Dental insurance for children: from what age, and is it worth it?

Dentist for your child: who pays for what

At the dentist, basic health insurance only pays in exceptional cases. Check-ups, fillings for tooth decay, dental hygiene and most braces are not included. Basic health insurance only pays in the cases that the law lists exhaustively (Art. 31 of the Federal Health Insurance Act, KVG). Disability insurance (IV) is responsible for some congenital jaw problems. You pay for everything else yourself or through dental insurance.

If basic health insurance covers treatment because of a severe general illness, prior cost approval from the insurer is required (Art. 18 para. 2 of the Health Care Benefits Ordinance, KLV). The child’s co-payment applies to all benefits of basic health insurance: a child deductible of your choice from CHF 0 to CHF 600 (Art. 93 KVV) and a 10 % retention fee, at most CHF 350 a year (Art. 103 para. 2 KVV).

When disability insurance pays for teeth and jaw

Up to the age of 20, disability insurance pays for medical measures for congenital disorders that are diagnosed by a specialist, impair health, reach a certain degree of severity and require long-term or complex treatment (Art. 13 IVG). Which disorders qualify is set out in the list of the FDHA Ordinance on Congenital Disorders (GgV-EDI). For teeth and jaw, these include for example:

• Item 201: cleft lip, jaw and palate.
• Item 205: congenital dysplasia of the teeth, if at least 12 permanent teeth are severely affected after eruption.
• Item 206: congenital absence of at least two adjacent or four permanent teeth per jaw, not counting wisdom teeth.
• Items 208–210: certain congenital jaw misalignments, with precisely defined measurements.

The criteria are narrow. Jaw misalignments only count as congenital disorders if they reach these measurements. Whether a disorder is recognised is decided by the disability insurance office of the canton of residence after registration, not by the dentist. The article Congenital disorders and disability insurance explains more about the boundary between disability insurance and the health insurer.

From what age dental insurance for children makes sense

Dental insurance is supplementary insurance under the Insurance Contract Act (ICA). Before the contract is concluded, the insurer may ask about the condition of the teeth and request a dental report (Art. 4 ICA). If the dentist finds a misalignment or plans orthodontics, the insurer can exclude this finding or reject the application. This leads to the most important rule: you must take out the insurance before there is a finding.

What to look out for in the terms and conditions:

• Entry age. From what age and up to what age does the insurer accept children?
• Report. Does it require a dental report or only a health questionnaire?
• Waiting period. From when is orthodontics insured?
• Benefit. What percentage of the bill, what maximum amount per year or for the whole treatment?
• Transfer. What happens to the contract when the child becomes an adult?

Before the contract is concluded, the insurer must inform you about the insured risks, scope, premiums and termination (Art. 3 ICA). You can revoke the application within 14 days (Art. 2a ICA). Later, only the policyholder may cancel with ordinary notice, not the insurer (Art. 35a para. 4 ICA). What counts are the general terms and conditions and the information from the insurer.

Step by step

1. Decide early. Sort out dental insurance before the first check-up produces a finding, ideally together with the other supplementary insurance for your child.
2. Get two or three quotes. Compare the premium, percentage, maximum amounts and waiting periods for orthodontics.
3. Answer the questions in full. If you conceal a fact you were asked about, the insurer may cancel the contract (Art. 6 ICA).
4. Ask for a cost estimate. Before treatment, it shows what the insurance pays; the insurer may require it for cost approval.
5. Involve disability insurance if a congenital disorder is suspected. For recognised congenital disorders, disability insurance is responsible before the health insurer; you register with the disability insurance office.
6. Keep the bills. You can deduct dental costs you paid yourself from your taxes as medical expenses; for direct federal tax, to the extent that they exceed 5 % of income after the other deductions (Art. 33 para. 1 let. h DBG).

Example calculation: is dental insurance worth it?

Example with fictitious people. Lina’s parents take out dental insurance when she is 3. The product is a sample contract: premium CHF 20 per month, 75 % of orthodontic costs, at most CHF 8,000 per treatment, waiting period fulfilled. The treatment costs are assumed at CHF 6,000 and fall due when she is 12.

Work it out with the figures from your quotes: premium times the years until the expected treatment, against the percentage times the expected costs, capped at the maximum amount. Part of the premium can be financed if your child’s basic health insurance becomes cheaper: child premiums 2026, municipality of Bern (region 1), born in 2026, deductible CHF 0, with accident cover, range from CHF 125.00 to CHF 189.80 per month (source: FOPH).

Dental accident: basic health insurance with accident cover

If your child breaks a tooth during sport or in the school playground, basic health insurance pays for the treatment of damage to the masticatory system (Art. 31 para. 2 KVG). This requires accident cover. It may only be excluded for people who are fully insured on a compulsory basis under the Accident Insurance Act (Art. 8 para. 1 KVG); for children without an employment relationship it is therefore included. The child’s co-payment applies: the child deductible and at most CHF 350 retention fee a year.

So you do not need dental insurance for accidents. It can, however, pay for benefits that basic health insurance does not cover, for example aesthetically better materials; this is set out in the general terms and conditions.

Special cases

Several children

Each child needs a separate supplementary contract, with its own health questions. Some insurers grant family discounts on supplementary insurance; this is set out in their terms and conditions. In basic health insurance, several children with the same insurer together pay at most the co-payment of one adult (Art. 64 para. 4 KVG). The article Lowering child premiums explains how to reduce your children’s basic premiums.

Families receiving supplementary benefits

If a parent receives supplementary benefits to old-age and survivors’ insurance (AHV) or disability insurance, the canton reimburses, among other things, the costs of dental treatment (Art. 14 para. 1 let. a ELG). The canton determines which treatments and up to what amount.

Deductible and retention fee

Dental insurance may not cover the co-payment of basic health insurance (Art. 64 para. 8 KVG). If basic health insurance pays for dental treatment, for example after an accident, the deductible and retention fee remain with you.

Common mistakes

• Taking out the insurance too late. Once a misalignment has been found, the insurer may exclude it. The insurance then does not pay for precisely the treatment you wanted it for.
• Comparing only the premium. What matters are the percentage, the maximum amount for orthodontics and the waiting period.
• Forgetting disability insurance. If a congenital jaw disorder is suspected, disability insurance examines entitlement; it pays if the criteria are met.
• Wanting to drop the child’s accident cover. Children without cover under the Accident Insurance Act need the accident cover of basic health insurance, including for dental accidents.
• Concealing findings. A false answer to a health question entitles the insurer to cancel the contract.

The article Supplementary insurance for your child explains what other supplementary insurance there is for children. The rules for adults at the dentist are in the article Dentist, and those for braces under Braces. You can compare basic health insurance premiums for children in the premium calculator, and you will find key figures for the insurers in the health insurer profiles. All topics for parents are in the Family and children section.