Compare supplementary health insurance in Switzerland

Why is comparing premiums not enough?

Because premiums are only comparable if they pay for the same benefits. According to the Federal Office of Public Health (FOPH), the scope of benefits in basic insurance under the KVG is the same everywhere. Supplementary insurance in Switzerland, by contrast, is governed by the Insurance Contract Act (VVG; Art. 2 para. 2 KVAG), and each insurer sets its benefits itself. According to the FOPH, these products sometimes differ considerably; the Swiss Financial Market Supervisory Authority counted almost 600 of them (as of January 2023).

Whether supplementary insurance is worth it at all is a separate question. The premium does not show these points:

• Hospital list: for one hospital supplement, the health insurance ombudsman office (Ombudsstelle Krankenversicherung) attributed the low premium to the long list of hospitals without a contract (individual case).
• Out-of-pocket costs: a supplement can also include cost sharing (20%, at most CHF 4'000, in one case handled by the ombudsman office).
• Discount and surcharge: also work it out without the discount, and look up when it ends. If you separate basic and supplementary insurance, a surcharge may be added, according to the FOPH.

In what order should you compare supplementary insurance?

The order is our recommendation; the advice to pay particular attention to the scope of benefits and to cancel only after written acceptance comes from the FOPH.

1. 1Clarify your needs: what does basic insurance cover, what does an existing supplement cover, what is missing?
2. 2Get the terms: AVB, additional terms and, for a hospital supplement, also the insurer's hospital list and maximum tariffs.
3. 3For each area, set benefit, percentage, annual maximum, waiting period and exclusions side by side.
4. 4Check the contract duration, age groups, discount and premium adjustment.
5. 5Only now compare the premium for the same scope of cover. In the easyall calculator, you compare supplementary insurance based on your details and needs.
6. 6Fill in the application yourself, taking time to read the documents first.
7. 7Only after written acceptance, cancel your existing supplementary insurance.

What should you check for hospital, outpatient and dental cover?

According to the FOPH, the yardstick is what the supplement offers beyond basic insurance.

What counts with a hospital supplement besides the ward?

What matters is what the insurer pays at the hospital you want. If there is no tariff agreement with the hospital, the insurer can, depending on the terms, apply a maximum tariff. In one case handled by the ombudsman office (2021), it was willing to pay CHF 4'000 plus CHF 400 per day for the procedure in the private ward, and CHF 3'000 plus CHF 300 per day in the semi-private ward; according to the insured person, that fell far short of the cost estimate.

According to the supervisory authority, what the terms promise remains owed, but according to the ombudsman office not at every hospital you might want. If the terms reserve maximum tariffs and hospital lists, these are not in the terms themselves, according to the ombudsman office (2017), and can change continually; ask for an extract before you sign.

We advise clearing up these questions from the ombudsman office on hospital stays before you sign:

• Is there a contract with the hospital you want?
• Which costs remain uncovered?
• How much extra does the flexible ward cost?
• When is cost coverage excluded? Exclusions must be stated in the contract specifically and unambiguously (Art. 33 VVG).

What do the percentage and annual maximum mean?

They are an upper limit, not a credit balance. With cover of 75% of costs, at most CHF 4'000 per calendar year (the ombudsman office's example), the insurer only pays as long as the treatment is effective, appropriate and cost-effective, if the AVB require this; according to the ombudsman office, they regularly do.

Which product pays more depends on the costs. Two orthodontic covers from a case handled by the ombudsman office, each calculated on its own and each per calendar year: A pays 75%, at most CHF 3'000; B pays 50%, at most CHF 12'000. A reaches its maximum at annual costs of CHF 4'000 (3'000 ÷ 0.75); B only pays CHF 3'000 at CHF 6'000 (3'000 ÷ 0.5). Below CHF 6'000, A pays more; above it, B does.

With dental supplements, according to the ombudsman office, no product insures orthodontics at 100%, and a new contract no longer covers existing misalignments. If you switch the dental insurance of a child over four, you risk neither the old nor the new insurer paying; the ombudsman office advises keeping it until it is no longer needed.

Which contract rules belong in the comparison?

These four rules determine benefits and costs over the years.

• Waiting period (Wartefrist, also Karenz): the VVG does not regulate it; whether one applies and for how long is set out in the terms. Its length can vary with the treatment, and it can also affect hospital stays.
• Commitment: even if a longer period has been agreed, you can cancel at the end of the third and each following year, with three months' notice (Art. 35a para. 1 VVG). The minimum term and notice period are set out in the terms; the end-of-November deadline of basic insurance does not apply here.
• Age groups (Altersklassen): according to the FOPH, premiums may be set by age and sex. The AVB of contracts from 2023 onwards must state the age groups and the effects of changing group on the premium (supervisory authority Circular 2010/3, margin nos. 31 and 75). Ask for the premium of the next age groups; the amounts are in the tariff. Some tariffs stay with the age group at which you took out the policy, others follow your current age.
• Tariff increase: according to the ombudsman office (2017), it is allowed if the terms provide for it. Every adjustment must be approved by the supervisory authority, which checks solvency and protection against abuse (Art. 38 para. 1 VAG). The VVG does not name a separate right to cancel because of it; the terms determine whether and by when you can cancel.

Why health assessment and acceptance first, then cancellation?

Because the new insurer may reject you without giving reasons, and your current insurer does not have to take you back after a cancellation. If you cancel before the written confirmation of acceptance, you can lose your cover for good, according to the FOPH: from a certain age (55 to 65) or in poor health, taking out a new policy is no longer possible, or only with reservations. If you only switch your basic insurance, you can keep the supplement.

Answer the health questions completely: 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 and claim back what it has already paid, insofar as this influenced the claim (Art. 6 VVG). According to the ombudsman office, your signature counts, even if someone else filled in the form.

A reservation (Vorbehalt) excludes certain ailments from cover, can affect individual products and can be unlimited in time; the duration is stated in the contract. According to the ombudsman office, it is a counter-offer that you must accept expressly; in one of its cases, the letter said it would count as accepted if no reply came within 10 days. So reply immediately. After a rejection, you can ask for a contract with an exclusion or try elsewhere.

Address your revocation directly to the insurer, in writing or in text form, within 14 days of your application or your acceptance of a counter-offer, not of acceptance by the insurer (Art. 2a VVG).

According to the ombudsman office, intermediaries repeatedly cancel supplementary insurance before the new insurer has agreed. Make sure that no cancellation goes out before then, no matter who sends it. With an application via easyall, it only goes out after written acceptance and the end of the revocation period; before that period ends only if, in the case of a premium increase, you expressly agree in the application. In a dispute, the ombudsman office advises neutrally and free of charge, provided the supplement is offered by a health insurer (Krankenkasse).