The question comes up often: is complementary insurance worth what it costs? There is no general answer, because it depends on what a household actually spends and what it wants to cover. There are, however, facts that let each person answer it for themselves.
What basic insurance already guarantees
Basic insurance covers the services used to diagnose or treat an illness and its after-effects: consultations, medicines on the list, laboratory tests, hospital in the general ward, maternity. These benefits are the same at every insurer, and no insurer may turn down a person who is required to be insured.
Complementary insurance therefore does not make necessary care better or faster: it is already owed. The Federal Office of Public Health describes it as optional, offering extra comfort, such as a stay in the semi-private or private ward of a hospital, or other benefits that basic insurance does not cover.
What complementary insurance adds
Complementary policies cover what basic insurance does not pay for, or pays for poorly. On the outpatient side, this mainly means alternative medicine not recognised by basic insurance, glasses and contact lenses, medicines not on the list, prevention and sport, dental care, and costs abroad beyond what basic insurance provides. On the hospital side, it means the room, free choice of doctor and hospitals not on your canton's list.
What complementary insurance cannot cover
A widespread idea is that complementary insurance reimburses the deductible or co-payment of basic insurance. That is impossible: the law forbids cost-sharing from being insured, whether by a health insurer or by a private insurance institution. The deductible and co-payment remain payable by the insured person, with or without complementary cover.
Nor does complementary insurance change the deadlines for changing basic insurer, or the basic premium. The two contracts are independent, and can be taken out with different insurers: you can keep your complementary cover with one insurer and move your basic insurance to another.
Each complementary policy is cancelled on its own terms, not on the basic insurance dates. Before changing either one, it is worth rereading the terms of the complementary contract: minimum term, notice period, and what would become of a reservation if you applied elsewhere.
The conditions that change everything
Complementary insurance falls under the Insurance Contract Act (VVG/LCA), not the LAMal. The insurer may ask health questions, refuse the application or exclude an existing illness through a reservation. Each product sets its own rates, ceilings, waiting periods and age limits for joining.
This freedom on the insurer's side has a practical consequence: it is generally easier to obtain complementary cover when young and in good health than later on. Conversely, cancelling an existing complementary policy may be final, if your state of health has changed since it was taken out.
The Insurance Contract Act also grants a right of withdrawal. The policyholder may withdraw the application for a contract, or its acceptance, in writing or in any other form that allows proof by text. The period is fourteen days from the application or acceptance, and it is met if the withdrawal is posted on the last day. It is a useful protection when a complementary policy was taken out too quickly, for instance after a sales call. It does not apply to group personal insurance, provisional cover or contracts lasting less than a month.
How to measure it against your situation
- Add up your actual spending for the year in the areas concerned: alternative medicine, glasses, sport, dentist.
- Compare that amount with what each product actually reimburses, with its rates, ceilings and conditions.
- Set that reimbursement against the annual premium for the complementary cover. For example, a product that reimburses 75 per cent up to a thousand francs a year pays back 600 francs on 800 francs spent, and a thousand francs at most, however much is spent beyond that.
- For hospital cover, ask yourself what matters: the room, the choice of doctor, or a hospital outside the canton.
- Think about the future: cover that is hard to obtain later may be worth keeping even in a year when it reimburses little.
This is precisely the calculation our comparator makes for the expenses you declare: it shows, product by product, what is documented by the insurer and what depends on conditions to be checked. The exact premium, for its part, has to be requested from the insurer or from an adviser.