force on unchanged terms. In a renegotiation, then, existing members keep their continuity, whereas a switch gives everyone a new start date. This is not an argument against switching, but it is a weight on the scales – when an indexation is fair, when it is worth renegotiating and when to re-tender is covered in our renewal article, and how to build the comparison table in our methodology article. In that table, takeover terms deserve a row of their own, alongside premium and network.
Timing: notice, start date, not a single day missing
Group health insurance policies typically run for one year and renew on the renewal date. According to Alfa's product information document, the contract terminates at the end of the fixed one-year term if either party does not wish to renew it and gives written notice of this 30 days before the end of the term – with other insurers the notice period and form may differ, so it is worth reading the termination clause of the old policy first. Cover starts at 0:00 on the specified day and ends at 24:00 on the last day: the start date of the new contract must be set so that it follows on directly from the last day of the old one. The notice of cancellation is given by the company, in its own name – this is the policyholder's non-transferable obligation, as is handing over the list of joiners and the employee declarations; the limits of processing health data are covered in our GDPR article. The other side of continuity is premium payment: if the company pays the old contract's premium late in the final months, retroactive termination may also affect care received before the switch – this is discussed in our article on late premium payment.
What should HR do before the decision?
First, obtain the start date of cover under the old contract and the members' joining dates – this is the basis of every takeover request. Second, in the request for quotation, ask by name for the waiting period to be waived for members already insured, for the earlier reference date for pre-existing conditions to be credited and for care in progress to be handled, and ask for the answers in writing. Third, compare the definitions of pre-existing conditions: one year, five years and permanent health impairment are three different levels of strictness, and with an ageing team this may weigh more than a few per cent difference in premium. Fourth, in your communication with employees, say honestly what changes: from when the new cover applies, who is affected by a waiting period, and where to turn with matters in progress – trust is decided at the first refused appointment, not at the announcement. As brokers, we can help get the takeover questions into the request for quotation and the answers into the table together with the conditions; if you let us know before the renewal date, we prepare the comparison and the paperwork, and we help where we can. The insurer pays only for what is an insured event under your contract – when you switch, this sentence has to be read again from the start date of the new contract.
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Sources
- Alfa Vienna Insurance Group – Doktor Plusz group health insurance conditions (CSEB-SZ-250501: points 5.3, 7.6, 9.4; CSOP-ASZF-Z-250601-PS clause, point 6)
- Alfa Vienna Insurance Group – insurance product information document for group health insurance (term, cancellation, start and end of cover, exclusions)
- UNION Vienna Insurance Group – UNION-Kompakt group life, accident and health insurance: special conditions for health insurance (U26702, in force from 11 July 2014): point 2.2 (illness with no prior history), point 3 (waiting period)
