Supplemental Health Insurance in Switzerland: Do you really need it?
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In Switzerland, we have mandatory health insurance for everybody. This basic health insurance is offered by many providers, but they are all based on the same legal basis. Next to this, insurance companies are also providing supplemental health insurance policies.
Each insurance company can provide its own policies with different conditions, so it is sometimes difficult to navigate this choice. Also, do we really need these policies? And how to choose? This is what this in-depth guide is going to answer.
Supplemental health insurance
The base health insurance is governed by the LAMAL law (or KVG in German). This law is only for health insurance and is quite strict as to what is covered and what is not.
On the other hand, the supplemental health insurance is regulated by the LCA (or VVG in German). This is the law that regulates all private insurance policies. So, there is nothing health-specific about this law.
We call it supplemental health insurance (and not simply supplemental insurance) because health insurance companies are offering these packages alongside standard health insurance.
Generally, there are two large families of supplemental health insurance:
- supplemental hospital insurance (or inpatient insurance).
- supplemental outpatient insurance.
We will cover these two groups in detail in this guide.
Limits and reserves
There is one essential distinction between the base health insurance and the supplemental health insurance. Since the base is mandatory, insurers cannot refuse you. However, insurers are free to refuse you if you do not meet their criteria for supplemental health insurance. In almost all cases, you will be asked to fill out a health questionnaire. And these companies can be very strict with whom they will accept.
It is important that you fill out this questionnaire faithfully. If you lie on the questionnaire and they find out, you will lose any coverage and will not be able to get any more supplemental health insurance later. And you will have paid for years for nothing.
In some cases, like dental insurance, the questionnaire will need to be filled out by a specialist.
If you already have some health conditions, it is already too late to get supplemental health insurance. Insurers only want to cover good risks, not bad ones. In some cases, they will not refuse you outright but put some reserves. For instance, dental insurance would not cover the teeth that you broke 10 years ago.
Another way an insurer can reduce coverage is by applying a delay to coverage. For instance, if you got a knee operation recently, the insurance may say that they will not cover anything related to that knee (or even that leg) for a certain amount of years (like 5 years).
And there are also some standard waiting periods. A typical example is for maternity. If you take out supplemental health insurance, they will usually only cover you after 9 or 12 months. It means that if you are already pregnant (even if you do not know it), it is generally too late to take out extra insurance for that birth.
So, this system means that you should take supplemental health insurance when you do not need it because it is too late to take it when you start needing it. This is unfortunate because it also means paying when you do not need the coverage.
Supplemental hospital insurance
The base health insurance will pay for your hospital fees. However, it will only cover your expenses in the general ward, and some insurance will limit which hospital you can go to. In most cases, you can also only be treated in the canton where you live. Supplemental hospital insurance, also called supplemental inpatient insurance, can help improve the quality of your stay in the hospital and your access to specialists.
Private and semi-private
If you want to be treated outside the general ward, you will need to opt for private or semi-private insurance.
Semi-private insurance lets you have a room with only two people inside. In some hospitals, this also gives you more choices of meals. Additionally, you will usually have a better choice of doctors in the hospital.
Private insurance lets you have a private room, all by yourself. This should also provide you with access to the best meals and the best doctors (generally the chief doctors).
However, both of these insurances can be prohibitively high, easily a few hundred per month for private insurance. Avoiding them can be a great way to save money every month.
Flexible hospital insurance
Private and semi-private insurance can be quite expensive, and you pay all your life and potentially never use it.
An alternative is the flexible insurance. This allows you to choose your ward when you enter the hospital. If you choose the general ward, you will not pay any extra fees. But you have the choice to go to a private or semi-private ward, and in this case you will pay some of the costs and the insurance will pay some of the costs.
Such insurance is much cheaper than private or semi-private insurance and allows you to have the choice of ward while not having to pay huge fees for your life. Of course, the insurance is still not free, but it is much cheaper than full coverage. You could choose to opt-in to private ward if you have a long stay in the hospital, for instance.
Choice of hospital
The cheapest option for supplemental hospital insurance is the insurance for the choice of hospital.
This supplemental health insurance allows you to choose a hospital in the entire country. Normally, you can only get coverage in your canton of residence.
One case when such insurance is quite useful is if you live close to a hospital from another canton. If you live near the border of your canton, the closest hospital may be the one from the next canton.
It is important to note that insurances have a list of hospitals they will allow. In most cases, this list is quite complete, but it is worth checking since otherwise, you may pay this insurance for nothing.
It is worth noting that this option is generally included in private and semi-private. So, make sure you are not overinsured if you already have this option included.
This insurance is very cheap, probably the cheapest of the supplemental health insurance. As a quick example, I got a quote at 1.50 CHF per month for my case.
Supplemental outpatient insurance
The other category of supplemental health insurance is the set of supplemental outpatient insurance.
Insurers have many packages of supplemental outpatient insurance. Since there are no set rules, they do not all have the same packs. Some insurers have few packs but with multiple modules. And others have many small modules.
Medications
The base health insurance does not always reimburse all medications. In general, it reimburses only medications prescribed by a doctor and on a special list. However, sometimes, they do not agree with the prescription and will not reimburse it. Also, medications that are not on the specialty list will not be reimbursed.
This is where supplemental health insurance may be interesting. They will generally reimburse medications from the specialty list that are not reimbursed by the base insurance. And they will often reimburse other medications, prescribed by a doctor but not part of a specialty list.
However, these supplemental health insurance policies also have limits, and they have their own list of medications. Additionally, they will not reimburse medicine that is not prescribed by a doctor.
Dental insurance
Going to the dentist is not reimbursed by the base health insurance.
But there are many supplemental health insurance policies that will cover dental care. If you go once a year to the dentist, this will be reimbursed, for instance. However, they generally cost more than they reimburse. So, in most cases, these policies are not very interesting. Additionally, they are among the most restrictive policies and will often add limits to what they reimburse based on your dental history.
Orthodontic insurance
If a child needs orthodontic correction, the bill can be expensive. And the basic health insurance will not cover any of it.
This is one of the best cases where orthodontic insurance can be useful. They will cover the costs of orthodontic correction (up to a limit, of course). If you imagine that a correction can cost more than 10,000 CHF, it could be interesting to get this insurance. A household with multiple children needing orthodontic corrections at the same time may be in financial trouble without insurance.
It is important to know that you should get this insurance early for your children. There is no dental check before 3 years old. After that, they will check the teeth, and if they detect any hint of a possible future correction, they will refuse coverage.
We have taken out orthodontic insurance for our son since he was born.
Glasses insurance
The base health insurance has a small contribution for glasses, but only for children.
Many insurance providers also provide glasses supplemental insurance. However, in most cases, they are covering a small amount and cost more than they cover. So, they are rarely interesting.
Travel insurance
The base health insurance has some coverage internationally, but depending on where you go, it may be limited.
If you go to Europe, you do not need extra coverage in most cases (there may be some expenses out of pocket) since we get the same coverage as European people.
However, if you get to a country outside the EU, this becomes a different story. In these cases, the Swiss health insurance will only cover costs if they are not too expensive compared to the price in Switzerland. So, if you go to a country like the United States or Japan, where healthcare costs can be very expensive, you could have to pay a very significant amount of money if you need to go to the hospital. And in this case, we are talking tens of thousands of Swiss francs potentially.
So, if you are traveling outside the EU to some countries known to be expensive for healthcare costs, travel insurance coverage may be quite helpful. I have an entire article on travel insurance if you want more details.
We have travel insurance since we travel to countries like the United States and China.
Rescue and transport insurance
If you need medical rescue, the base health insurance will only cover up to 50% of the costs and up to 5000 CHF per year.
A medical rescue can cost a lot more than that if you need helicopter rescue, for instance. And if you need rescue abroad, there is no coverage at all.
If you travel a lot or put yourself in situations where rescue is likely (hiking alone, for instance), rescue and transport insurance can be helpful. You have to make sure the coverage is good enough for the premium paid.
In many cases, this is bundled together with the travel insurance.
Alternative medicine
The base health insurance has limited coverage for alternative medicine. Some medicine, like osteopathy and naturopathy, is not covered at all.
If you want coverage for these forms of medicine, you will need supplemental health insurance. These alternative medicine modules will cover more forms of alternative medicine than are covered by the base health insurance.
As usual, each insurance will have different coverage. And most insurance will use a different list of recognized therapists.
Psychotherapy
Psychotherapy is covered by the base health insurance, but only if prescribed by a doctor and only if you go to a recognized psychotherapist.
Some supplemental health insurance can increase this coverage. They can cover more doctors, and some of them can also cover some therapy that is not prescribed.
These policies also have a list of reimbursed doctors. This list is usually longer than the one from the base health insurance, but you have to check this list so that your doctor is on the list if you already have a favorite therapist.
Prevention
The base health insurance covers almost nothing in terms of prevention. This is quite sad because early prevention is often cheaper than later correction.
If you would like to get some support from your insurance to get preventive checkups or more frequent checks, there are some supplemental health insurance options. Some insurances will pay for a checkup every two years, for instance. Some other things can be reimbursed, like going to the gym. As usual, the limits highly vary from one insurance to another.
While it sounds great, it is often not that efficient because they will cover a limited amount, and usually premiums will cost more than reimbursement.
Do we need supplemental health insurance?
The first big question is, do we need supplemental health insurance?
And it is not an easy question. We should start from the premise that insurance providers are not giving you free money. So, insurance will not make you save money. Supplemental health insurance policies should be weighed carefully. Generally, only a significantly expensive risk should be insured. If a risk is very unlikely or cheap, there is not much value in insuring it.
Therefore, I think that most supplemental health insurance is not that interesting. There is no point in paying 200 CHF per year for insurance that will reimburse 150 CHF per year in dental costs. This is the same as throwing away 50 CHF per year. In many cases, just saving some money is more efficient than supplemental health insurance.
For me, there are two exceptions:
- Travel insurance can save you a lot of trouble if you are traveling often in expensive countries in case of an emergency.
- Orthodontic insurance for children, since treatments can be incredibly expensive in Switzerland.
Obviously, some people prefer to be more insured than others. If you feel like you need to get insurance to feel safe, then by all means do it. But it is important to think about your real needs and your budget as well.
How to choose supplemental health insurance?
If you think you need supplemental health insurance, how do you choose one?
Unfortunately, there is no obvious answer to this question. It is easy to compare base health insurance offers since they offer the same coverage. But supplemental health insurance is not governed by law. So, even two dental insurance plans are difficult to compare.
There are some comparison tools, but you have to be cautious. I have not found an independent comparison tool for supplemental health insurance. This means that each comparison tool has incentives to sell some insurance policies, creating a conflict of interest.
The second issue is that I have not found any comparison tool that is complete. It means that each comparison tool will show only a subset of the offers.
I only found two comparison tools, and neither are fully independent nor complete:
So, I would recommend checking both and then also checking if you have a favorite insurance provider to use their services. And then, you would have to check the details of coverage of the offers you found to see if they really fit your needs and your budget.
Sometimes, you can get a better price if you bundle the base health insurance and the supplemental health insurance with the same provider. But you should be careful about that because even with the bundle, it is rarely worth it since the cheapest base health insurance often changes.
FAQ
How often can I change supplemental health insurance?
Supplemental health insurance policies are often longer than base health insurance policies. They usually last between 3 and 5 years. This means you need to be careful about when you can cancel them. Fortunately, by law, you can cancel a multi-year contract at the end of the third year. So, even if your contract is for five years, you can cancel it after three years, but you must still observe the notice period.
In most cases, the delay period is three months (sometimes six months) for the end of the year. So, if you want to cancel, you will need to do it before the end of September in most cases (sometimes before the end of June).
Does supplemental health insurance need to be with base health insurance?
No. You can have your base insurance at one provider and your supplemental insurance policies with another provider.
Do all my supplemental health insurance policies need to be with the same insurer?
No, you can have supplemental health insurance spread around multiple providers.
Conclusion
Overall, the world of supplemental health insurance is quite complicated. Since all insurance providers can do the packs they want, it is difficult to compare them. Also, it is packed with many insurance policies that are not very useful because they are simply too expensive for what they cover.
Generally, insurance is useful to cover things that can be expensive. In this case, something like travel and rescue insurance can be useful to cover medical and rescue costs abroad (or even in Switzerland). Another good example is orthodontic insurance for kids that could potentially save us several thousand Swiss francs.
But there are also examples where you pay 200 CHF per year to get 150 CHF in coverage for glasses or a dental appointment. This is simply not efficient, and paying out of pocket would be better.
Choosing supplemental health insurance is quite complex since they are all different, and each insurance has its own limits and conditions.
If you want to read more on the subject of insurance, you can read our guide on basic health insurance.
What about you? Do you have any supplemental health insurance?
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Hi Baptiste, thanks for the great article.
I would add my own experience and say, anyone who is a regularly gym goer, or doing some kind of sport in a club this insurance could be interesting to them. In my example I have Sympany and I pay 292.8 CHF a year (Plus + hospital general) and I managed to get back constantly every year (200 sport contribution + 300 check-up + only every 3 years 270 for glasses or contact lenses) so that’s a total of 560 CHF so it pays for itself in my case, the other things I haven’t used and I consider them as bonuses if I might needed them someday. But as Baptiste mentioned you will always pay out of the pocket more to rip thse benefits compared if you just have saved up the money. In my cases gym membership 800 CHF/year, glasses 900, care.me check-up I think was 500 got a promotional price. And another thing worth mentioning is that one time they refused to pay my check-up which was 700, although they confirmed before on the phone that I’m good to go, doing it at my Hausarzt, and one other time refused to pay for the glasses citing it has to be done in Switzerland not abroad but also another time they accepted it and I ended up buying 2 glasses and even contact lenses for the price they returned to me in Asia.(They might have changed this policy in the last few years.) I have also tried to get the premium insurance, because supposedly you could bypass your franchise if you’re sick and you go to the doctor in Germany and they would fully cover that, but I got rejected wanted to try it out. Also be aware you don’t need to have your supplementary health insurance where you have your basic health insurance, there is absolutely no monetary advantage of doing so. One other thing is they might try to upsell you, so be careful about that and actually just take what you need now, not when you’ll be 60.
Best regards.