What dental services does health insurance cover?

Basic health insurance covers dental costs only in legally stipulated exceptions. You are generally liable for the cost of check-ups, caries treatments, dental hygiene and prostheses.

Basic health insurance covers the costs only in the case of:

• Serious, unavoidable temporomandibular disorders
• Treatments required due to a serious general illness
• An accident, if no other accident insurance is liable
• Certain congenital disorders, if not covered by invalidity insurance.

The Health Insurance Benefits Ordinance stipulates which treatments are covered. Health insurers cannot expand or restrict this legally established list of benefits.

Whether or not the cost is covered by health insurance depends on the diagnosis. In the case of more extensive treatments, your dentist will create a cost proposal and submit it to your health insurer for review.

Basic health insurance also covers the cost of braces and other orthodontic treatments only in the aforementioned cases. Normal dental misalignment does not provide sufficient grounds for cost coverage.

What does health insurance cover in the event of dental trauma?

In the event of dental trauma, accident insurance usually covers the cost of the dental treatment as long as the damage to the teeth was caused by a sudden and unintended incident, such as a fall, impact or sports injury.

Tooth decay, age-related damage to the teeth and other dental diseases are not classed as dental trauma. In most cases, damage to the teeth resulting from biting down on a hard object is also not classed as an accident and is therefore not usually covered by accident insurance.

Including or excluding accident insurance

Do you work at least eight hours a week for the same employer? If so, you are insured against occupational and non-occupational accidents by your employer’s accident insurance. As such, your employer should be your first port of call when reporting dental trauma.

If you are not insured against accidents through an employer, you must include accident insurance with your basic health insurance. This applies to children, students, pensioners and the unemployed, for example.

Does health insurance cover emergency dental treatments?

The type of insurance that covers the cost of emergency treatment depends on why you need to visit the dentist: if the emergency arises from an accident that is covered by insurance, the accident insurance usually pays. This applies if a tooth is knocked out in a fall, for example.

On the other hand, treatment for acute dental pain due to tooth decay or inflammation is classed as normal dental treatment. You are usually liable for the cost. Supplementary dental insurance may contribute to this depending on the scope of benefits.

Basic health insurance covers the cost of a dental emergency only if a statutory benefit obligation is deemed to exist. This is the case, for example, with certain serious temporomandibular disorders or treatments associated with a serious general illness.

Supplementary dental insurance covers some of the costs of dental treatment depending on the health insurer and benefit class. 

The insured treatment types and the co-payment amount differ depending on the insurance. You should therefore compare the following points in particular prior to taking out insurance:

• Which treatments are insured?
• What percentage of the costs does the insurance cover?
• What is the maximum contribution per calendar year?
• Do waiting periods or age limits apply?
• Is a health check required?
• Is there an excess?

Supplementary dental insurance can protect you against high treatment costs. If your teeth are healthy, you should take out the insurance at an early stage. If dental conditions have already been identified, benefits are often restricted or it may no longer be possible to take out insurance at all.

Supplementary dental insurance from KPT

Depending on the benefit class, supplementary dental insurance from KPT contributes to the cost of treatments that are not covered by basic health insurance. No deductible applies. Eligible treatments include professional dental hygiene, orthodontic measures such as braces, surgical interventions, tooth extractions, implants, prostheses, root canal treatments, fillings, crowns and dentures.

Important: a waiting period applies with supplementary dental insurance. This means that you can only make a claim 6 months after the contract start date, or 12 months in the case of orthodontic treatment, dental prosthetics and dental restorations due to amalgam intolerance.

No, basic health insurance does not cover planned dental treatments performed outside Switzerland. You are generally liable for the cost of treatment by a dentist abroad.

Exception

An exception applies in the case of medically necessary emergency treatments during a temporary stay abroad.  In the case of dental trauma, cost coverage depends on your accident cover and the valid legal provisions.

Supplementary dental insurance may cover the cost of dental treatments abroad. Prior to any planned treatment, always consult your health insurer to determine whether and to what extent benefits are covered.

The cost of a dental treatment depends on various factors. These particularly include the type of treatment, the amount of work involved, the material(s) used and the tariff point value of the dental practice. 

How the price is calculated

All dental services are assigned a certain number of tariff points. The dental practice multiplies this number by its tariff point value.

Number of tariff points × tariff point value = treatment cost

Example: brief initial examination with 33.10 tariff points and a tariff point value of CHF 1.20

Calculation: 33,10 (TP) x CHF 1.2 (TPV) = CHF 39.72

The tariff point value can differ depending on the practice or the tariff agreement. According to the Swiss Dental Association (SSO) it should be no greater than CHF 1.70. Different values, which are stipulated by the authorities, apply to treatments covered by social insurance or basic health insurance. The Swiss Dental Association (SSO) explains how the treatment costs are calculated and which tariffs apply.

Additional costs for materials, labour or external work can also apply. In the case of crowns, bridges and implants, these often account for a large part of the overall cost.

Prices of regular dental treatments

If you would like to know how much dental treatment is likely to cost, the list below provides you with some guidance.

The prices are guide values. The actual costs may differ depending on the practice, region and level of work involved.

• Dental hygiene: 100 to 300 francs
• Dental filling: 150 to 300 francs; large or multi-layer fillings up to 400 francs
• Tooth extraction: 200 to 350 francs; 400 to 700 francs in the case of surgical intervention
• Wisdom tooth extraction: 300 to 800 francs depending on the level of work involved
• X-ray: 20 to 50 francs; 80 to 180 francs for a panoramic scan
• Root canal treatment: 700 to 1,800 francs
• Dental crown: 1,200 to 2,000 francs
• Three-unit dental bridge: 2,500 to 4,500 francs
• Implant with crown: 3,500 to 5,500 francs

In the case of implants, additional interventions such as a bone graft may be required. This increases the overall cost.

Request a written cost proposal prior to major treatments. Ask your dental practice to explain the individual services and the material and follow-up check costs included.