Previously in therapy: can I still get supplementary insurance?

Therapy and supplementary insurance: two worlds, two sets of rules

Many people have been in psychotherapy at some point, because of a separation, exhaustion or an anxiety disorder. When applying for supplementary insurance, the question then arises: do I have to declare it, and will I get a contract at all? The answer depends on which insurance you mean.

In basic health insurance, your history plays no role. Every insurer must accept you in its area of activity (Art. 5 let. i of the Health Insurance Supervision Act, KVAG), without a questionnaire and without a reservation. So you can change your basic health insurance at any time on the statutory dates, even in the middle of therapy. You make the comparison in the premium calculator.

Supplementary insurance is different. It is a private contract under the Insurance Contract Act (ICA). The insurer may ask, assess and decide whether and on what terms it insures you. Previous therapy is a fact like any other: it does not automatically exclude you, but it can lead to a reservation or a rejection.

What you have to declare in the application

The health questionnaire is the core of the application. Under Art. 4 para. 1 ICA, you must disclose all facts that are material to the assessment of the risk and that you know or ought to know. Facts that the insurer asks about in a specific, unambiguous form are deemed material (Art. 4 para. 3 ICA).

For previous psychotherapy, this means:

• The wording decides. If the insurer asks about “medical or therapeutic treatment”, psychotherapy is covered. All the more so if it asks explicitly about mental illness or psychotherapeutic treatment.
• The period decides. Many questions specify a period, for example “in the last five years”. If your therapy took place before that, this question does not cover it. If there is another question without a period, for example about existing illnesses, that question also applies.
• Completed therapy counts too. A therapy that has ended is a treatment within the period asked about. “I’m fine again” is not an answer to the question.
• Medicines are included. If the insurer asks about medicines taken regularly, also mention medicines you took as part of the treatment.
• Clarify borderline cases in writing. Coaching, couples counselling or a single assessment without a diagnosis: whether these are meant depends on the question. Ask the insurer in writing or declare it with a short explanation.

The questions must be asked in writing or in a form that allows proof by text, and so must your answers (Art. 4 para. 1 ICA). If an intermediary fills in the form with you, you remain responsible for the answers. The article Health questions in the application explains more about the whole questionnaire.

Step by step: how to apply for supplementary insurance

1. Do not touch existing contracts. If you already have supplementary insurance, it remains in place until you cancel it yourself. Do not cancel anything before a new contract has been confirmed in writing.
2. Gather your documents. Your insurer’s statements of benefits show which treatments have been billed in recent years, with dates. Note the start and end of the therapy, the number of sessions and whether it has ended.
3. Choose products in a targeted way. Consider which benefits you need: semi-private hospital, outpatient benefits, dental. Each product is a separate contract, and you can apply for them individually. The profiles under Health insurers show which insurers offer which products.
4. Read the questions word for word and answer in full. State the therapy with its period and status, for example “psychotherapeutic treatment 2023 to 2024, completed”. If the insurer requests a report, you decide whether to release your therapist from professional secrecy for this; without the documents, the insurer cannot assess the application.
5. Check the decision. The insurer accepts you, offers a reservation or rejects you. Read a reservation carefully: which illness is excluded, and is it limited in time?
6. Ask for a copy. Under Art. 11 para. 2 ICA, the insurer must give you a copy of your statements in the application on request. Keep it.
7. Know your right of revocation. Under Art. 2a ICA, you can revoke your application within 14 days, in writing or in text form.

How the insurer decides: acceptance, reservation, rejection

How an insurer assesses previous psychotherapy is not set out in any law. Each insurer has its own guidelines, and two insurers can assess the same application differently. Three decisions are possible:

A reservation only applies to what it states. If, for example, it says “mental illness”, supplementary insurance pays as normal for a broken leg or an operation. Only basic health insurance pays for the treatment of the excluded illness. Whether a reservation is limited in time and when it lapses is governed by the contract, not by law; there is no statutory maximum duration for supplementary insurance under the ICA. What counts are the GTC and the information from the insurer.

A rejection is not a statement about your health but a business decision by the insurer. You can apply again to another insurer. Declare the same facts just as fully there: if the new insurer asks about previous rejections, that also belongs in your answer.

If you conceal therapy: the legal consequences

An application without the therapy may be accepted more quickly. The risk comes later. A breach of the duty of disclosure usually comes to light when you submit bills and the insurer obtains reports.

• Cancellation: If you concealed or misstated a material fact that you knew and that you were asked about, the insurer may cancel the contract (Art. 6 para. 1 ICA).
• Deadline: The right of cancellation expires 4 weeks after the insurer learned of the breach (Art. 6 para. 2 ICA).
• Benefits: For claims that have occurred, the obligation to pay benefits lapses to the extent that the concealed fact influenced their occurrence or extent; the insurer can reclaim benefits already paid for them (Art. 6 para. 3 ICA).
• Protection: Art. 8 ICA prohibits cancellation in certain cases, for example if the insurer knew or ought to have known the fact or itself caused the incorrect statement.

Basic health insurance is never affected by this. It remains in place even if the insurer cancels the supplementary insurance.

What basic health insurance pays for psychotherapy

Even without supplementary insurance, you are insured for psychotherapy. Basic health insurance pays for it as a compulsory benefit if an authorised professional provides the treatment and the conditions of the Health Care Benefits Ordinance (KLV) are met. The benefits page Does health insurance pay for psychotherapy? explains the details of referral, authorisation and tariff.

Rule	Value	Legal basis
Psychological psychotherapy	only on medical referral	Art. 11b para. 1 KLV
Sessions per referral	at most 15	Art. 11b para. 2 KLV
Continuation after 30 sessions	report to the medical adviser of the insurer	Art. 11b para. 3 KLV
Crisis intervention or short-term therapy	at most 10 sessions	Art. 11b para. 4 KLV
Medical psychotherapy	initially at most 40 sessions	Art. 3 KLV
Retention fee for adults	10 %, at most CHF 700 per year	Art. 103 KVV

On top of that comes the deductible you have chosen. Supplementary insurance may not cover the deductible and retention fee of basic health insurance. What supplementary outpatient insurance can additionally provide for therapies, for example contributions to methods outside basic health insurance, depends entirely on the product. What counts are the GTC and the information from the insurer.

Example: two applications after the same therapy

Example with fictitious people. Sara, 31, was in psychological psychotherapy from 2023 to 2024, 24 sessions on medical referral. The therapy has ended. In autumn 2026, she applies for supplementary outpatient insurance and semi-private supplementary hospital insurance. Both applications ask about treatment “in the last five years”.

The insurer’s decisions in variant A are assumed; another insurer may decide differently. The example only shows how the rules of the ICA work.

Special cases: existing contract, changing insurer, children

You already have supplementary insurance. Then you have an advantage you should not give up lightly. The insurer may not cancel your contract with ordinary notice because you are in therapy or claim benefits: in supplementary health insurance, the ordinary right of cancellation belongs only to you (Art. 35a para. 4 ICA). The duty of disclosure applies when the contract is concluded (Art. 4 ICA): therapy that only starts after the contract begins does not change anything about the existing contract. The article Cancelling supplementary insurance explains how to cancel supplementary insurance without losing cover.

You only change your basic health insurance. Your previous insurer may not force you to cancel the supplementary insurance and may not cancel it solely because of the switch (Art. 7 para. 7 and 8 KVG). So you can change your basic health insurance and keep your supplementary insurance. Switching insurer shows the procedure.

You are in ongoing therapy. You must declare ongoing treatment if the question covers it, and the insurer assesses it according to its own guidelines. Some insured persons therefore decide to keep their existing cover and apply later. You decide whether that suits you; there is no guarantee of a later decision.

For children and adolescents, the parents answer the questions. A child’s therapy also belongs in the application if the question covers it.

Common mistakes

• Leaving out the therapy because it has ended. Completed treatments within the period asked about belong in the answer.
• Cancelling existing supplementary insurance before the new one is confirmed. If you are rejected, you are left without supplementary insurance.
• Not reading the reservation. A reservation for “mental illness” is broader than one for a specific diagnosis. Ask exactly what is excluded.
• Believing basic health insurance asks questions too. It does not ask health questions. A form with questions about therapy always concerns supplementary insurance.
• Relying on the intermediary. Responsibility for the answers remains with you.

In disputes about a cancellation or a benefit, the Office of the health insurance ombudsperson mediates free of charge, including for supplementary insurance. You will find further topics relating to hospital, outpatient benefits and contracts in the Supplementary insurance section. We explain how we use sources under How we calculate.