Glasses and lenses: what does basic insurance cover?

Are you short- or far-sighted? Then you're not alone. Many Swiss people wear glasses or contact lenses. You rightly ask yourself: what costs are – and aren’t – covered for glasses or lenses under basic insurance?

What does basic insurance cover?

When it comes to the assumption of costs by basic insurance, a distinction must be made between children up to the age of 18 and adults.

Glasses and lenses for adults aged 19 and over

Adults generally receive no contribution to the costs of contact lenses and glasses from compulsory basic insurance. In 2011, visual aids for adults were removed from basic insurance.

In certain exceptional medical cases, basic insurance covers between CHF 180 and CHF 850 once a year per eye. These include, for example, eye surgery or disease-related changes in vision, such as those associated with diabetes. The amount of costs covered in such a case is specified in the List of medical supplies and devices (MiGel). Accident-related changes in vision may also be covered – these cases are governed by the Accident Insurance Act (UVG).

Glasses and lenses for children up to the age of 18

For babies and children, basic insurance covers CHF 180 per calendar year for glasses and lenses. This applies up to the age of 18.

Does supplementary insurance for glasses and lenses make sense?

Yes, supplementary insurance for spectacle lenses and contact lenses can make sense.

In Switzerland, there is no specific supplementary insurance only for visual aids. However, many supplementary insurance policies contribute to the cost of contact lenses and glasses. What the supplementary insurance costs, how much the cost contribution is, and how often this is paid depends on the provider and the insurance you choose.

Do I need an ophthalmologist’s prescription to cover the costs?

A distinction must be made between basic and supplementary insurance and between children and adults.

• Basic insurance for children up to the age of 18: An ophthalmologist’s prescription is required for the health insurer to cover the costs of spectacle lenses and contact lenses.
• Adults with supplementary insurance: This may vary depending on the provider. With supplementary insurance from AXA, prescription glasses or lenses are paid for without a prescription.

Sight tests: What do basic and supplementary insurance cover?

Depending on the case, there are different rules on what basic and supplementary insurance cover:

• A medically necessary sight test by an ophthalmologist is covered by basic insurance. In some cases, supplementary insurance also contributes to preventive examinations and thus also to a preventive sight test by an ophthalmologist.
• A sight test by an optician is not insured. Tip: Often, a sight test is free when buying glasses or contact lenses.