What are supplementary health insurances?

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Reading time 12 min. Updated on May, 15th 2024.

The Swiss healthcare system is structured around two main components:

  • Compulsory health insurance: Almost essential for everyone living or working in Switzerland, this insurance is governed by the Health Insurance Act (LAMal). It guarantees basic cover, reimbursements and other essential benefits for everyone.
  • Supplementary health insurance: As the name suggests, this type of insurance is designed to compensate for certain limitations of basic insurance. They offer additional benefits that may include dental care, alternative medicine, better hospital cover and so on. Although they are optional, they allow you to tailor protection to your own specific needs.

This article focuses on these supplementary insurances, exploring their role in the Swiss healthcare system and how they can optimise your healthcare cover to suit your personal needs.

What are supplementary health insurances for? 

Do you have a myopia problem? Did your dentist advise you to get braces? Do you want to give birth at a private clinic? Or get attractive discounts on your gym membership?  

Since neither of the above-mentioned cases are covered by the basic insurance, you will have to take out a supplementary insurance from the same company, or insurance. 

Compulsory health insurance is subject to strict specifications. Medical needs and treatment must always meet three criteria:

  • Care must be economical
  • Care must be efficient/effective
  • Care must be appropriate

And so it often happens that what you think is essential to your health is not essential to the Federal Office of Public Health (OFSP), for example :

  • Have acupuncture?
  • Get a second medical opinion?
  • Get treatment abroad?
  • Wait less time for an appointment?
  • Try treatments that are not yet fully approved in Switzerland?

So your best chance of accessing this type of care is either :

  • Pay out of pocket.
  • Or to find supplementary insurance that offers this type of service.

In short, supplementary insurance is an optional insurance system that completes the benefits offered by the mandatory health insurance. While the latter aims to offer quality care to the entire population (exceptions may apply), the supplementary insurance aims to meet your specific needs. This is why the amounts, premiums and services vary from one insurance company to another. 

It can either be built into a global insurance solution (basic and supplementary insurance with the same insurance company) or be completely dissociated from your basic insurance. 

Can anyone take out supplementary insurance?

Yes and no, anyone can try to take out supplementary insurance, but the insurance company can, without really having to justify itself, refuse you, often on the basis of a health questionnaire that you have to fill in.

I know that for people coming to Switzerland from abroad this may seem completely absurd (especially for French people) but yes, the Swiss mentality when it comes to health insurance is that a company doesn’t insure a car that’s on fire… We agree that it’s not very cool, or even very ethical, but it’s the rule. Supplementary insurance should always be taken out as long as you are in perfect health. There are three possible scenarios:

  • Accepted: After verification, your insurance is accepted without any problem, and that’s good.
  • Accepted with reservations: The insurance company may offer you less favourable terms than initially planned to take account of your less-than-perfect questionnaire, for example by insuring only part of your body.
  • Refused: as you will have understood, the insurance company can simply refuse you.

What are the contractual terms of supplementary insurance?

In 2021, the Swiss Insurance Contract Act (LCA) was revised and since then all contracts must, in principle, be terminable after 3 years. After 3 years, you can ask to terminate your contract, subject of course to a 3-month notice period.

Even if the maximum term is 3 years, you should be able to ask your insurance company for a shorter term. A shorter term potentially means a slightly higher premium.

You can terminate your supplementary insurance contract for reasons other than duration:

  • Cancellation following a claim: Strangely enough, following a reimbursement, you will have the right to request cancellation of the policy.
  • Leaving Switzerland: As soon as you have a certificate of departure, you can send it to your insurer to request early cancellation of your insurance policy.
  • Increase or decrease in premiums: As with basic insurance, if your supplementary insurance changes in price, you also have the right to cancel your policy without waiting for the end of the contract.

What types of supplementary insurance are available?

Outpatient supplementary insurances

The term, which I find a little barbaric (please keep it between us), put simply, refers to the services offered in less than 24 hours and that do not require a stay at the hospital.  

This includes

  • Dental care,
  • Eye care: everything to do with eyesight (glasses, contact lenses),
  • Natural and alternative medicines,
  • cover abroad,
  • Sport,
  • Prevention: check-ups, vaccinations, etc,
  • Other presentations such as domestic help and home care.

For example, I am a cross-eyed sportive person. 

My eyes are just like a bad camera, in the middle of a rainy night. From far, everything is blurry and the lights shine around me. 

In my free time, I go to the gym twice a week, I go for jogs in the forest twice a week as well and I play badminton with my friends on the weekend. 

I thus need a supplementary insurance that will, on the one hand, partially cover my glasses and contact lenses costs and, on the other hand, refund part of my sport and recovery (osteopathy and other massages) costs.

A combined supplementary insurance 

Insurance companies came up with packs of outpatient services in order to make up for the gaps in mandatory health insurance. Each company includes a certain number of services in the supplementary insurance. Most of the time this includes: 

Visual aide

(between 100 and 300 CHF per year)

Companies make a certain amount available annually or every three years in order to cover the costs of corrective lenses and eyeglass frames. 

Sport incentive

(between 200 and 800 CHF per year)

A doctor a day keeps the doctor away, take deep breaths, make sure you exercise.  Mens sana in corpore sano: the healthier you are, the less risk you represent for your insurance. Therefore, most of insurance companies have programmes encouraging various types of sportive activities. 

Refunding your gym membership, contributing to the membership fees of a club… Supplementary insurances offer various solutions to make your favourite sport more affordable. However, your gym must be recognised by a quality label (Qualitop or Fitnessguide, from three stars and up). 

Supplementary medicine

The basic insurance covers five types of so-called natural medicines. It does so because it considers that these medicines do not go against orthodox medicine but rather complements it: 

  • Anthroposophical medicine. 
  • Traditional Chinese medicine. 
  • Homeopathy. 
  • Neural therapy. 
  • Phytotherapy. 

Natural and alternative medicines that are covered by supplementary insurances do not require, unlike the basic insurance , for the therapist to have been trained in classical medicine. 

The list of alternative medicine reimbursed therefore significantly increases: 

  • Etiopathy
  • Kinesiology
  • Osteopathy
  • Sophrology
  • Shiatsu
  • Mesotherapy
  • Fasciatherapy-pulsology
  • Bio resonance
  • Psychology
  • Etc

Coming up with an exhaustive list is impossible: it is constantly evolving and varies depending on the insurance companies. The cost reimbursed is usually partial and can include a limited number of sessions.

Treatments abroad 

Treatments abroad are, in principle, covered by the mandatory insurance and let’s be honest, this care is pretty well assured. However, it is important to differentiate between two cases:

  • Medical expenses abroad in the European Union: As long as you travel to European countries, in principle Switzerland will contribute at least as much as the country would have done for its own residents. The LAMal will adapt to each country’s coverage, and as European countries generally have good insurance cover, you can rest easy.
  • Medical expenses outside the European Union: In this case, the situation is more complicated. Switzerland proposes to pay twice what it would have paid in Switzerland. At first glance, this seems like a good deal, but on closer inspection, some countries, such as the United States, Japan and Australia, are even more expensive than Switzerland (yes, it is possible). If you travel regularly to these countries, you may want to consider taking out additional cover abroad.
Medicine

In Switzerland, everyone has the right to access medicine but that does not mean that every medicine is reimbursed. Mandatory healthcare covers only medicine that was prescribed by a doctor and which is on the speciality list (SL)

This supplementary insurance covers the cost of drugs for academic medicine as well as supplementary medicine.

Dental care

Each and every one of us eventually had to lay on the nerve-wrecking chair (and under the blinding LED lamp) of a dental office. 

And though the metallic noise of the dentistry instruments clinking against each other is enough to give us goosebumps on its own, the most frightening part remains the final bill! 

While supplementary insurances only rarely fully cover the latter, they do greatly contribute to it. Whether it be for a descaling, a check-up, an outpatient treatment such as cavities or crowns or for orthodontia. 

Our advice: Although it may seem strange, at FBKConseils we are not big fans of dental supplements for several reasons:

  • Reason 1: Supplementary dental cover is very expensive
  • Reason 2: Supplementary dental insurance rarely reimburses the full bill.
  • Reason 3: They contain many exclusions that are not covered even if you are insured.
  • Reason 4: The questionnaire required to be accepted is not that simple (except for children).

In conclusion, if you manage to find that rare gem: supplementary dental insurance that offers good cover, accepts you and is also affordable, then why not? But make sure you do your homework before signing.

Inpatient supplementary insurance (hospital care)

First of all, let’s touch wood. A stay at the hospital is never a good time. Although, it is not always a negative experience. For example: giving birth! 

In this case, as well as in other cases, it is always nicer to be able to choose the conditions of one’s stay: hospital, room, doctor. 

Yet, the basic insurance covers the costs for being treated at a public hospital and in a shared room (4 to 6 beds). Supplementary insurances offer several care options. 

The shared room option throughout Switzerland 

The mandatory health insurance offers you access without any additional costs to the hospital of your canton of residence. In certain cases, a surgery at another hospital can incur significant additional costs. With supplementary insurance, your insurer will cover these costs in full. 

Be careful: this supplementary insurance excludes any kind of refund in case of a stay at a clinic or a private hospital.  

In case of an emergency, of course, this does not apply, you may go to the nearest hospital as soon as possible without any financial loss. 

In case of a planned intervention, this supplementary insurance does not offer any advantages in terms of speed of care compared to what the basic insurance offers. You will thus have to wait several weeks before getting operated. 

Finally, the cost of this supplementary insurance is quite attractive. Indeed, though it is determined based on your age, it should not set you back more than a couple of dozens per month. 

The semi-private option

Opt for more comfort and intimacy with the semi-private option. Though you will not get a single room, you will share it with a maximum of one other person. You can also choose your doctor in the whole country and at any public hospital as well as private practices and clinics.

With the semi-private option, the waiting period for your planned surgery can be divided by two before being treated by the doctor of your choice. 

However, it is important to pay attention to the price of this supplementary insurance, which can have a considerable impact on the amount of your monthly premiums. 

You should thus make sure to determine precisely your needs and budget before taking out such an insurance. 

The private option

Even more comfort and privacy with the private option, which exclusively offers single rooms. All the requirements are met to insure you the quickest recovery from your stay. 

The costs of such an option are rather high, but it is a good option if: 

  • You have sufficient financial resources. 
  • You have to undergo a heavy procedure which includes a long stay at the hospital. 

This insurance guarantees you the best health treatment possible. 

  • The wait time to be treated are reduced from one months to just a few days. 
  • The treatment and post-surgery care are not time-limited. 
  • You can get several medical opinions before deciding to get surgery. 
  • Transportation costs to the clinic are also covered (the same goes for when you go back home). 
  • Even the costs related to your family’s care (housekeeping, children, etc…) are fully covered. 

The flex model

Subject to financial compensation, you can choose what option you want up until you are admitted at the hospital. Otherwise, by default, you will get the shared room option. 

While this option allows you to make considerable savings on your premiums, the financial compensations are usually expensive when staying at a semi-private or private hospital.

Before taking out any kind of supplementary insurance, I strongly advise you to carefully examine the health system, starting with the basic insurance: What is it for? and especially, how much does it cost? Then, by taking interest in the other supplementary insurances that exist: outpatient insurance and capital insurances. 

The health insurance industry is vast and complex. Should you have any more questions after reading all this, please do not hesitate to ask us!

Capital supplementary insurance

The sole goal care Health Insurance Act of Switzerland (LAmal) is to cure and not to refund the financial losses related to a health problem. Even though it is possible, if not expected, that you will not receive your entire income while you are hospitalised. 

These supplements can take various forms: 

  • Daily benefits in case of a long-term hospitalisation.
  • Daily benefits for loss of earnings following an illness or an accident. 
  • Payment of capital following a case of incapacity or death.

Be careful: this kind of supplementary insurance should not be taken out without having fully evaluated the global situation in order to have a good idea of other social insurances or professional ones (OASI / OPA / AIA / APG) that could compensate for your loss of income. 

As always, I urge you to have a close look at the amounts the insurance is offering you and to compare them to the price you must pay monthly. I can assure you that in many cases, this kind of insurances are not as attractive as they seem. 

Even worse, brokers tend to try to get you to sign several supplementary insurances without really taking a step back to consider whether you actually need them or explain them to you. Next thing you know, you end up with plenty of small supplementary insurances that you do not know of and that turn out to be costly. 

Tips and advice on supplementary insurance

Tip no. 1: Supplementary insurance is not automatically necessary.

Bear in mind that health insurance in Switzerland is good insurance. It has no vital gaps, and supplements will always be a plus but never a necessity.

Tip no. 2: The duration of a contract

As far as possible, try not to commit yourself for too long a period. Before signing, take the time to fully understand the terms and conditions of your future insurance contract.

Tip no. 3: Broker and insurer

While compulsory health insurance is fairly tightly regulated by law, supplementary insurance is a veritable jungle. Brokers’ commissions can be substantial and are often proportional to their profitability. Always try to understand what you are being offered and ask yourself: do I really need this insurance?

 

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