Guide to Supplementary Health Insurance in Switzerland

Supplementary health insurance is optional insurance intended to cover certain services that are not covered, or are only partly covered, by compulsory health insurance.

It may also provide greater choice or additional comfort.

Supplementary insurance is governed primarily by:

• the Swiss Federal Insurance Contract Act, known as the LCA
• the insurer’s general terms and conditions
• any product-specific terms and conditions
• the insurance policy
• insurance supervision legislation

It is supervised by the Swiss Financial Market Supervisory Authority, FINMA. Compulsory health insurance, by contrast, is supervised by the Federal Office of Public Health.

There is no general obligation to take out supplementary insurance.

Nor is there any general obligation for an insurer to accept an application.

The distinction between basic and supplementary insurance concerns more than the benefits provided. It also concerns the legal nature of the contract.

Basic insurance under the LAMal

Under compulsory insurance:

• the insurer must accept anyone subject to compulsory insurance
• health does not affect admission
• benefits are defined by law
• the insurer may not exclude a pre-existing condition
• the insured person may change insurer in accordance with the statutory deadlines

Supplementary insurance under the LCA

Under supplementary insurance:

• the insurer may assess the risk before entering into the contract
• a health questionnaire may be required
• an application may be accepted, amended or refused
• certain benefits may be excluded
• cover depends on the contract
• cancellation deadlines and conditions must be checked in the policy and terms and conditions

Supplementary insurance is optional, and the applicable terms vary from one product to another.

This difference explains why basic insurance may be compared every year, whereas an existing supplementary policy should be changed with greater caution.

No.

Supplementary insurance is only useful where it meets an identifiable need and the insured person wishes to transfer all or part of the corresponding financial risk to an insurer.

A person may decide to pay certain expenses personally, particularly where they are:

• foreseeable
• relatively limited
• occasional
• easy to finance
• lower than, or close to, the cumulative cost of the premiums

Insurance may be more valuable where it covers:

• an infrequent but potentially expensive risk
• a service that would be difficult to finance immediately
• a regular need resulting in significant reimbursements
• a medical or hospital choice considered important
• a substantial gap in basic insurance cover

The relevant question is therefore not merely:

What does this insurance reimburse?

It is also necessary to ask:

What financial risk or genuine need does this insurance allow me to cover?

Products may be structured differently from one insurer to another. They may be sold separately, grouped into a package or combined within several levels of cover.

The principal categories are:

• outpatient supplementary insurance
• hospital insurance
• dental insurance
• complementary medicine cover
• travel and overseas medical cover
• transport and rescue cover
• prevention and wellbeing benefits
• certain daily allowance insurance policies

The same benefit may sometimes appear in several products offered by the same insurer. Possible duplication should therefore be checked.

Outpatient supplementary insurance generally covers a selection of services provided without admission to hospital.

It may include:

• complementary medicine
• medicines not reimbursed by basic insurance
• spectacles and contact lenses
• certain preventive measures
• travel vaccinations
• check-ups
• certain medical aids
• medical transport
• rescue costs
• certain services abroad
• contributions towards physical activity
• certain dental treatments
• home care
• domestic assistance
• health cures or convalescence stays

The content varies considerably from one product to another.

A policy described as “comprehensive” may in practice include:

• low reimbursement limits
• sub-limits for individual benefits
• closed lists of providers
• a requirement for a medical prescription
• a maximum number of sessions
• age-related conditions
• waiting periods
• geographical exclusions

An outpatient policy should therefore never be assessed solely on the basis of its name or marketing brochure.

Supplementary benefits are often expressed as:

• a reimbursement percentage
• a fixed amount
• an annual limit
• a limit over several years
• a maximum number of sessions
• a combination of a percentage and a limit

Example 1: percentage with a limit

A policy reimburses 75% of the cost, up to CHF 1,000 per year.

For an expense of CHF 800:

• 75% of CHF 800 is CHF 600
• the maximum reimbursement is therefore CHF 600

For an expense of CHF 2,000:

• 75% of CHF 2,000 is CHF 1,500
• as the annual limit is CHF 1,000, reimbursement will be limited to CHF 1,000

Example 2: periodic allowance

A policy provides CHF 300 every three years towards spectacles.

This does not mean CHF 300 per year.

If the entire amount is used in the first year, no further entitlement may be available until the next contractual period.

Example 3: shared overall limit

A product may provide CHF 1,500 per year for a group of benefits including:

• spectacles
• preventive care
• complementary medicine
• vaccinations
• physical activity

In such a case, all reimbursements may be deducted from the same overall allowance.

It is therefore necessary to check whether each benefit has its own limit or whether several benefits share a common allowance.

Basic insurance covers inpatient treatment in the general ward of approved hospitals, in accordance with the LAMal.

Supplementary hospital insurance may extend:

• the choice of hospital
• the choice of doctor
• the level of comfort
• cover outside the canton of residence
• access to certain private hospitals
• benefits before or after hospitalisation
• cover abroad

The value of hospital insurance cannot, however, be reduced to the number of beds in the room.

Basic insurance already provides a relatively broad choice of hospital. However, where a patient chooses, without medical necessity, an out-of-canton hospital that charges more than the reference tariff, part of the cost may remain payable by the patient.

Some products supplement basic hospital cover for treatment outside the canton of residence.

They may cover all or part of the difference between:

• the tariff recognised in the canton of residence
• and the tariff charged by the chosen hospital in another canton

This cover should be assessed in light of:

• the hospital list of the canton of residence
• the hospitals already accessible under basic insurance
• agreements entered into by the insurer
• the private hospitals included
• geographical restrictions
• whether there is a medical necessity

“Cover throughout Switzerland” does not necessarily mean that every cost is covered at every hospital.

Semi-private hospital insurance may provide:

• accommodation in a two-bed room, subject to availability and contractual conditions
• a wider choice of doctor
• access to certain senior doctors or specialists
• a broader choice of hospital
• more extensive out-of-canton cover
• certain comfort-related benefits
• additional services

The two-bed room is generally the most visible feature, but it is not necessarily the most important one.

The more significant benefits may include:

• freedom to choose the treating doctor
• access to partner hospitals
• the way medical fees are covered
• rules applying to affiliated doctors
• restrictions resulting from hospital agreements

Private hospital insurance may provide:

• a private room, subject to the contractual conditions and availability
• a wider choice of doctor
• access to certain specialists or senior doctors
• a broader choice of hospital
• improved cover outside the canton
• certain comfort-related services
• benefits abroad

Private insurance does not, however, automatically guarantee:

• a private room in every circumstance
• access to any doctor
• the absence of all personal costs
• cover at every hospital in Switzerland or abroad

The policy may include:

• a list of hospitals
• a partner system
• excluded hospitals
• a personal contribution
• a requirement for prior authorisation
• maximum reimbursable tariffs
• restrictions applying to particular doctors

Flexible hospital policies allow the insured person to choose the ward category at the time of hospitalisation.

Depending on the product, the insured person may choose between:

• the general ward
• the semi-private ward
• the private ward

Where a higher ward category is selected, the insured person will generally pay a personal contribution.

This contribution may take the form of:

• a fixed amount
• a daily amount
• a percentage of the bill
• an amount capped per hospital stay
• an amount capped per year

Possible advantages

• a lower premium than full private cover
• the ability to choose on a case-by-case basis
• access to a higher ward category where it appears genuinely useful
• protection against a significant part of the cost

Points to check

• the exact personal contribution
• the limit per stay
• the annual limit
• actual access to doctors
• the hospital list
• any prior notification requirement
• the rules applying in an emergency
• treatment at a non-partner hospital
• the distinction between choice of room and choice of doctor

A flexible product may be a useful middle ground, provided the personal contribution remains affordable.

Freedom to choose the doctor is one of the principal reasons for taking out supplementary hospital insurance.

The meaning of this benefit must, however, be examined carefully.

Depending on the contract, it may mean:

• choosing from among the doctors authorised by the hospital
• access to a senior doctor
• choosing from among the insurer’s partner doctors
• choosing an affiliated doctor
• a choice subject to the insurer’s prior approval
• cover up to a defined tariff

Freedom of choice is therefore not always absolute.

It is important to check:

• whether the chosen doctor practises at the hospital
• whether the doctor is recognised by the insurer
• whether the doctor’s fees are covered in full
• whether a payment guarantee is required
• whether the choice also applies to the anaesthetist and other medical professionals
• whether the treatment must be inpatient treatment

Some products reduce the premium by limiting the choice of hospital to a selected network.

Such products may be appropriate where:

• the preferred hospitals appear on the list
• the network is sufficiently broad in the relevant region
• the rules for updating the list are clear
• the consequences of treatment outside the network are acceptable

It is important to establish whether the list:

• may be amended by the insurer
• differs according to ward category
• excludes certain private hospitals
• requires an additional personal contribution
• provides exceptions in emergencies
• covers hospitals outside the canton

A hospital list that is satisfactory at the time of purchase may change. The policy should therefore be assessed over the longer term.

Some supplementary hospital policies provide worldwide cover or cover in selected countries.

It is important to distinguish between:

• an emergency arising during a journey
• planned hospital treatment abroad
• treatment that is unavailable in Switzerland
• an intervention deliberately chosen at a foreign hospital
• repatriation to Switzerland

These situations are often subject to different rules.

Cover may include:

• a daily limit
• an annual limit
• a maximum duration
• a requirement for prior authorisation
• a list of countries
• exclusion of certain hospitals
• emergency-only cover
• reimbursement up to the equivalent Swiss tariff
• coordination with travel insurance

For travel outside the EU, EFTA and the United Kingdom, it is important to check whether suitable travel insurance or supplementary cover is in place, particularly where local medical costs may exceed the protection provided by basic insurance.

Supplementary insurance may cover treatment provided by non-medical therapists in areas such as:

• acupuncture
• osteopathy
• naturopathy
• traditional Chinese medicine
• homeopathy
• reflexology
• certain manual therapies
• other methods recognised by the insurer

Reimbursement generally depends on several cumulative conditions:

• the method must be recognised
• the therapist must be recognised
• the treatment must meet the product conditions
• the invoiced tariff must be accepted
• a maximum number of sessions may apply
• an annual limit may apply

Recognition of the therapist

A therapist recognised by a professional organisation is not automatically recognised by every insurer.

A therapist may be:

• recognised by one insurer
• unrecognised by another
• recognised only for certain methods
• recognised only where specific training requirements are met

Recognition should be confirmed directly with the insurer before treatment begins.

Tariff limits

The insurer may restrict reimbursement to:

• a maximum hourly tariff
• a maximum duration
• a maximum number of sessions
• a particular method
• a percentage of the cost
• an annual limit

Any difference remains payable by the insured person.

Outpatient supplementary insurance may contribute towards:

• frames
• lenses
• contact lenses
• certain repairs
• certain examinations
• in some cases, refractive eye surgery

It is necessary to check:

• the reimbursement amount
• how frequently it is available
• the age of the insured person
• whether a prescription is required
• which providers are recognised
• how purchases abroad are treated
• whether the benefit shares an overall limit with other services

Assessing the true value

A contribution of CHF 300 every three years represents a theoretical average value of CHF 100 per year, provided it is used in full.

Where the product costs several hundred francs per year, the optical benefit alone will rarely justify the policy.

The product must be assessed as a whole.

Dental insurance may contribute towards the cost of:

• preventive care
• check-ups
• treatment of tooth decay
• conservative dental treatment
• crowns
• prostheses
• implants
• dental surgery
• orthodontic treatment

Products differ considerably in relation to:

• the reimbursement percentage
• the annual limit
• the category of treatment
• the maximum age for admission
• the waiting period
• the country in which treatment is provided
• recognition of the dentist
• the accepted tariff

Assessment before admission

Before accepting an application, the insurer may require:

• a questionnaire
• a dental certificate
• X-rays
• an examination by a dentist
• confirmation that no treatment is planned

Treatment that has already begun, been recommended or is foreseeable may be excluded.

Orthodontic treatment can represent a substantial expense over several years.

Supplementary insurance may cover part of the cost, but products vary significantly.

It is important to check:

• the reimbursement percentage
• the annual limit
• the total lifetime limit
• the maximum age
• the age at entry
• the waiting period
• whether a dental examination is required
• whether existing misalignment is excluded
• the rules applying to treatment abroad
• the maximum recognised tariff

Do not wait for a diagnosis

An application submitted after a dentist or orthodontist has recommended treatment may be refused or accepted with an exclusion.

It is therefore preferable to examine cover before a specific need has been identified.

Calculate the total cost

A policy offering a significant reimbursement may also generate high premiums over many years.

It is necessary to compare:

• the estimated total premiums
• the maximum reimbursement
• the probability of treatment
• the amount remaining payable
• the other benefits included in the product

Some supplementary policies reimburse medicines not included on the official lists applicable to compulsory insurance.

The contract may nevertheless restrict reimbursement to medicines that are:

• authorised in Switzerland
• prescribed by a doctor
• not excluded by an internal list
• recognised by the insurer
• purchased from an approved pharmacy
• used for a particular indication

It is important to check:

• the reimbursement percentage
• the annual limit
• excluded medicines
• whether a prescription is required
• the rules applying to pharmacy-compounded preparations
• cover for medicines purchased abroad

The expression “medicines not covered by the health insurer” does not necessarily mean that every medicine excluded from the LAMal will be reimbursed.

Supplementary insurance may contribute towards:

• travel vaccinations
• vaccinations not covered by basic insurance
• health assessments
• screening programmes
• additional gynaecological examinations
• cardiovascular examinations
• preventive consultations
• prevention programmes

Reimbursement may depend on:

• a medical recommendation
• a specified age
• a required interval between examinations
• use of a recognised provider
• an annual limit
• a defined list of benefits

Medically recognised preventive care should be distinguished from general wellbeing services.

Some products provide contributions towards:

• gym memberships
• group exercise classes
• swimming
• yoga
• Pilates
• dance
• certain sporting activities
• health programmes
• antenatal classes
• certain preventive health memberships

Reimbursement may depend on:

• recognition of the centre
• certification of the course
• a minimum membership duration
• the number of sessions
• the type of activity
• proof of payment
• the reimbursement rate
• a shared annual limit

A contribution is not automatic reimbursement

An insurer may recognise:

• certain centres but not others
• certain types of membership
• particular disciplines
• supervised classes only
• memberships of a specified minimum duration only

Eligibility should be checked before purchasing the membership.

Do not assess a policy on this benefit alone

A fitness contribution may be attractive, but it must be compared with the total premium.

Taking out supplementary insurance solely to receive an annual fitness contribution may offer poor value where:

• the premium is high
• the reimbursement limit is low
• the activity is not maintained
• the centre is not recognised
• the other benefits are not used

Basic insurance covers only a limited proportion of transport and rescue costs.

Some supplementary policies increase the amounts covered for:

• ambulances
• medically necessary transport
• mountain rescue
• rescue helicopter services
• search operations
• repatriation
• transport abroad

It is important to distinguish between:

• transport
• rescue
• search
• repatriation
• assistance

These concepts may be defined separately in the policy conditions.

A policy may cover rescue without covering all search costs, or it may cover transport to the nearest hospital without financing repatriation to Switzerland.

Some supplementary policies include assistance benefits such as:

• arranging treatment abroad
• providing payment guarantees
• medical repatriation
• early return
• transport for a relative
• accompaniment of a child
• telephone assistance
• advance payment of costs
• locating a suitable hospital

It is necessary to check whether the cover applies to:

• medical emergencies only
• pre-existing conditions
• accidents
• business travel
• extended journeys
• study abroad
• high-risk sports
• countries subject to official travel advice
• planned treatment

A credit card, separate travel policy or household insurance may already provide some of these benefits. Possible duplication should therefore be identified.

Some supplementary policies cover part of the cost of:

• domestic assistance
• private home nursing
• childcare
• health cures
• convalescence stays
• delivered meals
• assistance following hospitalisation

Cover may depend on:

• a medical prescription
• prior hospitalisation
• use of a recognised provider
• a maximum number of hours
• a daily amount
• a maximum duration
• a waiting period

It is also necessary to establish whether the benefit is provided as:

• reimbursement of expenses
• a fixed allowance
• a service arranged directly by the insurer

Specific maternity-related medical services are extensively covered by compulsory insurance in accordance with the statutory rules.

Supplementary insurance may nevertheless contribute towards:

• private or semi-private hospital treatment
• certain antenatal classes
• additional examinations
• domestic assistance
• convalescence
• certain postnatal services
• certain complementary medicine treatments

Waiting periods

Supplementary products may include a waiting period for certain maternity benefits.

A person who is already pregnant when taking out the policy should not assume that the current pregnancy will be covered.

It is necessary to check:

• the policy commencement date
• the waiting period
• the expected date of delivery
• admission requirements
• excluded benefits
• the hospital ward category actually guaranteed

Taking out cover before pregnancy

Where private or semi-private hospital cover is desired for a future pregnancy, it is generally preferable to apply sufficiently early.

An application may be refused or restricted because of health or an existing pregnancy.

A newborn child must be registered for basic insurance within three months of birth for cover to apply retrospectively from birth.

Different rules apply to supplementary insurance.

Some insurers offer prenatal admission or simplified admission where the application is submitted within a specified period.

Depending on the product, this may allow:

• admission without a full health questionnaire
• simplified admission
• cover from birth
• certain benefits despite health problems discovered at birth

The conditions vary considerably.

It is necessary to check:

• the application deadline
• the commencement date
• the products concerned
• exclusions
• benefit limits
• any minimum contract period
• whether the parents must already be insured

Prenatal insurance can be particularly important where the parents want cover that might become difficult to obtain after birth.

The insurer uses the health questionnaire to assess the risk it is being asked to cover.

Questions may relate to:

• illnesses
• accidents
• treatment
• operations
• medicines
• medical consultations
• symptoms
• planned examinations
• incapacity for work
• hospital stays
• mental health conditions
• chronic conditions
• previous insurance applications
• exclusions or refusals imposed by other insurers

Each question should be read exactly as written.

Information should neither be minimised nor expanded beyond what is asked.

Answers must be:

• accurate
• complete
• consistent
• limited to the period specified
• based on information known to the applicant

Respect the period specified

Where the question refers to the previous five years, the answer should cover that period.

Where it refers to the applicant’s entire life, the answer must cover the entire lifetime.

Do not rely solely on uncertain recollection

Where there is doubt, it may be useful to consult:

• the treating doctor
• medical records
• invoices
• prescriptions
• previous reports
• insurance statements

Disclose planned examinations

An examination, procedure or consultation that has already been recommended may need to be disclosed even where no final diagnosis has yet been made.

Request clarification

Where a question is ambiguous, it is preferable to request written clarification from the insurer or insurance intermediary.

Under Swiss insurance law, an omission or incorrect answer to an important question may constitute misrepresentation.

Depending on the circumstances and legal conditions, the insurer may:

• terminate the contract
• refuse certain benefits
• request repayment of benefits already paid
• limit the consequences to claims connected with the undisclosed fact

The LCA governs the consequences of an incorrect declaration or failure to disclose a material fact in response to the questions asked by the insurer.

The fact that information is old or appears unimportant to the insured person does not mean that it may be omitted where the question clearly requires disclosure.

After assessing the application, the insurer may:

Accept without restriction

All benefits included in the product are granted.

Accept with an exclusion

Certain illnesses, parts of the body, treatments or consequences are excluded from cover.

Accept on special terms

The insurer may propose:

• a different product
• reduced cover
• a particular deductible
• an exclusion
• an additional premium, where permitted
• a later commencement date

Defer the decision

The insurer may wait for:

• the end of treatment
• the result of an examination
• a period of stability
• recovery
• additional medical information

Refuse the application

An insurer is under no general obligation to accept an applicant for supplementary insurance.

An exclusion generally removes cover for a specified risk.

It may apply to:

• an illness
• a part of the body
• a disorder
• a treatment
• the consequences of a previous accident
• a category of benefits

Read the precise wording

An exclusion limited to a specific condition is not equivalent to a broad exclusion relating to:

• an entire anatomical region
• all direct and indirect consequences
• every similar condition
• any treatment connected with a previous medical history

Request written clarification

Before accepting a policy with an exclusion, it is important to understand:

• what is excluded
• for how long
• whether the exclusion may be reviewed
• what evidence would be required for its removal
• whether all other benefits remain fully covered

A significant exclusion may substantially reduce the value of the policy.

This depends on the contract and the insurer’s practice.

A review may sometimes be requested following:

• a period without treatment
• recovery
• a period of stability
• submission of a medical report
• the absence of recurrence
• expiry of a specified period

The insurer may:

• remove the exclusion
• retain it
• narrow it
• request further information

There is no general guarantee that a temporary exclusion will be removed automatically.

Any commitment to review the exclusion should ideally be confirmed in writing.

For many insurance contracts governed by the LCA, the policyholder has fourteen days in which to withdraw their proposal or acceptance.

The period begins when the policyholder submits or accepts the contract in accordance with the statutory conditions.

Withdrawal must be capable of being evidenced in text form.

This right allows a person to reverse a recent decision to take out insurance, but it should not be confused with ordinary cancellation after several months or years.

It is prudent to:

• state clearly that the contract is being withdrawn
• identify the policy
• comply with the deadline
• use a method that provides evidence of sending and receipt
• retain a copy

Cover does not necessarily begin:

• on the date of signature
• on the date the application is sent
• on the date the first premium is paid

The commencement date depends on:

• the insurer’s acceptance
• the date stated in the policy
• any special conditions
• any waiting periods
• coordination with previous cover

The final acceptance and policy should be checked.

A mere application or indicative quotation does not guarantee that the risk is already covered.

Before the contract is concluded, the insurer must provide certain essential information in a comprehensible form.

This includes information on:

• the insured risks
• the extent of cover
• premiums
• the duration of the contract
• cancellation arrangements
• certain obligations of the policyholder
• data processing

Supplementary insurers are expected to provide clear information concerning the contract, benefits, premiums and cancellation deadlines.

The policyholder should receive and retain:

• the application
• the policy
• the general terms and conditions
• the supplementary terms and conditions
• any exclusions
• benefit schedules
• pre-contractual information

The premium may depend on several factors, including:

• age
• the product
• the level of cover
• region
• sex, where lawfully included in the relevant tariff
• tariff category
• the financing method
• discounts
• membership of a collective contract
• changes in costs

Unlike basic insurance, premiums are not standardised for a particular region and model.

Supplementary health insurance tariffs and conditions applied in Switzerland are subject to FINMA’s supervisory rules.

Yes, depending on the product’s tariff structure.

Products may use:

• premiums based on current age
• age bands
• entry-age tariffs
• a combination of entry age and attained age
• ageing provisions
• general tariff adjustments

It is important to ask:

• whether the premium changes at every age
• whether it rises when moving into a new age band
• at what ages the principal increases occur
• whether the entry age remains relevant
• how general adjustments are applied
• what happens when changing product

A premium that appears attractive at the age of 25 may increase considerably by the age of 45, 55 or 65.

The cost should therefore be assessed over time rather than only at the point of purchase.

Supplementary insurance may allow the insurer to adjust premiums in accordance with the contractual terms and supervisory rules.

A premium increase does not automatically mean that the insured person can easily move to another insurer.

As a person grows older or develops a medical condition, a new application may become:

• more difficult
• subject to an exclusion
• restricted
• refused

Before cancelling following a premium increase, it is important to examine:

• the contractual rights
• the cancellation deadline
• whether the same insurer offers an alternative product
• whether cover can be reduced
• the medical consequences of making a new application
• final acceptance by another insurer

An insurer may stop offering a product to new customers while continuing existing contracts.

The product then becomes part of a closed portfolio.

Within a closed portfolio:

• the insured population grows older
• younger new customers no longer enter
• premiums may develop differently
• the product may become less competitive
• the benefits may no longer match newer products

FINMA’s supervisory framework includes rules concerning closed products and the transfer to a comparable open portfolio. Where a product is no longer offered, customers should be able to move to a comparable product where such a product exists.

It is useful to ask the insurer:

• whether the product is still open
• whether a current comparable product exists
• whether a transfer is possible without a new health assessment
• whether the benefits are equivalent
• whether premiums are calculated differently
• which guarantees would be lost

Supplementary insurance may be offered through:

• an employer
• an association
• a professional organisation
• a partnership
• a group or framework agreement

The discount may depend on maintaining that relationship.

It is necessary to check what happens in the event of:

• leaving the employer
• retirement
• termination of the partnership
• a change of residence
• termination of the group agreement
• withdrawal of the discount

The individual policy may sometimes be retained without the discount, but at a higher premium.

A discount should not conceal:

• an unsuitable product
• a high underlying premium
• limited benefits
• future increases

The contract may be:

• annual
• multi-year
• renewed automatically
• linked to an insurance year that differs from the calendar year

It is necessary to identify:

• the commencement date
• the end date of the insurance year
• the initial term
• automatic renewal provisions
• the cancellation period
• the deadline for receipt

The insurance year does not always run from 1 January to 31 December.

Under the LCA, a contract may generally be cancelled at the end of the third insurance year and at the end of each following year, subject to three months’ notice, even where a longer initial term was agreed.

The contract may provide more favourable terms.

It is nevertheless important to check:

• the start date of the insurance year
• the date on which the cancellation must be received
• any special conditions
• additional rights following a premium increase
• whether several products are included within the same policy

The general terms and conditions may provide a cancellation right where the insurer increases the premium or changes the contract.

The deadline may be shorter than the ordinary cancellation period.

The insurer’s notice should be read carefully. It will normally specify:

• the new premium
• the date on which it takes effect
• the reason or contractual basis for the adjustment
• any right to cancel
• the applicable deadline

A general increase caused by age or movement into another tariff band may not create exactly the same rights as an extraordinary contractual change.

Under certain conditions, the LCA provides cancellation rights following a claim.

In supplementary health insurance, many insurers contractually waive their own right to cancel after a claim, except in cases such as fraud, misrepresentation or a serious breach of contractual obligations.

This waiver should not, however, be assumed to be identical in every contract.

The general terms and conditions should be checked for:

• the insured person’s rights
• the insurer’s rights
• exceptions
• the consequences of misrepresentation
• fraud
• the effect of partial cancellation

This is the most important precaution in supplementary insurance.

Before cancelling existing cover, the insured person should have received:

• written acceptance from the new insurer
• confirmation of the accepted products
• details of any exclusions
• the final premium
• the commencement date
• the applicable terms

A premium estimate, marketing quotation or oral confirmation is not sufficient.

Once an existing policy has been cancelled, it may be impossible to recover it on the same terms.

Yes.

Basic and supplementary insurance may be held with different insurers.

Cancellation of basic insurance does not entitle an insurer to require the customer to cancel supplementary insurance as well.

The practical consequences should nevertheless be considered:

• separate insurance cards
• invoices sent to two organisations
• successive reimbursement procedures
• possible loss of a combined discount
• changes in administrative processes

These administrative disadvantages may be acceptable where they allow the insured person to retain valuable supplementary cover while optimising basic insurance.

Often yes, but this depends on the contractual structure.

A policy may contain:

• several legally separate products
• an indivisible package
• optional modules
• a main policy and extensions
• mandatory product combinations

Before requesting partial cancellation, it is important to check:

• whether the module can be removed independently
• whether the price of the remaining modules changes
• whether a discount is lost
• whether some benefits depend on a main product
• whether a new health declaration would be required to reinstate the module later

A reduction in cover may be irreversible in practice.

Where a premium becomes too expensive, several alternatives may be considered:

• moving from private to semi-private cover
• moving from semi-private to a flexible model
• choosing a restricted hospital network
• removing certain modules
• increasing the personal contribution
• transferring to a newer product with the same insurer
• reducing certain outpatient benefits

A reduction may sometimes be accepted without a new health assessment.

Returning to a higher level of cover later may, however, require:

• a new application
• a health questionnaire
• acceptance
• an exclusion
• or may be refused

The long-term consequences should therefore be considered carefully.

A serious comparison should not be limited to a column of reimbursement amounts.

At a minimum, the following should be compared.

Benefits

• reimbursement percentage
• overall limit
• sub-limits
• frequency
• maximum duration
• geographical scope
• approved providers

Conditions

• health questionnaire
• age limits
• waiting periods
• prescription requirements
• prior authorisation
• partner lists
• exclusions

Contract

• duration
• cancellation deadline
• rights following an increase
• renewal
• development of the premium
• age-band changes
• closed product status

Actual use

• current needs
• future needs
• usual expenditure
• financial risk
• ability to pay personally
• availability of providers

Cost

• current premium
• likely future premium
• cost over several years
• realistic reimbursement
• amount remaining payable
• duplication of cover

Marketing materials may present numerous maximum reimbursement amounts.

Adding all these limits together produces an unrealistic impression of the product’s value.

An insured person will not generally use every year:

• the full complementary medicine allowance
• the full optical allowance
• the full prevention allowance
• the full fitness allowance
• the full transport allowance
• the full medicine allowance
• the full home-care allowance

In addition:

• some benefits share the same limit
• some require a prescription
• some providers may not be recognised
• some reimbursements are available only every two or three years
• some benefits may not correspond to the insured person’s needs

The value should be assessed according to likely use, not the theoretical maximum.

For small and predictable expenses, personal savings may sometimes be more suitable.

Expenses that can often be budgeted for

• ordinary spectacles
• sports memberships
• preventive examinations
• limited complementary medicine treatment
• routine dental care

Risks that may be more difficult to self-fund

• expensive private hospital treatment
• substantial orthodontic treatment
• high medical costs abroad
• transport or repatriation
• prolonged services not covered elsewhere
• treatment at a private hospital

The choice depends on financial circumstances, the expected frequency of the need and the importance attached to contractual protection.

There is no single ideal age.

Taking out cover relatively early may offer advantages:

• better health
• easier admission
• lower risk of exclusions
• access to certain child-specific products
• protection before a need is identified

However, early purchase also means:

• paying premiums for more years
• funding benefits that may remain unused
• accepting future tariff developments
• choosing a product that may become less suitable

The right time depends on:

• the type of cover
• the risk being insured
• health
• family plans
• financial circumstances
• the ability to obtain cover later

Cover commonly considered for children includes:

• orthodontics
• dental care
• spectacles
• complementary medicine
• hospital treatment
• transport and rescue
• medical treatment abroad
• certain medicines
• prevention

Important considerations include:

• admission before birth
• age limits
• dental examinations
• waiting periods
• orthodontic reimbursement limits
• cover for congenital conditions
• benefits for a parent staying with a hospitalised child
• whether the product can be retained in adulthood

With age, several considerations become more significant:

• premiums may rise
• new admission may become more difficult
• medical history becomes more extensive
• existing cover may be difficult to replace
• hospital needs may change
• certain comfort benefits may become more relevant

An older policy should not, however, be retained automatically.

It is useful to check:

• whether the product remains suitable
• whether the portfolio is closed
• whether a less expensive option exists
• whether certain benefits are no longer useful
• whether cover can be reduced without losing essential protection
• whether an internal transfer is possible without a new health questionnaire

People moving to Switzerland may face particular difficulties, including:

• understanding the distinction between LAMal and LCA insurance
• coordination with previous temporary cover
• lack of Swiss medical history
• frequent international travel
• treatment in several countries
• a need for service in English
• plans to leave Switzerland in the future
• international cover provided by an employer

It is necessary to check:

• whether Swiss insurance supplements or duplicates international cover
• whether treatment outside Switzerland is covered
• whether cover may be retained after leaving the country
• whether the contract ends following a change of residence
• whether planned treatment in the home country is covered
• whether foreign providers are recognised
• whether a payment guarantee is available

Swiss supplementary insurance is not necessarily a substitute for international health insurance.

Where a person leaves Switzerland permanently, the consequences depend on:

• the new country of residence
• whether Swiss insurance obligations continue
• the supplementary contract
• the insurer’s rules
• international agreements
• employment status

Some supplementary policies end when Swiss residence ends.

Others may potentially be retained, converted or replaced with an international product.

Before departure, written confirmation should be obtained regarding:

• the end date
• benefits after relocation
• the possibility of continuation
• transitional cover
• the handling of earlier invoices
• benefits relating to an ongoing hospital stay

The same benefit may be covered by:

• supplementary health insurance
• travel insurance
• household insurance
• a credit card
• accident insurance
• an employer
• an association
• motor insurance
• international medical insurance

Duplication frequently concerns:

• repatriation
• rescue
• travel cancellation
• medical expenses abroad
• assistance
• domestic help
• certain medical aids

Duplication is not necessarily useless, as limits and conditions may complement one another.

However, coordination rules should be checked. Expense-based insurance generally does not allow the insured person to receive more than the loss actually incurred.

To obtain reimbursement, the insured person may need to submit:

• an itemised invoice
• proof of payment
• a prescription
• a medical report
• confirmation that the provider is recognised
• a form
• a certificate of attendance
• proof of membership

The following must be respected:

• the submission deadline
• digital or postal procedures
• formal requirements
• prior authorisation requirements
• coordination with basic insurance

For certain benefits, the invoice must first be submitted to basic insurance. The corresponding statement must then be sent to the supplementary insurer.

For an expensive or uncertain benefit, written confirmation should be requested before treatment begins.

This applies in particular to:

• hospital admission
• treatment abroad
• an operation in a private hospital
• orthodontic treatment
• a health cure
• long-term therapy
• medical transport
• experimental treatment
• treatment by a particular provider

The request should specify:

• the diagnosis, where necessary
• the treatment
• the provider
• the location
• the date
• the estimated cost
• the quotation
• the duration

General information provided by telephone does not replace written confirmation relating to the specific case.

The first step is to request a detailed explanation from the insurer.

The reason for refusal should be identified:

• the benefit is not insured
• the limit has been reached
• the provider is not recognised
• no prescription was provided
• a waiting period applies
• an exclusion applies
• the treatment was not authorised
• a contractual obligation was not respected
• medical information is missing

The decision should then be compared with:

• the policy
• the general terms and conditions
• the supplementary terms
• the benefit schedule
• any exclusions
• written exchanges
• any prior confirmation of cover

FINMA supervises insurance companies and may examine information indicating an irregularity or supervisory concern.

As a general rule, however, it does not determine each individual contractual dispute in place of a court.

Possible steps in the event of a problem include:

• submitting a complaint to the insurer
• seeking mediation
• contacting the Health Insurance Ombudsman
• obtaining legal advice
• bringing proceedings before the competent civil court

The Health Insurance Ombudsman may intervene in certain disputes between insured persons and insurers.

Its involvement may be appropriate where:

• the insurer’s explanations remain insufficient
• the dispute concerns interpretation of the contract
• a benefit has been refused
• a cancellation is disputed
• direct discussions have not resolved the matter

It is useful to prepare a file containing:

• a chronology
• the policy
• the terms and conditions
• the benefit request
• the refusal
• correspondence
• invoices
• relevant medical reports

Taking out cover for one reimbursement alone

A contribution towards fitness or spectacles is not enough to assess the overall value of a policy.

Failing to read the sub-limits

A high general limit may include several much lower individual limits.

Confusing recognition of the therapist with recognition of the method

Both conditions may need to be satisfied at the same time.

Waiting until a medical need has been identified

Once a diagnosis has been made or treatment recommended, admission may become difficult.

Completing the health questionnaire too quickly

An omission may have consequences several years after the policy begins.

Cancelling before final acceptance

The previous cover may become impossible to recover.

Comparing current premiums only

Supplementary insurance should be assessed over several years.

Assuming that private cover means everything is included

Choice of doctor, hospitals and medical fees may still be restricted.

Ignoring waiting periods

The desired benefit may not be available immediately.

Keeping an old product without reviewing it

A closed product may become less attractive or more expensive.

Step 1: identify the needs

List the benefits that genuinely matter:

• hospital treatment
• orthodontics
• travel
• complementary medicine
• spectacles
• dental treatment
• transport
• prevention

Step 2: prioritise the needs

Separate them into three categories:

• significant financial risk
• regular need
• comfort benefit

Step 3: examine existing cover

Review:

• basic insurance
• accident insurance
• employer benefits
• credit card cover
• travel insurance
• other supplementary policies

Step 4: determine what can be self-funded

Assess the ability to pay for:

• routine expenses
• unexpected expenses
• hospital treatment
• dental treatment
• repatriation

Step 5: compare conditions, not only amounts

Check:

• limits
• percentages
• exclusions
• provider lists
• waiting periods
• prescription requirements
• geographical scope

Step 6: examine how the contract may develop

Consider:

• age bands
• duration
• cancellation
• closed portfolio status
• reduction of cover
• transfer options

Step 7: prepare the health declaration carefully

Gather the necessary information before completing the application.

Step 8: wait for written acceptance

Do not change any existing cover before the final decision has been received.

Before signing, check:

• the exact product name
• the benefits
• the overall limits
• the sub-limits
• the percentages
• the waiting periods
• the exclusions
• recognised providers
• approved hospitals
• cover abroad
• age conditions
• the current premium
• future tariff changes
• the contract duration
• the cancellation period
• the commencement date
• any exclusions or reservations
• duplication of cover
• the right of withdrawal
• the contractual documents

Before cancelling, check:

• the genuine reason for cancellation
• the insurance-year date
• the contractual deadline
• whether the notice will be received in time
• whether new cover has been accepted
• exclusions under the new policy
• the commencement date of the new cover
• waiting periods
• benefits that will be lost
• changes in health
• internal transfer options
• possible reductions
• consequences for other products
• loss of discounts
• proof of cancellation

Once a year, it is useful to review:

• premiums
• changes in age band
• updated benefit schedules
• recognised providers
• partner hospitals
• benefits used
• reimbursements received
• unused benefits
• possible duplication
• family plans
• travel
• dental needs
• planned treatment
• reduction options
• whether the product remains open
• cancellation deadlines

An annual review does not mean that the policy should be changed every year.

Its purpose is simply to confirm that the cover remains suitable.

Supplementary insurance is a private contract

Benefits are not identical from one insurer to another.

Admission is not guaranteed

Health may influence the insurer’s decision.

The health questionnaire must be completed carefully

An omission may compromise benefits or the contract itself.

Reimbursement limits do not tell the whole story

Percentages, sub-limits and conditions must also be examined.

Hospital insurance is not merely about the room

Choice of doctor, the hospital network and medical fees are essential.

Premiums must be assessed over time

Cover that is affordable today may become more expensive with age.

Existing cover may be difficult to replace

It should never be cancelled before final acceptance of replacement cover.

Needs should be prioritised

A significant financial risk should be distinguished from a comfort benefit.

Supplementary health insurance can play a useful role in the medical and financial protection of individuals and families.

It may broaden the choice of hospital, cover certain outpatient services, improve protection abroad or contribute towards dental, optical and complementary medicine expenses.

Its value nevertheless depends entirely on the contractual conditions and the insured person’s circumstances.

A good supplementary policy is not necessarily the one containing the greatest number of benefits. It is the one that:

• covers genuinely important needs
• has understandable conditions
• properly limits significant financial risks
• remains affordable over time
• avoids unnecessary duplication
• can be retained if the insured person’s health changes

The decision should therefore be made in the following order:

• understand the gaps in basic insurance
• identify priority needs
• compare the conditions carefully
• assess the cost over several years
• complete the health declaration accurately
• wait for final acceptance before cancelling any existing policy

This guide explains the general principles applicable to supplementary health insurance in Switzerland.

Benefits, reimbursement limits, admission requirements, waiting periods, cancellation rules and premiums vary between insurers and products.

This guide does not replace:

• an assessment of individual circumstances
• the general and specific conditions of an insurance contract
• written confirmation of cover
• legal advice
• a decision by an authority or court

The legal and regulatory information reflects the position available in July 2026 and may change.