The Swiss system in one sentence
Teeth are insured differently in Switzerland than the rest of the body. Mandatory health insurance under KVG covers dental treatments only in a limited number of medically narrowly defined exceptional cases. Caries, root canal treatment, dental hygiene, implants and whitening are normally paid by the patient themselves unless dental supplementary insurance exists.
This separation has grown historically and has been politically discussed repeatedly. The two referendum initiatives for mandatory dental insurance in the cantons of Vaud and Geneva were rejected in 2018. Until further notice the dual system applies: minimal mandatory service, supplementary insurance optional.
What basic insurance covers
The KVG names three categories of dental services that are covered:
Severe, unavoidable disease of the masticatory system
This is the most important category and concerns treatments for diseases that did not arise from lack of care. Examples are jaw surgical procedures for tumors, treatments for cleft lip and palate, dental damages from a severe systemic disease such as leukemia or from a medical treatment such as head-neck irradiation.
Consequences of a severe systemic disease
When a systemic disease causes dental damages, basic insurance covers treatments. Classic examples are diabetes mellitus with pronounced periodontitis as a consequence or osteoporosis therapies with bisphosphonates that cause jawbone complications.
Accidents
Dental damages from an accident are covered by accident insurance, not by health insurance. Working persons are usually accident-insured through the employer, children through health insurance with accident inclusion. Important is timely reporting: dental damage treated only years later is difficult to prove as an accident consequence.
In all three categories reimbursement is tied to prerequisites. The diagnosis must be documented by a dentist, a cost estimate is submitted to health insurance before treatment begins, and health insurance must confirm coverage in writing.
What basic insurance does not cover
The vast majority of all dental treatments belong to the self-pay category:
- Routine check-up examinations
- Caries treatment with composite or amalgam
- Root canal treatment
- Crowns, bridges, inlays
- Dental hygiene
- Dental implants (in general)
- Orthodontics for adults
- Whitening and aesthetic treatments
- Dental replacement not necessary through accident or disease
This list covers about 95 percent of dental services. That is why dental supplementary insurance can be financially sensible for patients with expectable treatment need.
How supplementary insurance works
Dental supplementary insurance is voluntary additional service concluded independently of basic insurance. It is subject to different logic:
Risk check before conclusion. The insurance checks the dental status and can make reservations or refuse conclusion. Those who conclude a supplementary insurance at twenty usually have fewer reservations than someone at forty-five after years without insurance.
Waiting times. Most supplementary insurances have a waiting time of six to twelve months in which only emergencies are covered. An already planned implant treatment cannot be covered by a short-term insurance conclusion.
Maximum amounts per year. Reimbursement is limited to an annual amount, often between CHF 1,000 and 5,000 per year depending on tariff. Elaborate treatments such as multiple implants are submitted distributed over multiple years.
Reimbursement quota. Common are 50 to 75 percent of the treatment costs, with exceptions for purely aesthetic services such as whitening, which are often not or only minimally covered.
Providers with established dental supplementary insurances in Switzerland are Helsana, SWICA, Visana, Sanitas, EGK, Concordia and several others. The tariff conditions are very different. A comparison of conditions before conclusion is worthwhile, for example via Comparis or bonus.ch.
EMR and ASCA. What is recognized
EMR stands for Erfahrungsmedizinisches Register, ASCA for Association Suisse des Médecines Complémentaires. Both are quality seals that are with some supplementary insurances a prerequisite for the reimbursement of dental hygiene services.
Specifically this means: If you have a supplementary insurance with an EMR or ASCA clause, your dental hygiene session is only reimbursed if the hygienist is listed in EMR or ASCA. The certified hygienists at Resident are EMR-recognized. You receive the receipt immediately after the session and can submit it to your insurance.
Practical procedure before a treatment
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Obtain cost estimate. Before every larger treatment you receive a written cost estimate with detailed listing of all planned services. At Resident this is standard above a defined threshold. More on this in the article on the written cost estimate.
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Inquire with health insurance. If the treatment possibly falls under one of the three basic insurance categories (e.g. consequence of a systemic disease), submit the cost estimate with medical justification to your health insurance. The answer comes in writing.
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Inquire with supplementary insurance. Also without inquiry: with dental supplementary insurance submit the cost estimate. You get clarity about the reimbursement quota and residual costs.
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Begin treatment. After written confirmation by the insurance or after conscious self-pay decision. Resident awaits the answer if you wish.
How Resident handles this
We prepare a written cost estimate before every larger treatment with all relevant tariff positions. We do not name concrete prices on the website because the Swiss SSO dental tariff is standardized and the effort per patient varies strongly. Concrete amounts arise after assessment and diagnostics.
Our dental hygiene is EMR-recognized. You can submit the receipt directly to your supplementary insurance without us having to communicate with the insurance. For patients with complex treatment plans we support with submission and correspondence with health insurance.
If you are unsure what your insurance covers, bring your policy to the initial consultation. We discuss the options before the first diagnostics.
What is often misunderstood
“Health insurance pays once annually for a check-up.” Wrong. Basic insurance does not cover check-up examinations. Some employers offer a contribution through company health insurances, but that is not standard.
“With supplementary insurance everything is covered.” Wrong. Maximum amounts, waiting times and reservations limit coverage. Before a larger treatment the written pre-inquiry to insurance is worthwhile.
“Implants are never covered.” Mostly correct, with exceptions. After an accident or with a severe systemic disease an implant can be covered by basic insurance. Prerequisite is the written confirmation before treatment begins.
“Dental hygiene is luxury.” Wrong. Dental hygiene is the most effective measure to avoid periodontitis and therefore also implant follow-up costs. Those who go regularly to hygiene save long-term treatment costs.
The insurance logic of the Swiss system does not reward prevention but reimburses therapy. Those who take prevention seriously pay for it themselves and thereby avoid higher costs later. Dental supplementary insurance with prevention module is the only way to partially circumvent this logic.