Which supplementary insurance do I really need?

First basic health insurance: what it already pays for

If you are asking which supplementary insurance you need, the best place to start is basic health insurance. It is compulsory, the same with all insurers and covers every treatment that is effective, appropriate and cost-effective (Art. 32 of the Federal Health Insurance Act, KVG): doctor, hospital, medicines on the List of Pharmaceutical Specialties, physiotherapy on prescription, maternity and much more. So supplementary insurance does not make you “properly” insured. It closes gaps that the law deliberately leaves open.

The most important gaps and which supplementary insurance closes them:

What no supplementary insurance pays: the co-payment of basic health insurance. The deductible, retention fee (at most CHF 700 a year for adults, Art. 103 of the Health Insurance Ordinance, KVV) and the hospital contribution of CHF 15 per day (Art. 104 KVV) remain your responsibility. The law prohibits insuring them (Art. 64 para. 8 KVG).

Step by step: how to find out which supplementary insurance you need

1. Look at your costs over the last two or three years. Which bills did you pay yourself because basic health insurance did not cover them? Glasses, dental hygiene, osteopathy, massages, travel vaccinations? Your insurer’s statements of benefits help with this.
2. Rank the gaps by importance. Distinguish between costs you can plan for and bear yourself (a pair of glasses every few years) and risks that could overwhelm you financially (expensive dental treatment, an accident abroad outside Europe).
3. Choose the right supplementary insurance for each gap. Use the table above. Supplementary insurance without a matching gap costs premium without any return.
4. Get quotes with the general terms and conditions. Before concluding the contract, the insurer must inform you about the insured risks, scope, premium and term; you must have the general terms and conditions in hand when you apply (Art. 3 of the Insurance Contract Act, ICA). Compare benefit limits, retention fees, waiting periods and the term.
5. Weigh the premium against expected benefits. How much do you pay a year, and how much would you get back if you carry on as before? The example below shows how to calculate it.
6. Answer the health questions carefully. The insurer may ask questions and, on that basis, reject you or impose a reservation. How exactly this works is explained in the article Health questions in the application.
7. Know the 14-day revocation period. After applying, you can revoke your application in writing or by email within 14 days (Art. 2a ICA).

The needs check asks about your needs step by step: 7 questions without health details, followed by the model and deductible for basic health insurance and up to three suitable supplementary combinations.

Supplementary insurance at a glance

Supplementary hospital insurance

Supplementary hospital insurance pays for what goes beyond the general ward of a hospital on the Hospital List. The usual levels are “general ward throughout Switzerland” (free choice of hospital without a tariff difference), semi-private (usually a two-bed room and free choice of doctor in hospital) and private (usually a single room and free choice of doctor). Medically, you are treated in the general ward according to the same rules; the supplementary insurance pays for comfort and freedom of choice. Whether semi-private or private is worthwhile is covered in more depth in the article Semi-private or private.

Supplementary outpatient insurance

Supplementary outpatient insurance is a bundle: contributions towards glasses and contact lenses for adults, non-medical complementary medicine, medicines not on the List of Pharmaceutical Specialties, transport and rescue, prevention and often benefits abroad. How much it pays for what differs from product to product. This is where comparing with your own bills pays off most.

Dental insurance

Without dental insurance, you pay for caries, fillings, dental hygiene and most braces yourself, because basic health insurance only covers dental treatment in the cases set out in Art. 31 KVG. Dental insurance usually pays a percentage of the costs up to an annual maximum. Many parents take it out early for their children, because orthodontic treatment can be expensive and the insurer may ask health questions about the teeth.

Travel insurance and cover abroad

Basic health insurance pays for emergencies abroad, but at most twice the amount that would be reimbursed in Switzerland (Art. 36 para. 4 KVV). In countries with high hospital costs, a gap can arise, as it can for repatriation to Switzerland. Many supplementary outpatient insurance policies include cover abroad; so do some credit cards and travel insurance policies. Before taking it out, check whether you already have it. Details are in the article Ill abroad and on holiday.

The rules of the ICA: what applies to every supplementary insurance

Supplementary insurance to social health insurance (Art. 2 para. 2 of the Health Insurance Supervision Act, KVAG) is not governed by the KVG but by the Insurance Contract Act. This has consequences:

• No obligation to accept. The insurer may ask health questions before concluding the contract (Art. 4 ICA), reject your application or impose a reservation for a specific illness. It does not have to give reasons for a rejection.
• Duty of disclosure. If you answer a question incorrectly or conceal a significant fact you were asked about, the insurer may cancel the contract within 4 weeks of becoming aware of it (Art. 6 ICA).
• Revocation within 14 days. The period begins with the application or acceptance (Art. 2a ICA).
• Cancellation only by you. You can cancel with ordinary notice at the end of the third or any subsequent year with 3 months’ notice; the contract may provide for a shorter commitment (Art. 35a para. 1 and 2 ICA). In supplementary insurance to health insurance, the insurer has no ordinary right of cancellation (Art. 35a para. 4 ICA).
• Independent of basic health insurance. When you switch basic health insurance, your current insurer may not force you to cancel your supplementary insurance, and it may not cancel it for that reason (Art. 7 para. 7 and 8 KVG). How to switch basic health insurance is shown under Switching health insurer.
• Different premium rules. In the approval procedure, FINMA checks whether the tariffs and general terms and conditions of supplementary insurance safeguard solvency and protect insured persons from abuse (Art. 4 para. 2 let. r and Art. 38 of the Insurance Supervision Act, ISA). Unlike in basic health insurance, however, there is no uniform premium per region. The premium depends on the product, usually on age, often on sex, on the region and on the chosen retention fee. There are no public premium lists like those on priminfo.admin.ch.

Sample calculation: is supplementary outpatient insurance worthwhile?

There are no public premium data for supplementary insurance. The following example therefore calculates with an assumed contract. Premium and benefits are sample contract terms, not offers from a specific insurer.

Example with fictitious people. Nina, 24, and Jonas, 27, are both considering taking out supplementary outpatient insurance. Assumed contract: premium CHF 25 per month, i.e. CHF 300 a year. It pays 90 % towards glasses, at most CHF 200 within 3 years, and 75 % towards non-medical complementary medicine, at most CHF 1,500 a year.

The calculation only shows how to work it out; it is not a recommendation. It depends on assumptions: that you estimate your costs correctly, that the premium stays the same and that the insurer recognises the therapist. Two further points come into play. First, the contract usually binds you for at least 3 years (Art. 35a ICA). Second, there is the value of “still being insurable later”: if you are accepted today without a reservation, you might no longer get the cover after an illness. Nobody can express this value in francs.

Special cases

Children

For children, timing matters. If you want supplementary insurance, it is best to register your child before birth: some insurers then accept the child without health questions, but there is no statutory rule on this. Orthodontic treatment is the benefit parents most often pay for themselves. The procedure is described in Insuring your baby.

Young adults

When moving into adulthood, many people wonder whether to keep the supplementary insurance they had as children. If you cancel it and want to return later, you have to answer the health questions again. For many products, the premium depends on your age when you join; joining early can therefore mean lower premiums. Check this in the general terms and conditions.

From 60 and in retirement

Some insurers have a maximum age for joining supplementary hospital insurance, and the health questions become more difficult with age. Conversely, the premiums of some products rise sharply with age. Whether you should keep, adjust or cancel is dealt with in the article Supplementary insurance from 60.

With a pre-existing condition

If you have had an illness or therapy, the insurer may reject your application or impose a reservation. Another insurer may decide differently. What you can then do is shown in Previously in therapy: can I still get supplementary insurance?.

Common mistakes

• Wanting to take out supplementary insurance for the deductible. This is prohibited by law. If you want to save costs, check the deductible and model of your basic health insurance instead, for example with the premium calculator.
• Being insured twice. Cover abroad is often already included in a credit card or travel insurance, and accident cover through your employer. Double premiums do not bring double benefits.
• Cancelling supplementary and basic health insurance together. When you switch basic health insurance, you can keep the supplementary insurance. If you cancel it and want to return later, you answer the health questions again.
• Only looking at the premium. What matters are the benefit limits, retention fees, recognised therapists and the minimum term in the general terms and conditions.
• Leaving something out of the application. An incorrectly answered health question entitles the insurer to cancel, even years later within 4 weeks of becoming aware of it (Art. 6 ICA).

On to the decision

For every supplementary insurance, what counts are the general terms and conditions and the information from the insurer. You can set the benefits of supplementary insurance policies side by side in the comparison of supplementary insurance, value by value with the reference in the general terms and conditions; key figures and contact details for the insurers are in the health insurer profiles. If you would like a personal assessment, you can get in touch via the enquiry form; this is voluntary. All articles about supplementary insurance are in the topic section Supplementary insurance.