Supplemental health insurance (LCA) is a mess

Hello Mustchians,
A new headache is coming this month, I have for me and my family the supplemental health insurance (LCA as it’s officially called) that is about to be at the end of the very long 5 years period and I have a shot to change them if needed.
I really want to optimize it a bit but LCA are really pervert as it might be difficult to get out but even more difficult to get back in. We are all at Assura (like the base as well, nothing really cheaper these last years), but all member of the family have a different combo of LCA. There is a base package (Complementa Maxi or Extra depending when started, of course the Extra replace the Maxi with higher price and almost nothing added beside a few hours more of house cleaning or something), this I will not touch. But then they are a lot of other package, Denta is clear, I think for kids it might be important, I will keep it for all kids, adult optional, Natura is clear as well, for natural medicine like Osteophaty (thus the among of money they give back is so limited that I’m wondering if it has any sense).

Then I see some of the family member with Previsia, it’s a kind of package with accident coverage and some very limited life/disability insurance (great to get 3000frs in case of a family member death… really life changing If you allow me the dark joke). Then about the accident coverage, it looks like most is cover by LAMAL, the base, and by the Complementa Maxi/Extra, so I was wondering, what’s the point then? But then I saw that some family member have some of the LCA with accident and some without (even kids, that are obviously not covered by work insurance).
Even more scary, in the general conditions, Previsia looks like not possible to cancel for the whole lifetime?! I cannot believe this, or is it only from Assura side, they cannot stop it if you will to keep it?

I really want to clean this up and keep only what is important and might cover very high cost single event or long term event that would significantly impact our budget, I don’t care for a cashback on something that will give us back 500, 1000 or even 3000frs only once that has 1% risk to happen in the next 10years, if not the lifetime. I want only to cover event that would cost tens of thousands or will incurred a life long or very long period with a high cost that is mostly covered. I see that most things are covered up to a maximum that is quite low (500 or 1000frs per year).

First I was even looking to change completely our insurance LCA to another one but after checking Comparis, it’s a huge nightmare, not 2 company offer the same and how can I guess what I would need or not. From what I found, all cheaper alternative cover much less and the one that cover slightly more are way more expensive. Also the whole family is still relatively young so we have no guess of what might happen in the future like most people of course.

Of course if you want to add new insurance it’s very easy with a couple of click but if you want to remove and change existing one, nothing is possible online. I asked to be called to clarify but I’m still waiting.

Is there any serious article or recommendation from a trusted party (FRC, Bon à Savoir, Konsumentenschutz, …) ? What is your strategy with risk, possible cashback and cost?

Moneyland has a better comparison tool imho.
Check the stars and comments for each.

Thanks, I always forgot about moneyland. It’s another view than Comparis you have to open in multiple windows to compare, unlike Comparis. Thus there are still many information missing, especially for natural medicine coverage. Swica looks always like a good deal with a lot of thing covered but then you see that 1) you must have the LAMAL with them and 2) there is a shared franchise between lamal and LCA, that remove all benefit of the LCA as we would most likely never reach the 2500frs franchise.
Also on both website, it’s never possible to compare with what you have already (I guess because offer change every years and they cannot have record of all previous offer you might have).

The problem is that I’m already last minute as I figure out that the delay is 6 months by Assura, so I have less than 15 days to find and confirm another insurance and stop with them, that is almost impossible if they ask for medical control or something. I thing my best bet is to keep Assura but remove what’s not necessary and be sure to cover accident when needed (as it’s not the case now).

I had already an extremely bad experience for trying to change a contract for car and house insurance with Zurich this year, waiting for a case to get out within 14 days (or I can “sell” the car to my wife maybe, not sure it will work easily). I also made a huge mistake with changing my mobile phone subscription, that cost me (at least) 70frs, but I learn from it. Now I avoid like plea any contract with a delay to stop it longer than 1 year.

I use Swica for my kid’s supplemental insurance and Assura for mandatory insurance. Yes, you can only get Swica’s supplemental insurance if you sign up for their mandatory insurance as well, so I got Swica’s mandatory insurance for 1 year to get the supplemental and then moved the mandatory to Assura. The value-for-money of Swica supplemental insurance is hard to beat. Only the cover for orthodontics is weaker than some other insurers (namely Visana with 80% cost coverage compared to Swica’s 50% coverage). For 2 of my kids I got the dental insurance as well, as that extends coverage and has saved me money.

I pay around 130 francs per month for my 3 kids combined, for all supplemental insurance (Top, Optima, etc.) including dental insurance for 2 of the kids. I get out 1800 francs per year just from the coverage for swimming pool/sports club, etc. subcriptions. Then dentist and orthodontics benefits on top. Another useful feature is that you get unlimited checkups with no deductible. The combined deductible (with mandatory) is actually beneficial because whether you claim on mandatory or supplemental, it all counts towards your deductible.

If you want to get your kids the best orthodontics coverage, on the other hand, I’d look at Visana. AFAIK they offer supplemental without mandatory. They have good coverage for natural remedies.

If you already have preexisting health or dental conditions, then I recommend you stick with Assura or at least get a full confirmation of acceptance by another insurer before suspending your current insurance. Swica, for example, requires bitewing x-rays for dental insurance applications.

Risky bet. What happens if they find out and invalid it? Supplemental is not compulsory for them to pay.

I think I read in Bon à Savoir that it’s forbidden by law to stop the LCA for the sole reason that you change your LAMAL but they might find another reason to stop your contract if they really want I guess, not sure that an insurance with such high reputation would want to do that.

Thanks @Daniel for the feedback. I will see with the person who call me back from Assura, I might be too late to find and approve a new one on time to stop with Assura unfortunately (as I discover the 6 months per-notice instead of the “usual” 3 months for end of the year).
I’m just wondering now if I can change each year or if I’m back stuck for another 5 years, another question I will ask when I get a contact.

Then if I have the possibility to change this year or next year, I might take the opportunity. I found Swica expensive but didn’t thought about sport and swimming pool cashback. From you experience, you must have an season pass for a swimming pool or you can send individual entry tickets (I guess not, otherwise how can they know it’s yours)? We don’t use fitness, we prefer outdoor sport and activities (I personally prefer eSport but I guess they will not give me anything for a new RTX graphic card purchase :laughing:).

Nevertheless I’m mostly OK with our contract at Assura, I like the website (beside you cannot do everything on it but I guess others don’t offer better) and the phone app to scan bills (before I was sending all at once in January, now I send as soon as I pay the bill, so I get the cashback much sooner and free up the money for other expense or investment). So already if I can figure out what is this Previsia coverage and if it’s really bringing something and clean up the accident included for everyone LCA, then I might stay with them until I get a good offer (I use to have a discount with Swica with my former employer but didn’t took the opportunity before we got kids, now I regret a little but maybe I might get it again with a future job).

You can get supplemental insurance with 1-year minimum terms. Those 5-year terms are generally pushed by agents for higher comissions or offered by insurers at a discount. I would always recommend 1-year minimum terms.

Most Swiss health insurers let you take out supplemental insurance alone. Swica is an exception in this case, in that it only offers supplemental along with mandatory. But they are two separate policies and you have every right to quit one contract and keep the other.

In fact, I only got the dental insurance from Swica after I had already cancelled the mandatory insurance.

For kids, I don’t find Swica expensive at all. For adults it’s midway. It really comes down to whether you use the allowance for gyms/pools/courses. That’s up to 800 francs of value, so more than covers the childrens’ premiums. This year I got annual passes to a thermal swimming pool, which is where we go on rainy weekends and in winter. If you don’t need that kind of thing, then the value is much lower. Visana which has higher orthodontics coverage might be a better choice in that case.

In my case, I realized at one point that supplemental really isn’t worth it for me. The mandatory covers me fine and supplemental costs a lot for adults. But for the kids supplemental is pretty crucial because of dental work.

That’s correct. Your mandatory and supplemental health insurance are two separate contracts. Insurance companies won’t cancel the supplemental if you quit their mandatory. I’ve done this twice (once when I changed mandatory from Visana to Agrisano, and again when I changed mandatory from Swica to Assura). I never had any issues with keeping the supplemental insurance.

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I was wondering, starting from what age should you get a dental complementary insurance for your kids?

Before they are born.

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Fully agree. you should actually get dental insurance before birth if you can. Its one of the best ways to avoid getting denied and can cover some birth complications with the palette. Otherwise I believe its best before 2y.o…the rates are actually quite reasonable even in Swizerland :wink:

I have the same coverage for my kids, but I’ve never thought about submitting swimming lessons etc. Did you just send in the registration for them? I totally agree that the combined deductible aspect of SWICA is a nice advantage especially if you plan to use the complementary actively…though they are not the frugal choice for premiums, the service has been amazing especially when my wife got quite sick in 2019 (thankfully better now).

I see, thanks for the hint. I checked with assura, that would be their product called denta plus right? I saw it would cost ~22 CHF per month extra, is it really worth the money?

I’m also wondering if it worth it at all for adults. But my supplemental is not so expensive, less than 30frs per month (it always look cheap when you compare to the basis) and cover some cases that might end up with an extremely high bill (like emergency transportation from abroad) but everything that give you back only some hundreds once every 3-4 years when you have pay as much in total if not more, I really don’t need them. Unless there is some “trick” like with Swica to cover activities that we would do anyway but that’s not the case right now.

It’s the same question here. Dental Plus at Assura, even for kids, is not necessarily worth it. For adults it’s already proven that it barely worth it in almost all cases when you use it and of course you “loose” even more if you didn’t use it, so better save this money and invest it in case of issue in the future, to cover it yourself. For kids it’s more tricky, there is always this risk of orthodontic (is it the word in English? alignment correction) that might cost a lot and still a certain percentage of kids end up having it, but Assura Dental Plus is very sneaky, you have to add up with years to get the maximum reimbursement level. You can do the math, it cost about 20frs per month, so 240frs per year. They reinburse 80frs per year from the second year for cleaning, let’s say you max it up each year with a cleaning, I guess it always cost more than 80frs (not sure for kids, I should check), so you end up with 160fr per year but the first 5 you will not use it (if you start as new born), because kids don’t need clean up until at least 5 or 6years old, so you paid already 1200frs for almost nothing. They encourage you to start as soon as possible because of the second part of this sneaky coverage. They cover 80% of dental correction cost but only up to 500frs*the number of full year you paid the insurance for. So if you don’t need orhtodentic correction, you end up paying 3600frs (deduced the 80frs of annual cleaning covered), if they need it, assuming a cost of 7500frs, spread on 2 to 3 years starting not before 7, you would save 3900frs. So I would say, if the risk for our kid to have orthodentic issue is less than 50% and you are willing to take the risk to have to get out this kind of money at some point, don’t take the insurance. BUT it’s only if you start this as new born, if you start later, like at 4 year old or later, it’s already making you loosing money, or not saving in best case. So Assura Dental Plus is only good if you are not able to get out 7500frs over 2-3 years for dental correction and start as new born, if you start later you might already have a hint that it will not be necessary (up to 7 they don’t ask for an X-Ray, then they know already the risk and will refuse you if there is one).

My conclusion is that, if you didn’t start as new born, Assura is not the good one for you kid dental insurance. For adult, almost none of them are worth it.

I know the standard advice is to sign your kids up before birth. But I signed my kids up for dental and orthodontic insurance when they were already fairly old, and as it turned out they did end up needing some orthodontic work.

I think the pre-birth advice is based on a worst-case scenario where orthodontic issues are already obvious from a young age. But this does mean paying premiums for a long time before you are likely to claim any benefits.

Another good point to consider is that disability insurance (DI/IV/AI) fully covers serious hereditary/genetic orthodontic conditions. I think it’s safe to assume that problems which are serious enough to be identified before at the age of 6 at least would probably qualify for IV.

One more point re Assura dental insurance: AFAIK Assura is the only insurer, or at least one of the few, which covers dental care outside of Switzerland. Nearly all Swiss dental insurance offers only cover dental care in Switzerland.

If, for example, you could get the same work done for half the price in France, then your copayment would be cut in half. i.e. the 20% or 50% which the insurance doesn’t cover. This is something worth considering before dropping Assura.

Good point, I didn’t know that. But at the end, will you really got abroad with your kids every month to do the control and re-adjustment? if you leave really close to the border and find an orthodental doctor that accept you and has really much more advantageous rate. Not rejecting your option but questioning if people would do it. When I had Lassik eye correction, I was thinking about going in France or even in Turkey for it but at the end I did in Switzerland and didn’t regret, the comfort to be home 30min after you left the hospital and don’t have to travel back or stay in an hotel doing nothing for a week to save 1000, 2000frs top on a 4000frs total (cost in Switzerland) when you take everything into account (not even counting the days off you might have to take extra when going abroad).

It’s an option, but would you want it for you? and for your kids?

To be honest I’m planning on looking into the complementary insurance soon since I don’t know it as well as I’d like. Becomes very subjective I think on what the personal priorities are like so many things. But true that orthodontics were more or less certain for my kids based on my families history so I went with it before birth

Fully agree. But I did some quick math back in the day and the 52chf per month for my two kids combined should pay back easily in the first 1-2 years on the first to get orthodontics. I can post some amounts if this interests anyone - so far only consultations and rdv for moulds etc but should start soon.

It depends on where you live and how far you’re willing to drive to save, say 4-5000 francs on orthodontics. If you live very close to the German or French borders, it’s a definite plus. I use a local dental practice here in Zurich, but to be completely honest I consistently feel ripped off even with insurance, compared to what I paid in Germany when we lived across the border. So it really depends on your situation and preferences. In any case, it’s worth keeping in mind.

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