Wisdom teeth removal: what does health insurance cover?
Wisdom teeth removal is not only uncomfortable, it’s also expensive. Comparis explains the costs and what health insurance covers.
iStock/Kobus Louw
1. Wisdom teeth removal: costs in Switzerland
The cost of wisdom tooth surgery – also known as wisdom tooth extraction – is usually between 500 and 1,000 francs per tooth.
The price depends on what is known as the tariff point value of the dental practice. The scope and complexity of the operation also affect the costs. Follow-up treatments, such as check-ups or painkillers, can lead to additional costs. Get a quote and, if necessary, look for a second opinion.
2. When does health insurance pay for having a wisdom tooth taken out?
In most cases, wisdom teeth are extracted as a preventive measure. That is, they are removed before they cause problems. In this case, you cannot expect to be covered by your compulsory basic health insurance. This insurance only covers dental treatments in a few cases:
In the case of serious, unavoidable diseases of the masticatory system. The list of “unavoidable diseases of the masticatory system” is found in the Health Insurance Benefits Ordinance.
If the treatment is “due to a serious general illness or its consequences”.
If the wisdom tooth surgery is necessary to support and ensure the treatment of a serious general disease.
Subsequent reimbursement by health insurance
Would you like to ask your health insurer to cover your wisdom teeth removal at a later date? Then note that claims expire after five years. This time is counted from the moment the policyholder receives the medical bill.
3. When do I have to pay for my wisdom tooth extraction myself?
Is your wisdom tooth extraction not medically necessary? You will have to pay for the treatment yourself. A simple wisdom teeth removal does not meet the requirements for reimbursement of costs by your health insurer.
Mild caries or inflammation are not considered a serious illness in terms of basic insurance.
Your dentist must assess whether the extraction of your wisdom teeth meets the requirements for reimbursement of costs in consultation with your health insurer. You need to get an X-ray for this.
Are you planning on getting treatment abroad? Then check beforehand whether your insurance covers outpatient treatment outside Switzerland. Please also note any qualifying periods. The qualifying period is the time you must wait between entering into the contract and receiving benefits.
4. Does supplemental insurance cover wisdom teeth removal?
With supplemental dental insurance or supplemental outpatient insurance, you can reduce the cost of having wisdom teeth removed.
You can find an overview of the contributions from supplemental dental insurance and supplemental health insurance here (list not exhaustive).
| Insurance | Product | Contribution |
|---|---|---|
| Axa | Supplemental dental insurance | 50% to 75%, max. CHF 1,000 to 3,000 per calendar year* |
| Concordia | Dental insurance | 50% to 75%, max. CHF 500 to 2,000 per calendar year* |
| CSS | Dental care insurance | 50% to 75%, max. CHF 1,000 to 5,000 per calendar year* |
| CSS | MyFlex Balance and Premium | 50%, up to a max. of CHF 1,000 to 2,000 per calendar year* (from age of 18) |
| Groupe Mutuel | Dentaire plus | 75 %, max. CHF 1’000 bis 15’000 pro Kalenderjahr* |
| Helsana | TOP and Completa | 75%, up to a max. of CHF 10,000 per calendar year (up to 19 years of age) |
| Helsana | DENTAplus | 50 bis 75 %, max. CHF 3’000 pro Kalenderjahr* |
| KPT | Supplemental dental insurance | 50% to 75%, max. CHF 500 to 2,000 per calendar year* |
| Sanitas | Dental | 80%, max. CHF 2,000 to 5,000 per calendar year* |
| Sanitas | Family | 80% from the benefit account |
| Sanitas | Classic and jump | CHF 100 per tooth |
| Swica | Denta | 50% to 75%, max. CHF 500 to 2,000 per calendar year (from the age of 25)* |
| Sympany | Supplemental dental insurance | 50% to 75%, max. CHF 1,000 to 5,000 per calendar year* |
*Depending on the selected insurance level
As at: September 2024.
Good to know: before taking out supplemental dental insurance, you’ll usually need a certificate from a dentist confirming that your teeth are in good condition. For adults, taking out dental insurance is often not worth it in terms of price.
This article was first published on 10.12.2021
