Understanding supplementary insurance: the comprehensive guide

The types of supplementary insurance

The product landscape is broad; the most common families can be grouped as follows:

• Outpatient supplementary insurance: contributions towards benefits that basic insurance does not cover, or covers only in part — such as glasses and contact lenses, medicines not on the statutory list, transport, prevention or fitness contributions.
• Hospital supplementary insurance: choice of ward (general throughout Switzerland, semi-private, private) and a wider choice of hospital and doctor — fixed when the policy is taken out or flexible on admission.
• Dental insurance: dental treatment and orthodontic corrections, which basic insurance covers only in narrow exceptional cases.
• Complementary medicine: extended cover for methods and therapists outside the basic insurance catalogue.
• Cover abroad: treatment costs beyond the limited benefits basic insurance provides abroad, for instance for travel to countries with high treatment costs.

The list describes product families, not specific products. Scope and names differ by insurer — the applicable AVB are decisive.

The health check and the duty of disclosure

Before a supplementary insurance policy is concluded, the insurer may ask health questions — in writing in the application or in another text form. Legally, this is the duty of disclosure under VVG Art. 4: the applicant must answer the questions asked completely and truthfully. Facts that are expressly asked about are deemed material by law (VVG Art. 4 Abs. 3).

If a material fact is stated incorrectly or not stated at all, the insurer may cancel the contract within four weeks of learning of the breach (VVG Art. 6 Abs. 1–2). For losses that have already occurred, it may refuse or reclaim benefits to the extent that the concealed fact influenced the loss (VVG Art. 6 Abs. 3). The VVG also provides exceptions in which the insurer cannot invoke the breach — for instance if it already knew the fact or the question was imprecisely worded (VVG Art. 8).

The health check applies only to supplementary insurance. Basic insurance has no health questions — admission there is guaranteed.

The four possible admission decisions

After the health check, the insurer has four options. All four are permissible — the Federal Office of Public Health (BAG) expressly states that supplementary insurers may reject applications, exclude benefits and charge risk-based premiums:

1. Acceptance without restriction

   The contract comes into effect on the ordinary terms. The usual outcome where the health information raises no concerns.

2. Acceptance with a benefit reservation

   The contract comes into effect, but benefits connected with a specific condition or part of the body are excluded — for a limited or an unlimited period. The reservation must be clearly stated in the contract documents.

3. Acceptance with a premium surcharge

   The contract comes into effect with the full scope of benefits, but at a higher premium adjusted to the risk — risk-based premiums are permissible in supplementary insurance.

4. Rejection

   The insurer does not accept the application. There is no obligation to give reasons; rejection by one insurer does not rule out acceptance by another, as each assesses applications independently.

What this means in practice with a pre-existing condition is covered in depth in its own guide →

The benefit reservation: limited or unlimited in time

A benefit reservation excludes benefits for a specific condition from the contract — the rest of the cover applies as normal. For individual supplementary health insurance, the VVG sets no statutory maximum duration: a reservation may be imposed for a limited period or without a time limit. What is required is that it is clearly stated in the contract documents — what exactly is excluded, and for how long.

There is a risk of confusion with two other sets of rules that do have a five-year limit: in daily allowance insurance under the KVG, a reservation lapses after five years at the latest (KVG Art. 69 Abs. 2), and in occupational pension provision a maximum duration of five years likewise applies to extra-mandatory cover (OR Art. 331c). Neither applies to supplementary health insurance.

Protection of existing policies: who may cancel

Since 1 January 2022, the law provides: in supplementary health insurance, the insurer waives the ordinary right of cancellation and the right to cancel in the event of a claim (VVG Art. 35a Abs. 4). An existing supplementary insurance policy therefore cannot be cancelled because the insured person grows older, falls ill or draws benefits — ordinary cancellation is a right held only by the insured person.

The general remedies for breaches of contract remain reserved, for instance where the duty of disclosure has been breached (VVG Art. 6) or in cases of insurance fraud. This protection is the reason the order of steps matters so much when switching: what exists is protected — what has been cancelled may not come back.

Switching in the right order

Because admission to a new supplementary insurance policy is not guaranteed, a fixed order of steps has become established — it also corresponds to the guidance of the Federal Office of Public Health (BAG):

1. Step 1

   Submit the application to the new insurer and go through the health check — the existing supplementary insurance remains untouched in the meantime.

2. Step 2

   Wait for the written admission decision and review it: without reservation, with a reservation, with a surcharge — or rejection.

3. Step 3

   Only once the new cover has been confirmed in writing and on known terms, cancel the existing supplementary insurance for the next possible date — observing the contractual notice period.

By law, a supplementary insurance policy can be cancelled at the end of the third policy year at the latest, and annually thereafter (VVG Art. 35a Abs. 1–2); many contracts provide for shorter commitment periods. Your own contract is decisive.

Deadlines and the cancellation process are covered in the guide to switching health insurers →

In the event of disagreements: the competent bodies

Supplementary insurers are supervised by FINMA, which also approves the tariffs of supplementary health insurance. For disputes concerning the basic and supplementary insurance of health insurers, the Ombudsstelle Krankenversicherung (the ombudsman's office for health insurance) is the competent neutral point of contact (om-kv.ch) — not the Ombudsman of Private Insurance, which expressly does not handle health insurance matters. Proceedings before the Ombudsstelle are free of charge for insured persons.

If a disagreement persists, the civil courts remain open; claims arising from supplementary insurance are governed by the rules of the Code of Civil Procedure.