The legal base covers almost no outpatient care beyond illness. Here in detail is what supplementary policies actually cover, and how to avoid unpleasant surprises.
LAMal is designed to cover care deemed medically necessary under strict criteria set by the Confederation. Routine dental care, optical care and complementary medicine are considered outside the basic basket, save for very limited exceptions (certain dental procedures linked to a serious illness, for example). Hence the large gap between what people think is covered and the reality of their policy.
Check-ups, scaling, conservative care, and depending on the contract: orthodontics (often with an annual cap and waiting period). Purely cosmetic care generally remains excluded.
A contribution towards glasses and contact lenses, with a maximum reimbursable amount defined per period (often 2 years). Luxury frames frequently exceed the reimbursed cap.
Osteopathy, acupuncture, naturopathy, chiropractic, homeopathy: covered per session or by annual cap, provided the practitioner is recognised by a professional register (ASCA, RME).
A contribution towards a gym membership or a prevention programme, usually as a modest annual allowance that can be combined with the other benefits.
Watch out: each supplementary policy has its own caps, waiting periods and lists of recognised practitioners. Two "dental" contracts from two different insurers can have very different terms for a similar price, and that's where independent comparison makes the difference.
Unlike LAMal, supplementary policies can be subject to a health questionnaire and a medical reservation, particularly for orthodontics or care already identified at the time of application. Taking one out early, before an identified need arises, avoids these restrictions.
We compare outpatient supplementary policies from several insurers based on your real needs (dental, optical, complementary medicine), not a generic contract. Free, impartial advice, with no health questionnaire imposed by our firm.
It depends entirely on the contract. Some provide for them with a specific cap, others exclude them. A precise check of the contract before subscribing is essential.
Yes; unlike LAMal, supplementary policies can generally be taken out at any time, subject to acceptance by the insurer.
Often yes; particularly for orthodontics or certain dental care, a waiting period of several months may apply before cover actually starts.
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