Supplementary insurance: when it pays off and when it does not

Supplementary insurance is the part of health coverage that goes beyond what is guaranteed by the KVG/LAMal (the federal health insurance act). While the basic policy is compulsory and the same for everyone, supplementary insurance is optional and highly customisable. But is it really worth paying for?

What the KVG/LAMal covers and what it does not

The basic policy covers all medically necessary care: doctor visits, hospital stays in the general ward, medicines on the reimbursement list, maternity care, physiotherapy on prescription, laboratory tests. It does not cover: adult dental care (except accidents), standard eye care (glasses, lenses), single or semi-private rooms in hospital, alternative medicine such as acupuncture or homeopathy, cosmetic surgery, treatment abroad beyond twice the Swiss tariff.

The most common types of supplementary insurance

• Hospital supplementary: semi-private or private room, free choice of surgeon
• Outpatient supplementary: dentist, glasses, alternative medicine, prevention
• Travel and treatment abroad: repatriation, emergency care in non-EU countries
• Daily allowance: income replacement in case of prolonged illness

When supplementary insurance really pays off

Hospital supplementary insurance makes sense if you want the freedom to choose your surgeon throughout Switzerland and do not want to share a room with other patients. The monthly cost ranges from CHF 30 to CHF 150 depending on age and insurer. Outpatient supplementary insurance is worthwhile if you regularly use the dentist, wear glasses or lenses, or follow alternative therapies. Calculate your average annual spending in these categories: if it exceeds the supplementary premium, it is a good investment.

Careful: exclusion clauses

Unlike the basic policy, supplementary insurance can refuse you or exclude pre-existing conditions. Before signing, answer the medical questionnaire carefully. An inaccurate statement can lead to refusal of reimbursement just when you need it most. Some insurers offer supplementary insurance without a medical questionnaire up to age 30: if you are young and do not yet have supplementary insurance, this is the best time to consider it.

Supplementary insurance and switching insurer: what to know

You can change the basic policy (KVG/LAMal) without touching the supplementary one, and vice versa. However, if you move your supplementary insurance to another insurer, the new insurer may subject you to a new medical questionnaire and exclude pre-existing conditions. For this reason, it is prudent to separate the assessment of supplementary insurance from that of basic insurance and to turn to an independent broker such as Callenium to compare supplementary offers.