Glasses and contact lenses: cost coverage by the health insurance
The health insurance offers contributions to cover the costs of glasses, lenses and contact lenses with supplementary insurance. The benefits of supplementary insurance for spectacles and contact lenses vary from health insurance to health insurance.
Does health insurance pay for glasses?
Compulsory basic health insurance does not normally cover the cost of glasses and contact lenses for adults in Switzerland. The basic insurance covers glasses if there is a severe visual impairment or a special medical indication. For children and young people under the age of 18, the contributions for glasses and contact lenses are covered by the health insurance if prescribed by a doctor.
What does the health insurance pay for glasses?
The health insurance pays an average of CHF 300 per year for glasses. The cost sharing varies depending on the health insurance company and the supplementary insurance chosen. Some health insurance companies offer lump sums or a percentage of the costs for visual aids up to a certain maximum amount, which is granted every three years.
When does the health insurance pay for glasses or contact lenses?
In Switzerland, the compulsory basic health insurance pays for glasses or contact lenses in certain cases:
- Children and adolescents under the age of 18
Basic health insurance covers the cost of glasses and contact lenses if there is a doctor's prescription. However, the cost sharing may vary depending on the health insurance company.
- Severe visual impairment or special medical indications
For adults, the basic insurance usually covers the cost of glasses or contact lenses only if there is a severe visual impairment or a special medical indication. For example, after cataract surgery or in the case of certain eye diseases that require special visual aids.
How can I submit the glasses to the health insurance fund?
You have to submit a claim to the health insurance fund for the cost of the glasses in order to receive a contribution towards the cost of the glasses from the health insurance fund. You must follow the steps below to submit a claim for glasses or contact lenses to your health insurance company.
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Make sure your insurance covers the cost of glasses or contact lenses. Check the terms and conditions of your basic and/or supplementary insurance or ask your health insurer directly.
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Collect all the necessary documents, such as a doctor's prescription for the glasses or contact lenses (especially for children and adolescents under 18 years of age or in case of a severe visual impairment) and the bill from the optician or ophthalmologist showing the cost of the visual aid.
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Submit the documents to your health insurance fund. The documents can be sent by post, e-mail or via the health insurance company's online portal, depending on the requirements of your health insurance company.
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Wait for the health insurance company's feedback regarding cost sharing. The health insurance company will review your application and reimburse you the approved amount, depending on the terms of your insurance.
How much does the supplementary insurance pay for glasses and contact lenses?
Supplementary insurances pay between CHF 100 and CHF 420 per year for glasses and contact lenses. List of supplementary insurances that contribute to the costs of glasses/contact lenses:
| Health insurance | Supplementary insurance & cost coverage |
|---|---|
| Helsana | Completa: 90% bis max. CHF 300 pro Jahr Completa Extra: 100% bis max. CHF 300.–/Jahr – 100% bis max. CHF 750.–/Auge und Kalenderjahr für Augenlaserkorrekturen |
| Swica, Provita | Completa Top: 90% der Optikerrechnung, bis CHF 200 alle 3 Jahre Optima: +90% bis CHF 300.– alle 3 Jahre Suplementa: +90% bis CHF 300 alle 3 Jahre |
| Sympany | Plus: bis CHF 270.- bei Kindern, Erwachsene alle 3 Jahre Premium: bis CHF 420.- bei Kindern, Erwachsene alle 3 Jahre |
| Visana | Basic, Ambulant 2/3: 90% bis max. CHF 300.–/Jahr, Erwachsene alle 3 Jahre |
| Sanitas | Classic: bis CHF 200.- bei Kindern pro Jahr, Erwachsene bis CHF 300.- alle 3 Jahre |
In which exceptional cases does the basic insurance pay for glasses and contact lenses?
In Switzerland, compulsory basic insurance does not normally cover the cost of glasses and contact lenses for adults. However, there are some exceptions where the basic insurance covers the cost of visual aids:
Children und Adolescents
For children and adolescents under the age of 18, the basic insurance covers the costs of spectacle lenses and contact lenses if there is a doctor's prescription confirming a change in visual acuity. The cost contribution is CHF 180 per year.
People with special illnesses
For adults, basic insurance only covers the cost of glasses or contact lenses if there is a severe visual impairment or a special medical indication. Examples are:
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After cataract surgery (cataract).
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In the case of certain eye diseases that require a special visual aid.
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In the case of congenital or acquired severe visual impairments.
When are children's glasses covered by health insurance?
In Switzerland, the compulsory basic health insurance covers the cost of children's glasses if there is a doctor's prescription confirming a change in visual acuity. The cost contribution is CHF 180 per calendar year. It is important to check the terms and conditions of your health insurance to know exactly what is covered.
Does the health insurance pay for glasses for diabetes?
Health insurance does not usually pay for glasses specifically due to diabetes. The compulsory basic insurance only covers the cost of glasses and contact lenses in cases of severe visual impairment or special medical indications. However, if there is a severe visual impairment due to diabetes, the cost of glasses or contact lenses may be covered. In such cases, it is advisable to contact your health insurance company directly and check the conditions of your insurance policy.
Does the health insurance cover blue light filter glasses?
Compulsory basic health insurance in Switzerland does not normally cover blue light filtering glasses as they are not considered medically necessary. If you would nevertheless like cost-sharing for blue light filter glasses, you should check whether your supplementary insurance covers such glasses. The conditions and the extent of cost sharing vary depending on the health insurance company and the insurance model chosen. It is advisable to check the conditions of your supplementary insurance policy or ask your health insurance company directly.