Dental insurance in Switzerland: is it worth it?

What does basic insurance pay at the dentist?

Only the cases in Art. 31 KVG: for illness, those that, according to the Federal Office of Public Health (FOPH), are listed exhaustively in Art. 17 to 19a KLV, such as arthrosis of the temporomandibular joint, dental treatment because of leukaemia (only with the insurer's prior special approval, Art. 18 para. 2 KLV) or for heart valve replacement, and certain congenital disorders; in addition, accidents, insofar as no accident insurance pays. According to the FOPH, it does not pay for ordinary fillings for caries or for correcting the position of teeth.

If it does pay, you bear the deductible and the 10% co-payment (Art. 64 KVG); no dental insurance may cover this cost sharing (Art. 64 para. 8 KVG). More on this in the guide Dental costs for adults.

Who pays if a tooth breaks?

If it is an accident, accident insurance pays first: if you work for an employer for at least eight hours a week, you are also insured against non-occupational accidents under the UVG (Art. 13 UVV), including treatment at the dentist (Art. 10 para. 1 UVG). If no accident insurance pays, the accident cover in basic insurance pays for the treatment, with deductible and co-payment.

Under Art. 4 ATSG, an accident is “the sudden, unintentional, harmful effect of an unusual external factor on the human body” that impairs health or leads to death. If one of these elements is missing, the health insurer does not have to pay under Art. 31 para. 2 KVG. For example, in 1986 the Federal Insurance Court found that there was no accident when a tooth broke while someone was eating a home-baked cake made with cherries that still had their stones; a bone splinter in a sausage, by contrast, would be unusual (BGE 112 V 201). If it is not an accident, you pay yourself, or your supplementary dental insurance pays under its terms, except in the illness cases above.

After a dental accident, Suva advises:

1. 1Go to a dental practice immediately and have the dental accident confirmed there.
2. 2Catch whatever you had in your mouth and photograph it; a foreign body that has been swallowed can no longer be proven.
3. 3Report the accident early to your accident insurer or health insurer.

How does dental insurance calculate what it pays?

It pays a percentage of the costs, at most up to an annual limit per calendar year; you bear the rest. Some variants only apply the percentage to the part above a fixed annual deductible of their own. Under some terms, anything above the limit is not carried over to the following year, and if the insurance starts during the year, the limit may be reduced pro rata in the first year.

Not every percentage is the same: some terms calculate on the amount of your invoice, others on the social insurance tariff and its point value. Practices that bill under the tariff of the Swiss Dental Association SSO must disclose their point value for private patients (State Secretariat for Economic Affairs SECO; Art. 10 PBV); according to SECO, a formal cost estimate, which may be charged for, is more reliable than an approximate figure.

You must have the general terms and conditions (AVB) at the latest when you apply (Art. 3 para. 2 VVG). Also check these points in them:

Waiting period and dental report: what applies when you take out cover?

Whether a waiting period applies and how long it lasts is set out in the terms; the VVG does not regulate it. Some terms have no waiting period, others one of several months, sometimes twelve months for dental prosthetics and orthodontics. Under some terms, anything that starts during the waiting period remains excluded even if the treatment ends afterwards, and a later increase in cover can be subject to a new waiting period.

Some terms require a report from the dental practice with the application, or a check-up in the year before cover starts; depending on the insurer, you pay for the report yourself. According to the ombudsman office, a new contract does not insure existing conditions, including a misalignment of the teeth. With supplementary insurance under the VVG (Art. 2 para. 2 KVAG), the insurer may also add reservations, even for the whole term of the contract, or reject the application.

For children, ch.ch advises taking out dental insurance early; older children must be examined before they are accepted.

When you apply, the following applies:

• Answer the health questions completely, including those about your teeth (Art. 4 VVG). If you conceal a material fact you were asked about and that you knew or should have known, or state it incorrectly, the insurer may terminate the contract within four weeks of finding out and claim back what it has paid, insofar as the fact influenced the claim (Art. 6 VVG).
• You can revoke your application within 14 days, in writing or in text form; the period runs from your application or your acceptance, not from the insurer's acceptance (Art. 2a VVG).

When is dental insurance worth it?

In purely financial terms, when it pays out more in a year than it costs. For a sense of scale: according to the Federal Statistical Office (FSO), costs of CHF 3'957 million arose in dental practices and dental clinics in 2024 (provisional), which, with an average resident population of 9.01 million, is around CHF 439 per person on average (3'957 ÷ 9.01), across all age groups and regardless of who paid. This says nothing about your own bill; your dental bills from recent years, leaving out treatment that is already foreseeable, give you a reference point.

In the easyall calculator, you compare supplementary insurance based on your details and needs. With the percentage, limit and annual premium, you calculate as follows:

• The insurance pays out more than it costs as soon as your annual bill exceeds the annual premium divided by the percentage: at 75%, about 1.33 times the premium; at 50%, twice the premium.
• From a bill equal to the limit divided by the percentage, it pays nothing more: at 75% and a CHF 3'000 limit (the ombudsman office's example), from CHF 4'000 (3'000 ÷ 0.75). If the premium is as high as the limit or higher, in no year does it pay more for treatment than it costs.
• If your variant has its own annual deductible, both thresholds are higher by that amount.
• In the first year, the waiting period and any pro-rated limit also count.

What applies when you cancel or switch?

Ordinary cancellation is possible at the end of the third and each following year, with three months' notice, in writing or in text form; the contract may allow an earlier date (Art. 35a VVG). After a claim, you may also withdraw from the contract, at the latest when the benefit is paid; cover then ends 14 days after you give notice (Art. 42 paras. 1 and 2 VVG). The insurer may not cancel supplementary insurance to social health insurance, either with ordinary notice or after a claim (Art. 35a para. 4 VVG), but it may do so, for example, after incorrect information (Art. 6 VVG). The minimum term and the cancellation date are set out in your terms.

Only cancel after the new insurer has accepted you in writing: otherwise, according to the FOPH, you can lose your cover for good, and according to ch.ch, your current insurer does not have to take you back. If treatment is ongoing, it is possible that no one pays after a switch, because the new contract does not cover existing conditions and, under some terms, the right to follow-up treatment also ends with the old one. More on this in the guide Cancelling supplementary insurance.

Two dental insurance policies are allowed, but according to the ombudsman office, together they pay at most the actual costs if they are indemnity insurance; report the double cover to both insurers without delay, in writing or in text form (Art. 46b para. 1 VVG). In a dispute, the health insurance ombudsman office advises free of charge, including on dental insurance from health insurers, but not on questions about treatment at the practice.