Dental costs for adults: when does health insurance pay?

What basic insurance pays at the dentist — and what it doesn't

Compulsory basic insurance (OKP) only covers dental treatment after accidents, for severe, unavoidable diseases of the masticatory system and for severe general illnesses or their effects, such as leukaemia (Art. 31 KVG). Everything that comes up in day-to-day dental care — check-ups, fillings or orthodontic treatment — adults pay for themselves: these costs are simply outside the basic insurance catalogue of benefits.

On the exceptional case of accidents: if you are employed by one employer for at least 8 hours a week, you are insured against accidents through your employer (UVG) — a dental accident is then usually handled through that insurance. Self-employed and non-employed persons, on the other hand, need accident cover in their basic insurance.

How dental supplementary insurance works

Dental supplementary insurance is voluntary insurance under private law, governed by the VVG. It usually covers a percentage of the treatment costs up to an annual maximum. For the dental products of easyall's partner insurers, the share is usually between 50 and 75%, depending on the product; annual limits range from a few hundred to several thousand francs, and individual products have considerably higher limits. Orthodontics is not included in every product either.

So compare the benefits first and only then the premium: what matters is the coverage rate, the annual maximum and the treatments insured. The AVB of the product concerned are always decisive — easy, our AI guide, can look up conditions and limits directly in them.

Health check: timing is everything

Unlike basic insurance, supplementary insurance has no obligation to accept: the insurer may ask health questions, impose reservations or reject the application. For dental insurance, the assessment is often particularly thorough — a dental status report or a dentist's report is often required.

The consequence: if treatment is already foreseeable, it is usually excluded by a reservation or the application is rejected. The best time to take out cover is therefore while your teeth show no problems — not once there is a finding. In any case, answer the health questions truthfully: false information can put the contract at risk.

Waiting periods: the second reason to take out cover early

A second reason to take out cover early is waiting periods: some supplementary insurance plans only pay benefits after a certain period of insurance — this is common with dental insurance in particular. If you only take out cover when treatment is due, you are therefore too late twice over: the health check excludes anything foreseeable, and the waiting period pushes back the start of benefits further still. Whether waiting periods apply, and which, is set out in the product's AVB.

Term, cancellation and switching

Many dental supplements have minimum terms — often three years, sometimes one year — usually with three months' notice to the end of the term. The legal framework is set by the revised VVG (Art. 35a): every supplementary health insurance can be cancelled at the latest as of the end of the third year and annually thereafter, with three months' notice in text form.

When switching, the golden rule applies: only cancel your existing dental insurance once you have the new insurer's written acceptance confirmation. At most insurers, the cancellation must arrive by 30 September for the contract to end on 31 December; because the health check, the acceptance confirmation and the 14-day revocation period take time, ideally submit your new application by mid-August. If you apply via easyall, the cancellation letter is created automatically.

Is a dental supplement worth it? Checklist for adults

Whether a dental supplement pays off is ultimately a matter of calculation — with one important difference from other supplements: you can only insure what is not yet foreseeable. This is how to proceed:

easyall compares dental supplements based on their benefits; the calculator shows benefits and premiums.

• Know the principle: basic insurance only pays after an accident, for a severe, unavoidable disease of the masticatory system or for a severe general illness (Art. 31 KVG) — everything else is a matter for the dental supplement or your wallet.
• Take out cover early: while no treatment is foreseeable — otherwise you risk reservations or a rejection.
• Check the AVB: coverage rate, annual maximum, inclusion of orthodontics and waiting periods.
• Answer the health questions completely and truthfully.
• When switching: only cancel after the written acceptance confirmation — receipt by your current insurer by 30 September for the contract to end on 31 December.