The 6 Essential Areas of Supplementary Health Insurance in Switzerland

An authorised medicine is not automatically reimbursed

A common misunderstanding is that every medicine authorised by Swissmedic is covered by compulsory health insurance.

This is not the case.

Swissmedic examines, among other matters, the quality, safety and effectiveness of a medicine before authorising it for sale in Switzerland.

For a medicine to be reimbursed by compulsory health insurance, it must generally also appear on the List of Pharmaceutical Specialities published by the Federal Office of Public Health.

It must also be prescribed and used in accordance with the applicable reimbursement conditions and limitations.

A medicine may therefore be authorised in Switzerland without being covered by compulsory health insurance.

Which medicines may remain outside compulsory cover?

These may include:

• a recently authorised medicine
• a treatment whose inclusion on the List of Pharmaceutical Specialities is still under review
• a medicine used for an indication other than the one approved for reimbursement
• a treatment whose price is still being assessed
• a medicine intended for a rare disease
• a product imported for a particular medical situation
• a treatment excluded by a limitation attached to the List of Pharmaceutical Specialities

Medicines developed for rare diseases are sometimes referred to as orphan medicines.

They are intended for relatively small numbers of patients and may involve particularly high costs.

Not every orphan medicine is excluded from compulsory health insurance. Some are reimbursed. Others may not yet appear on the List of Pharmaceutical Specialities or may only be covered under specific conditions.

Exceptional reimbursement

In certain circumstances, compulsory health insurance may exceptionally reimburse a medicine that does not appear on the List of Pharmaceutical Specialities or that is used outside its recognised indication.

This may be considered where:

• the illness is serious
• the treatment is expected to provide a significant therapeutic benefit
• no effective reimbursed alternative is available
• the statutory conditions are met

A detailed medical request is generally required.

The decision is made after an individual assessment and does not constitute an automatic entitlement to reimbursement.

A potentially substantial financial risk

Some non-listed medicines cost only a few dozen or a few hundred francs.

Others may cost several thousand francs per month.

Recent, specialised treatments or medicines intended for certain rare diseases may reach amounts that a household could not reasonably finance over a prolonged period.

Depending on the policy terms, outpatient supplementary insurance may reimburse certain medicines that are:

• authorised by Swissmedic
• medically prescribed
• not reimbursed by compulsory health insurance
• not excluded by the policy terms

What should be checked?

Are Swissmedic-authorised medicines outside the List of Pharmaceutical Specialities covered?

What percentage is reimbursed?

Is there an annual limit?

Is there a list of excluded medicines?

Is a medical prescription required?

Are imported medicines covered?

Is off-label use covered?

Is prior authorisation required?

Cover for medicines not reimbursed by compulsory health insurance is one of the most important protections provided by outpatient supplementary insurance.

Compulsory health insurance cover depends on the country in which treatment is received.

In the European Union, EFTA and the United Kingdom

The European Health Insurance Card generally provides access to medically necessary treatment during a temporary stay.

Treatment is covered according to the rules of the country concerned.

The insured person may nevertheless have to pay:

• the patient contributions required by the local system
• treatment provided in the private sector
• costs not covered by the public system
• certain expenses in advance

Treatment in a private clinic is not automatically covered.

Outside the European Union, EFTA and the United Kingdom

Compulsory health insurance reimburses emergency treatment within certain limits.

It generally covers no more than twice the amount that the same treatment would have cost in Switzerland.

For hospital treatment, cover may be limited to 90% of the cost of an equivalent stay in Switzerland, since the ordinary cantonal contribution does not apply to hospital treatment abroad.

Why this cover may be insufficient

In several countries, private healthcare can be significantly more expensive than in Switzerland.

This applies in particular to certain hospitals:

• in the United States
• in Canada
• in some parts of Asia
• in countries where foreign patients are primarily directed towards the private sector

An operation, a hospital stay or intensive care may result in a bill far exceeding the limits of compulsory health insurance.

The difference then remains payable by the insured person.

Medical repatriation

Medical repatriation to Switzerland is not generally covered in full by compulsory health insurance.

A repatriation may require:

• an ambulance to the airport
• medical supervision
• several seats on a commercial flight
• stretcher transport
• an air ambulance
• medical coordination between hospitals
• transfer to a hospital in Switzerland

A long-distance medical flight may cost tens of thousands of francs, or more.

What supplementary insurance may cover

Depending on the policy:

• medical costs exceeding compulsory health insurance limits
• treatment in private hospitals
• medical transport
• repatriation
• 24-hour assistance
• payment guarantees
• travel by a family member
• the return of children
• search and rescue
• certain planned treatments

What should be checked?

Is the cover worldwide?

What is the maximum benefit?

Are private hospitals covered?

Are only emergencies covered?

Must repatriation be medically necessary?

Is repatriation to Switzerland fully covered?

Are search and rescue costs included?

Is a permanent emergency assistance service available?

What is the maximum permitted duration of travel?

Are certain regions or activities excluded?

For anyone who travels, medical treatment abroad and repatriation are essential forms of protection.

General ward treatment in the canton of residence

Compulsory health insurance covers medically necessary hospital treatment in the general ward of hospitals included in the relevant hospital planning system.

It finances treatment according to the rules applying between the insurer and the canton.

The medical quality of Swiss public hospitals remains high.

However, compulsory insurance does not provide unrestricted access to every hospital in Switzerland.

Hospital treatment outside the canton

An insured person may choose a hospital included on a cantonal hospital list.

Where the selected hospital is outside the canton of residence and charges more than the reference tariff recognised by the home canton, the difference may remain payable by the insured person.

It is therefore incorrect to say that compulsory health insurance systematically reimburses twice the tariff of the canton of residence.

The rule concerning twice the Swiss tariff mainly applies to certain emergency treatments abroad.

For a voluntary hospital admission outside the canton, reimbursement depends on the recognised hospital tariffs and the reason for choosing that hospital.

Where treatment is not available in the canton

Hospital treatment outside the canton may be medically necessary where the required treatment is not available in a suitable hospital within the canton of residence.

This may apply to:

• highly specialised surgery
• a technique available only at certain centres
• a rare disease
• a particular medical team
• a specialised university hospital

In such cases, broader reimbursement may be granted, subject to the required procedures and authorisations.

A simple preference to be treated by a doctor practising in another canton is not always sufficient to establish medical necessity.

It is necessary to determine whether:

• the treatment is unavailable in the home canton
• the doctor or centre provides indispensable expertise
• the choice is medically justified
• a payment guarantee has been obtained

General ward cover throughout Switzerland

Supplementary hospital insurance covering the general ward throughout Switzerland may reimburse certain tariff differences arising from treatment outside the home canton.

It can provide greater freedom to:

• choose a particular hospital
• access a centre recognised for a particular specialty
• follow a doctor practising in another canton
• remain closer to family during a hospital stay
• avoid having the choice restricted by a tariff difference

Benefits vary according to the insurer and the recognised hospitals.

Semi-private and private wards

Compulsory health insurance does not cover:

• a twin room in the semi-private ward
• a single room in the private ward
• extended freedom to choose the doctor or surgeon
• general access to private clinics
• enhanced hotel-style services
• personalised organisation of the hospital stay

Semi-private or private cover may also provide:

• broader access to accredited doctors
• access to more hospitals and clinics
• shorter waiting times for certain planned procedures
• greater freedom in organising treatment

Flex models

Flex hospital insurance generally allows the insured person to choose the ward at the time of admission.

The patient may remain in the general ward or choose semi-private or private care by paying the contribution specified in the policy.

This arrangement preserves access to a higher ward without requiring the insured person to pay the full premium for permanent private cover.

What should be checked?

Is the general ward covered throughout Switzerland?

Are tariff differences outside the canton covered?

Which hospital lists are recognised?

Which private clinics are accessible?

Is free choice of doctor included?

Is the cover Flex, semi-private or private?

What personal contribution applies under Flex?

Is there an annual maximum contribution?

Are rehabilitation hospitals covered?

Are inpatient psychiatric benefits restricted?

Is prior authorisation required?

Hospital cover is one of the areas in which supplementary insurance can significantly change the freedom and organisation of the treatment pathway.

What compulsory health insurance covers

Compulsory health insurance reimburses certain complementary medicine methods when they are provided by a doctor with the required qualifications.

Recognised methods include:

• acupuncture
• anthroposophic medicine
• traditional Chinese medicine pharmacotherapy
• classical homeopathy
• phytotherapy

The treatment must be provided by a doctor and meet the reimbursement requirements of compulsory health insurance.

Non-medical therapists

In practice, a substantial proportion of complementary medicine is provided by professionals who are not doctors.

This includes:

• osteopaths
• naturopaths
• traditional Chinese medicine therapists
• non-medical acupuncturists
• non-medical homeopaths
• reflexologists
• manual therapists
• certain therapeutic massage practitioners

Their services are generally not covered by compulsory health insurance.

Supplementary insurance is therefore required to obtain reimbursement, subject to the policy terms.

Recognition of both the method and the therapist

An insurer may require both of the following to be recognised:

• the therapeutic method
• the professional providing it

A therapist recognised by one insurer is not automatically recognised by every other insurer.

The same practitioner may also be recognised for one method but not another.

Possible limitations

The policy may provide:

• a reimbursement percentage
• an annual limit
• a maximum hourly tariff
• a maximum number of sessions
• a list of recognised methods
• a list of recognised therapists
• a medical prescription requirement
• prior authorisation

The health questionnaire

Someone who already knows that treatment is about to begin must answer the application questions accurately.

A known need must not be presented as an uncertain future risk.

Complementary medicine cover should be arranged before a specific need is known, in accordance with the insurer’s admission rules.

Why this cover may matter

A course of treatment may cost several hundred or several thousand francs.

Without supplementary insurance, treatment provided by non-medical therapists will generally remain entirely payable by the patient.

What should be checked?

Which methods are recognised?

Is the therapist recognised?

What percentage is reimbursed?

What is the annual limit?

Is there a maximum hourly tariff?

Is a prescription required?

How many sessions are covered?

Are certain therapists or registers excluded?

Does cover apply abroad?

Medical transport

Where the insured person’s state of health prevents the use of ordinary transport, compulsory health insurance covers:

• 50% of medically necessary transport costs
• up to CHF 500 per calendar year

This may include:

• an ambulance
• a medically equipped vehicle
• adapted transport
• certain medically necessary journeys to treatment

Why CHF 500 may be far from sufficient

A single ambulance journey may cost several hundred francs, or more than CHF 1,000, depending on:

• the distance
• the region
• the personnel involved
• the medical equipment
• treatment provided during transport
• the urgency of the intervention

The insured person’s share may therefore already be substantial after a single journey.

Several journeys within the same year may create a much greater financial burden.

Rescue

Where someone is in a situation involving serious danger to life or health, compulsory health insurance covers:

• 50% of rescue costs
• up to CHF 5,000 per calendar year
• only for rescue operations carried out in Switzerland

A rescue operation may require:

• a helicopter
• a specialist team
• a mountain intervention
• a difficult evacuation
• technical equipment
• medical transport

An air rescue operation can quickly exceed the limit of compulsory health insurance.

Search, rescue and transport

These concepts must be distinguished.

An operation may include:

• searching for a person
• locating them
• rescuing them
• transporting them to an accessible location
• transferring them to hospital

The different stages are not necessarily covered in the same way.

What supplementary insurance may cover

• ambulance costs
• medical transport
• transfers between hospitals
• helicopter transport
• rescue
• search
• evacuation
• repatriation
• interventions in Switzerland and abroad

What should be checked?

What percentage is reimbursed?

Is there an annual limit?

Are ambulance journeys covered?

Are transfers between hospitals covered?

Are helicopter costs covered?

Are search operations included?

Are rescue operations abroad covered?

Is repatriation included?

Are there exclusions for certain activities?

Are interventions by private rescue organisations recognised?

Medical transport and rescue are rarely needed, but one intervention alone can result in a substantial bill.

Compulsory health insurance does not cover ordinary orthodontic treatment

Orthodontic treatment intended to correct an ordinary misalignment of the teeth or jaw is generally not covered by compulsory health insurance.

In most cases, the cost of braces therefore remains payable by the parents.

Compulsory health insurance only covers dental treatment in specifically defined medical situations.

Cover through Disability Insurance

Disability Insurance may cover certain orthodontic treatments where they relate to a congenital condition included in the statutory list.

It is not enough for treatment to be complex or expensive.

The condition must meet precise medical criteria.

This may include certain severe congenital abnormalities of the jaw, palate or dentition.

Most ordinary orthodontic treatments are not covered by Disability Insurance.

How much does orthodontic treatment cost?

The cost depends on:

• the type of misalignment
• treatment duration
• the type of appliance
• the child’s age
• X-rays
• check-ups
• adjustments
• any extractions
• retention after treatment
• the practitioner’s tariff

A complete course of treatment frequently costs several thousand francs.

A range of CHF 8,000 to CHF 12,000 is realistic for many complete treatments.

Some cases may cost less.

Complex cases may cost more.

A detailed quotation remains essential in order to establish the actual cost.

A significant likelihood during childhood

Many children and teenagers require braces.

It is difficult to predict with certainty during early childhood whether treatment will eventually be necessary.

Orthodontic treatment therefore combines two important features:

• a meaningful likelihood of use
• a potentially high cost

Why cover should be arranged early

Dental insurance covering orthodontic treatment generally needs to be taken out before:

• a misalignment is identified
• treatment is recommended
• a quotation is issued
• treatment begins

The insurer may request:

• a dental certificate
• X-rays
• an examination
• a statement from the dentist
• confirmation that no treatment is planned

Once the need is known, the insurer may:

• refuse the application
• exclude the treatment
• impose a waiting period
• restrict benefits

What should be checked?

What percentage is reimbursed?

What is the annual limit?

Is there a total lifetime limit?

What is the maximum admission age?

Until what age is treatment covered?

Is there a waiting period?

Is a dental certificate required?

Are X-rays covered?

Is diagnosis covered?

Is treatment abroad accepted?

Which dental tariff is recognised?

Is there a deductible or personal contribution?

Orthodontic treatment is one of the most important forms of supplementary cover to consider for a child.

How should cover for these six risks be selected?

1. Begin with the financial consequences

For each area, ask:

What is the highest plausible cost?

Could I afford it personally?

Would the expense be temporary or ongoing?

Would the lack of cover also restrict my treatment choices?

2. Review existing insurance

Some benefits may already be partly covered through:

• employer group insurance
• accident insurance
• travel insurance
• credit-card insurance
• a rescue organisation
• an existing supplementary policy
• international insurance

3. Examine the limits

Cover may appear extensive but still be inadequate where it provides:

• a low annual maximum
• a low reimbursement percentage
• a restrictive provider list
• a significant exclusion
• cover limited to Switzerland

4. Review admission conditions

The insurer may:

• accept the application without restriction
• apply an exclusion
• impose a reservation
• refuse part of the risk
• refuse the application

Existing cover should never be cancelled before written and final confirmation of acceptance under the new policy has been received.

5. Read the policy terms, not only the commercial summary

A benefit summary does not always explain:

• definitions
• exclusions
• recognition requirements
• prior authorisation
• geographical limitations
• reimbursement procedures

Our position

Compulsory health insurance provides strong medical protection.

However, it leaves several significant gaps.

We believe that supplementary insurance should be assessed primarily on its ability to protect against:

• expensive medicine that is not reimbursed
• hospital treatment or repatriation abroad
• significant restrictions on hospital choice
• the cost of treatment provided by non-medical therapists
• a high medical transport or rescue bill
• orthodontic treatment costing several thousand francs

Not all six risks will arise.

Insurance exists precisely to protect against events whose timing, frequency and cost cannot be predicted.

The right question is not how often the cover will be used.

It is which consequences the insured person or family would be unable to absorb comfortably without protection.

Checklist of the six essential areas

Medicines

• Swissmedic-authorised medicines outside the List of Pharmaceutical Specialities
• reimbursement percentage
• limits
• exclusions
• prescription requirements
• imported medicines
• off-label use

Treatment abroad and repatriation

• medical cost limit
• private-sector treatment
• repatriation
• assistance
• search
• rescue
• permitted travel duration
• geographical exclusions

Hospital treatment

• general ward throughout Switzerland
• tariff differences outside the canton
• choice of hospital
• private clinics
• Flex
• semi-private
• private
• choice of doctor

Complementary medicine

• recognised methods
• recognised therapists
• recognised registers
• reimbursement percentage
• limit
• hourly tariff
• prescription
• number of sessions

Medical transport and rescue

• ambulance
• medical transport
• transfer between hospitals
• helicopter
• search
• rescue
• repatriation

Switzerland and abroad.

Orthodontic treatment

• admission age
• questionnaire or certificate
• reimbursement percentage
• annual limit
• total limit
• waiting period
• recognised tariff
• duration of cover

Key points to remember

A medicine authorised by Swissmedic is not automatically reimbursed by compulsory health insurance.

Non-listed medicines may result in very high costs.

Compulsory insurance cover abroad may be insufficient in countries where treatment is expensive.

Medical repatriation requires specific protection.

Hospital treatment outside the home canton may leave a tariff difference payable by the insured person.

General ward cover throughout Switzerland can already broaden choice considerably.

Semi-private, private and Flex cover provide benefits that compulsory health insurance does not.

Certain complementary medicine methods are covered by compulsory insurance only when provided by an appropriately qualified doctor.

Treatment provided by non-medical therapists generally requires supplementary insurance.

Compulsory insurance reimburses only 50% of medical transport costs, up to CHF 500 per year.

It reimburses only 50% of rescue costs in Switzerland, up to CHF 5,000 per year.

Ordinary orthodontic treatment is generally not covered by compulsory health insurance.

Disability Insurance intervenes only in relation to certain precisely defined congenital conditions.

Orthodontic cover should be arranged before treatment is recommended.

The principal gaps in compulsory health insurance do not necessarily concern the most frequent forms of medical care.

They become apparent mainly when treatment is expensive, specialised or dependent on a particular choice.

This may involve:

• a medicine not included on the List of Pharmaceutical Specialities
• expensive hospital treatment abroad
• medical repatriation
• choosing a hospital outside the home canton
• treatment provided by a non-medical therapist
• several ambulance journeys
• helicopter rescue
• several years of orthodontic treatment

These situations can expose an individual or family to substantial costs.

Supplementary insurance should therefore be assessed by reference to these risks and the consequences they could have.

The six areas presented in this guide form, in our view, the foundation of a serious assessment of supplementary health insurance in Switzerland.

This guide presents the general principles applying in Switzerland.

Exact benefits depend on:

• the insurer
• the product
• the date on which the policy was taken out
• age
• health status
• exclusions
• recognised provider lists
• the general and supplementary policy terms

Before taking out a policy, undergoing expensive treatment, choosing a hospital outside the home canton or incurring significant expenditure, written confirmation should be obtained from the insurer where cover is uncertain.

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