Dental insurance

What is dental insurance?

Dental insurance is a supplementary insurance that pays part of your dental bills. It is optional and governed by the Insurance Contract Act (ICA; in German VVG), not by the Federal Health Insurance Act (KVG). Health insurers offer it, usually as a separate product or as part of a supplementary outpatient insurance.

The reason dental insurance exists lies in a particular feature of the Swiss system: dental treatment is, as a rule, not part of basic health insurance. The law assumes that tooth decay and gum disease can largely be avoided through good dental care. So if you have no dental insurance, you pay for check-ups, dental hygiene, fillings, root canal treatment, crowns, implants and most braces yourself.

Basic health insurance steps in only in three cases: when there is a serious, unavoidable disease of the masticatory system, when a serious general illness causes the dental treatment or makes it necessary, and for accident damage to the teeth if no accident insurance pays. The Health Care Benefits Ordinance (KLV) lists exhaustively which diseases are meant, for example certain tumours in the jaw area, diseases of the jaw joint or dental treatment before chemotherapy.

For children, disability insurance (IV) also plays a role: it covers dental treatment for recognised congenital disorders, such as a cleft lip and palate, until the age of 20. Ordinary orthodontics for crooked teeth is not included.

How it works

What dental insurance typically covers

Each insurer designs its own dental insurance. The benefits are set out in the general and supplementary terms and conditions of the product. Commonly covered are:

• check-ups and dental hygiene,
• fillings, root canal treatment and extractions,
• crowns, bridges and sometimes implants,
• orthodontics for children and adolescents,
• dental accidents, insofar as neither accident insurance nor basic health insurance pays.

Most contracts do not pay the whole bill but a percentage, capped at a maximum amount per calendar year. There are often waiting periods before expensive treatments are covered, and separate limits for orthodontics. These values differ widely between insurers and products. So always compare the percentage, the annual limit, the waiting period and the premium together.

Acceptance and health questions

Unlike basic health insurance, the insurer does not have to accept you. It may ask health questions, request a dentist’s report, exclude existing damage with a reservation or reject your application. You must answer the questions completely and truthfully. If you conceal a significant fact, for example a treatment that is already planned, the insurer may terminate the contract and refuse benefits for the damage concerned.

Premium

The premium for dental insurance is not approved by the Federal Office of Public Health (FOPH) and is not publicly available as a dataset. It may vary by age, sex and region. Many insurers set it according to your age on joining or increase it in age steps.

Cancellation and switching

You can cancel the contract under the rules of the ICA and the terms and conditions. The insurer itself may not give ordinary notice on a supplementary insurance linked to health insurance. If you switch your basic health insurance, your dental insurance stays with your previous insurer until you cancel it separately.

Legal basis

For basic health insurance, Art. 31 KVG applies. Under para. 1, it covers dental treatment caused by a serious, unavoidable disease of the masticatory system (let. a) or by a serious general illness or its after-effects (let. b), or that is necessary to treat a serious general illness (let. c). Under para. 2, it pays for damage to the masticatory system after an accident if no accident insurance covers it. Art. 17 to 19a of the Health Care Benefits Ordinance (KLV) list the conditions exhaustively. Treatments under Art. 18 KLV require prior cost approval from the insurer.

Under Art. 13 of the Federal Act on Disability Insurance (IVG), disability insurance covers congenital disorders in children and adolescents until the age of 20. Art. 19a KLV sets out when basic health insurance pays afterwards or in addition.

Dental insurance itself is a contract under private law. The Insurance Contract Act (ICA) applies: Art. 4 ICA requires you to answer the health questions truthfully, and Art. 6 ICA allows the insurer to terminate the contract for a breach of the duty of disclosure within four weeks of learning about it. Under Art. 2a ICA, you can withdraw your application within 14 days. Art. 35a para. 4 ICA states that for supplementary insurance linked to social health insurance, only the policyholder can give ordinary notice, i.e. the person who took out the policy; for children, this is usually the parents. Scope, limits and waiting periods are not set by law but in the general terms and conditions of each insurer.

Example: who pays what?

The Keller family has three dental bills in the same year. The amounts are assumed treatment costs; the deductible and retention fee are calculated with the statutory values.

Person	Treatment	Cost	Who pays
Leo, 15	Front tooth broken in a bike fall	CHF 1,800	Basic health insurance (accident), Leo pays a 10% retention fee
Mia, 11	Braces for a misalignment	CHF 6,000	The family itself or dental insurance under the contract
Sandra, 44	Two fillings and dental hygiene	CHF 650	Sandra herself or dental insurance under the contract

Basic health insurance does not pay for Mia’s braces or Sandra’s fillings, because none of the conditions listed by law applies. Only if the family took out dental insurance beforehand will it cover part of the cost, according to the percentage and limit in the contract. Dental insurance taken out only after the misalignment has been diagnosed will, as a rule, no longer cover the braces.

What this means for you

Dental insurance is a matter of doing the maths. These points help you decide:

1. Weigh the premium against the benefits. Add up the annual premium and compare it with what the insurance would actually reimburse for your usual dental costs. Your past bills show you the order of magnitude.
2. Think of braces for children. They are the most common expensive item for children. Check waiting periods and the orthodontics limit before you sign.
3. Read the health questions carefully. Answer them completely. One incorrect answer can cost you your entire cover.
4. Clarify your accident cover. Dental accidents are covered by the UVG or by basic health insurance. If you are employed, check whether you can exclude accident cover from your health insurance.
5. Compare providers. Basic and supplementary insurance can be with different insurers. You will find insurer profiles under health insurers and basic insurance premiums in the premium calculator. We are building a benefits comparison of supplementary insurance under compare supplementary insurance.

The needs check also helps you find out whether dental insurance suits your needs. More on typical costs is under the term dental costs, and on accidents under dental accident.

Common mistakes

• Assuming health insurance pays for the dentist. Basic health insurance pays only in a few cases listed by law. Check-ups and tooth decay are not among them.
• Taking out insurance too late. If a treatment is already foreseeable, it is usually excluded. This applies especially to braces.
• Answering health questions inaccurately. For a breach of the duty of disclosure, the insurer may terminate the contract and reclaim benefits.
• Cancelling your old dental insurance too early. Without written acceptance by the new insurer, you may be left without cover.
• Looking only at the premium. A low premium with a low annual limit pays little for an expensive treatment.