Legal advice about OHRA health insurance

Questioner

I took out comprehensive health insurance with ohra for 2015. This includes 100% physiotherapy reimbursement. After my shoulder surgery, I had intensive physiotherapy. 3 times a week from January 26 to the present. These are declared as chronic by the physiotherapist. and indeed the first 20 were reimbursed from the comprehensive insurance, however after the 20th treatment these are reimbursed from the basic insurance. unfortunately this has the consequence that these are charged to the deductible. This is not mentioned in any of Ohra's advertising or documentation. see below. The OHRA collective health insurance contract offers you the following benefits: • a competitive premium on the OHRA Health Insurance • You choose your own healthcare provider • Always free choice • Extension of reimbursement for IBM with regard to physiotherapy: o OHRA Extra Supplementary 9 sessions per indication instead of 9 sessions per year; o OHRA Extensive 100% instead of 18 treatments per year; o OHRA Extensive Vitality 100% instead of 18 treatments per year (no longer available for new purchase). when I look at the ohra website I see this under the supplementary insurance "No, you do not have to pay a deductible for the reimbursements from your supplementary insurance." When I look at the Ohra website under physiotherapy I see the following. ''Then you will be reimbursed for physiotherapy from the basic insurance from the twenty-first treatment. Your physiotherapist can tell you whether you are entitled to this reimbursement. In some cases, the reimbursement applies for a certain period. This period is also specified in the list of indications and applies from the first treatment.'' and here too there is no mention of these treatments being charged to the deductible. I assumed that a supplementary insurance with 100% Physio reimbursement would also reimburse all Physio treatments. But unfortunately I first have to study the health care law to find out that this is not the case. I find this to be a misleading state of affairs. is there a chance that I can legally win this from OHRA?

Lawyer

It is not possible to say in advance that the texts you quoted indicate that OHRA is misleading. If there were multiple complaints from customers, the chance would be greater. The question arises whether, when you concluded the insurance online, you ensured that you knew what you were concluding or at least were informed about it, for example by clicking on the conditions, etc. In my opinion it will be difficult to prove it to someone else, but it is not impossible provided there is clear substantiated evidence. I advise you to first send a letter to OHRA with the above comments. If desired, you can contact me directly for help and further advice.