# Dispute over supplementary insurance

Your supplementary insurance to your health insurance is a private contract, not a social insurance relationship. In a dispute – for example over a refused benefit, a termination, or an alleged breach of the duty of disclosure – different rules therefore apply than for basic insurance: no ruling, no objection procedure, but the contract, the general insurance conditions (AVB) and the Insurance Contract Act (VVG).

This guide covers: Disputes arising from private supplementary insurance to health insurance: hospital (semi-private/private), dental treatment, complementary medicine, daily sickness benefits and similar. These contracts are governed by the Insurance Contract Act (VVG), not social insurance law.

Not covered: Compulsory basic insurance (KVG) with its ruling and objection procedure – there is a separate overview for that. Life insurance and private supplementary insurance outside health care (for example pure accident supplementary insurance) are not covered here either.

## Your answers

- What is your dispute with the supplementary insurance about? (It is refusing or reducing a benefit / It is relying on incorrect or missing information given when the contract was concluded / It concerns termination of the contract / It concerns the premium or an arrears in payment / I don't know exactly)
- Have you already received anything in writing from the insurer about this? (Yes / No / I don't know)
- Has your canton designated a single court for disputes of this kind? (Yes / No / I don't know)

## Watch out

If the insurer asked you about a material fact when the contract was concluded and you concealed it or gave incorrect information, although you knew or should have known it, it can terminate the contract in writing. The termination takes effect from the time it reaches you, not retroactively (Art. 6 para. 1 VVG). The insurer then also does not have to pay for losses that have already occurred, to the extent the concealed fact affected them, and can reclaim such benefits (Art. 6 para. 3 VVG). Important: the right to terminate lapses four weeks after the insurer learned of the breach (Art. 6 para. 2 VVG). This time limit only begins once it knows for certain and completely; a mere suspicion, for example from a doctor's bill, is not enough. The insurer must prove that it met the time limit. So ask when the insurer had the relevant information.

*Applies if: What is your dispute with the supplementary insurance about? → It is relying on incorrect or missing information given when the contract was concluded / I don't know exactly*

Sources: [VVG · Art. 6](https://www.fedlex.admin.ch/eli/cc/24/719_735_717/de#art_6), [BGer 4A_366/2020 vom 29. September 2020, E. 3.1](https://mcp.opencaselaw.ch/entscheid/bger_4A_366_2020#e-3-1)

If you concluded your contract before 1 January 2022, partly different rules apply to a breach of the duty of disclosure and to arrears in premium payment than those described here. Of the new provisions, only the formal requirements and the rights of termination under Art. 35a and 35b VVG apply to older contracts; everything else is governed by the law then in force (Art. 103a VVG). If you no longer know the date your contract was concluded, or are unsure, ask your insurer when the contract began, or get advice, before relying on the rules described here.

*Applies if: What is your dispute with the supplementary insurance about? → It is relying on incorrect or missing information given when the contract was concluded / It concerns the premium or an arrears in payment / I don't know exactly*

Sources: [VVG · Art. 103a](https://www.fedlex.admin.ch/eli/cc/24/719_735_717/de#art_103a)

If only part of a loss has occurred and you claim benefits for it, the law in principle allows either side to terminate the contract at the latest on payment (Art. 42 para. 1 VVG). In supplementary insurance to social health insurance, however, only the insured person as policyholder has this right, not the insurer; only in collective daily allowance insurance do both sides have it (Art. 35a para. 4 VVG). If you terminate, cover ends 14 days after the insurer is notified of the termination (Art. 42 para. 2 VVG). If you terminate within the year after the contract was concluded, the premium for the current insurance period remains owed (Art. 42 para. 3 VVG).

*Applies if: What is your dispute with the supplementary insurance about? → It concerns termination of the contract / It is refusing or reducing a benefit / I don't know exactly*

Sources: [VVG · Art. 42](https://www.fedlex.admin.ch/eli/cc/24/719_735_717/de#art_42), [VVG · Art. 35a](https://www.fedlex.admin.ch/eli/cc/24/719_735_717/de#art_35a)

If you do not pay the premium on time, the insurer must send you a written reminder, give you 14 days from when the reminder was sent, and point out the consequences (Art. 20 para. 1 VVG). If this time limit passes unused, the insurer's duty to pay benefits is suspended from then on (Art. 20 para. 3 VVG) – an event during this period may therefore not be covered. So check whether you received a valid reminder with a 14-day time limit at all.

*Applies if: What is your dispute with the supplementary insurance about? → It concerns the premium or an arrears in payment / I don't know exactly*

Sources: [VVG · Art. 20](https://www.fedlex.admin.ch/eli/cc/24/719_735_717/de#art_20)

Claims under the insurance contract become time-barred five years after the event giving rise to the duty to pay benefits (Art. 46 para. 1 VVG); for collective daily sickness benefit insurance it is only two years (Art. 46 para. 3 VVG). A contractual shortening of this time limit is invalid (Art. 46 para. 2 VVG). Once it has expired, you can no longer enforce your claim in court – act in good time. Limitation is interrupted, for example, by debt enforcement proceedings, a request for conciliation or a legal action, or if the insurer acknowledges the claim (Art. 135 OR). A letter or an enquiry to the Ombudsman's Office is not enough for this.

Sources: [VVG · Art. 46](https://www.fedlex.admin.ch/eli/cc/24/719_735_717/de#art_46), [OR · Art. 135](https://www.fedlex.admin.ch/eli/cc/27/317_321_377/de#art_135)

## What to do

**1.** Ask the insurer for written reasons: which provision of the contract or of the general insurance conditions (AVB) is it applying? Keep the policy, the AVB, the completed health questionnaire and all correspondence. Without these documents it is hardly possible to judge whether the insurer is right, and you will need them for advice or any legal action.

**2.** If you have not yet received anything in writing, ask the insurer in writing to give reasons for its refusal, termination or demand, and set a reasonable time limit, for example 10 to 14 days. This written reply is the basis for everything that follows – without it, neither advice nor a legal action can be properly prepared.

*Applies if: Have you already received anything in writing from the insurer about this? → No / I don't know*

**3.** Examine the written communication closely: which provision of the contract, the AVB or the law does the insurer rely on? Is the date correct, and exactly when did the communication reach you? Were the policy and the AVB properly handed to you when the contract was concluded? You will need these details for advice or a legal action.

*Applies if: Have you already received anything in writing from the insurer about this? → Yes*

**4.** If the insurer refuses or reduces a benefit, compare the reasons given with your policy and the AVB: does the insurer name a specific exclusion clause or reservation? Is it missing documents in its view? Submit any missing medical records and ask for a written reassessment before you consider further steps.

*Applies if: What is your dispute with the supplementary insurance about? → It is refusing or reducing a benefit / I don't know exactly*

## The law

Your supplementary insurance to your health insurance – for example for semi-private/private hospital care, dental treatment or complementary medicine – is a private-law contract. Such supplementary insurance is governed by the Insurance Contract Act (VVG), not the Health Insurance Act (KVG). This means: the insurer does not issue a ruling, and there is no objection procedure as there is for basic insurance. What matters is your contract, the general insurance conditions (AVB) and the VVG. In a dispute you must, if necessary, sue for your claim before the civil court.

Sources: [KVAG · Art. 2](https://www.fedlex.admin.ch/eli/cc/2015/839/de#art_2)

Only insurance that covers the risks of illness, accident or maternity and supplements the benefits of compulsory health insurance counts as supplementary insurance to social health insurance. Under case law, a private insurance that, for example, only improves the benefits of accident insurance (UVG) does not belong to this category; the special court jurisdiction under Art. 7 ZPO does not apply to it.

Sources: [BGer 4A_169/2023 vom 31. Januar 2024, E. 4.2](https://mcp.opencaselaw.ch/entscheid/bger_4A_169_2023#e-4-2), [ZPO · Art. 7](https://www.fedlex.admin.ch/eli/cc/2010/262/de#art_7)

When the contract was concluded, you had to answer truthfully all questions the insurer asked about your health and other risk factors, as far as you knew or should have known the facts (Art. 4 VVG). Material facts are those that could have influenced the insurer's decision to conclude the contract at all, or to conclude it on these terms. Anything the insurer asked about clearly and unambiguously counts as material.

*Applies if: What is your dispute with the supplementary insurance about? → It is relying on incorrect or missing information given when the contract was concluded / I don't know exactly*

Sources: [VVG · Art. 4](https://www.fedlex.admin.ch/eli/cc/24/719_735_717/de#art_4)

Despite a breach of the duty of disclosure, the insurer may not terminate the contract if, for example: the concealed fact had ceased to exist before the event occurred; the insurer itself caused the incorrect or missing information; it already knew or should have known the fact; it has waived the right to terminate; or a question remained unanswered and the insurer concluded the contract anyway (Art. 8 VVG). If one of these exceptions applies, object to the termination in writing and give your reasons.

*Applies if: What is your dispute with the supplementary insurance about? → It is relying on incorrect or missing information given when the contract was concluded / I don't know exactly*

Sources: [VVG · Art. 8](https://www.fedlex.admin.ch/eli/cc/24/719_735_717/de#art_8)

The contract can be terminated in the ordinary way at the earliest for the end of the third year and thereafter for the end of any further year, with three months' notice (Art. 35a para. 1 VVG); other time limits, equal for both sides, can be agreed. Important for supplementary insurance to social health insurance: this ordinary right of termination belongs only to you as the policyholder, not to the insurer (Art. 35a para. 4 VVG). Only in collective daily sickness benefit insurance may both sides terminate in the ordinary way.

*Applies if: What is your dispute with the supplementary insurance about? → It concerns termination of the contract / I don't know exactly*

Sources: [VVG · Art. 35a](https://www.fedlex.admin.ch/eli/cc/24/719_735_717/de#art_35a)

Either side can terminate the contract at any time for good cause (Art. 35b VVG), for example on an unforeseeable change in the law that makes performance of the contract impossible, or if continuing the contract can no longer reasonably be expected in good faith. No notice period applies to this. The termination must be made in writing or in another form that can be evidenced by text, for example by email.

*Applies if: What is your dispute with the supplementary insurance about? → It concerns termination of the contract / I don't know exactly*

Sources: [VVG · Art. 35b](https://www.fedlex.admin.ch/eli/cc/24/719_735_717/de#art_35b)

If the insurer does not legally pursue the outstanding premium within two months of the reminder period expiring, it is deemed to have withdrawn from the contract and to have waived the overdue premium (Art. 21 para. 1 VVG). If the insurer nevertheless later demands or accepts the premium, its duty to pay benefits only revives once you have paid the overdue premium together with interest and costs (Art. 21 para. 2 VVG).

*Applies if: What is your dispute with the supplementary insurance about? → It concerns the premium or an arrears in payment / I don't know exactly*

Sources: [VVG · Art. 21](https://www.fedlex.admin.ch/eli/cc/24/719_735_717/de#art_21)

If your canton has designated a single court for disputes arising from supplementary insurance to social health insurance (Art. 7 ZPO), that court decides directly as the sole cantonal instance. No prior conciliation procedure then takes place (Art. 198 let. f ZPO); you file your claim directly with that court. Whatever the amount in dispute, the simplified procedure applies (Art. 243 para. 2 let. f ZPO).

*Applies if: Has your canton designated a single court for disputes of this kind? → Yes / I don't know*

Sources: [ZPO · Art. 7](https://www.fedlex.admin.ch/eli/cc/2010/262/de#art_7), [ZPO · Art. 198](https://www.fedlex.admin.ch/eli/cc/2010/262/de#art_198), [ZPO · Art. 243](https://www.fedlex.admin.ch/eli/cc/2010/262/de#art_243)

If your canton has not designated such a court (Art. 7 ZPO), the ordinary rules on jurisdiction apply: usually a conciliation attempt first, then the claim before the competent civil court. There too, the simplified procedure applies to your dispute regardless of the amount in dispute (Art. 243 para. 2 let. f ZPO). You can find out whether your canton has designated a court under Art. 7 ZPO from the cantonal court administration or a legal advice centre.

*Applies if: Has your canton designated a single court for disputes of this kind? → No / I don't know*

Sources: [ZPO · Art. 7](https://www.fedlex.admin.ch/eli/cc/2010/262/de#art_7), [ZPO · Art. 243](https://www.fedlex.admin.ch/eli/cc/2010/262/de#art_243)

## Costs

No court costs are charged for disputes arising from supplementary insurance to social health insurance, either in the conciliation procedure or in the decision procedure (Art. 113 para. 2 let. f and Art. 114 let. e ZPO). In the conciliation procedure, no party compensation is awarded either, as a rule (Art. 113 para. 1 ZPO). In court proceedings, however, the losing party in principle bears the costs of proceedings. This includes party compensation, above all the other side's lawyer's costs (Art. 95 and 106 ZPO).

Sources: [ZPO · Art. 113](https://www.fedlex.admin.ch/eli/cc/2010/262/de#art_113), [ZPO · Art. 114](https://www.fedlex.admin.ch/eli/cc/2010/262/de#art_114), [ZPO · Art. 95](https://www.fedlex.admin.ch/eli/cc/2010/262/de#art_95), [ZPO · Art. 106](https://www.fedlex.admin.ch/eli/cc/2010/262/de#art_106)

## Advice

If a larger amount is at stake, if a termination endangers your insurance cover, or if the insurer relies on a breach of the duty of disclosure, it is usually worth getting advice from an insurance law specialist before you let a time limit pass or sign anything. This overview does not replace legal advice in an individual case.

## Help

The Health Insurance Ombudsman's Office mediates free of charge between you and your insurer – including in disputes arising from supplementary insurance under the VVG. It does not replace a court, but can often contribute quickly and without red tape to a solution before you sue. However, an enquiry to it does not interrupt any time limits – keep an eye on limitation periods and notice periods.

Many cantonal bar associations offer a free or low-cost initial legal consultation. Use such an offer to assess your prospects of success and how to proceed, before you miss a time limit or sign a declaration.

## Sources

- [KVAG · Art. 2](https://www.fedlex.admin.ch/eli/cc/2015/839/de#art_2)
- [VVG · Art. 4](https://www.fedlex.admin.ch/eli/cc/24/719_735_717/de#art_4)
- [VVG · Art. 6](https://www.fedlex.admin.ch/eli/cc/24/719_735_717/de#art_6)
- [VVG · Art. 8](https://www.fedlex.admin.ch/eli/cc/24/719_735_717/de#art_8)
- [VVG · Art. 35a](https://www.fedlex.admin.ch/eli/cc/24/719_735_717/de#art_35a)
- [VVG · Art. 35b](https://www.fedlex.admin.ch/eli/cc/24/719_735_717/de#art_35b)
- [VVG · Art. 42](https://www.fedlex.admin.ch/eli/cc/24/719_735_717/de#art_42)
- [VVG · Art. 46](https://www.fedlex.admin.ch/eli/cc/24/719_735_717/de#art_46)
- [VVG · Art. 103a](https://www.fedlex.admin.ch/eli/cc/24/719_735_717/de#art_103a)
- [VVG · Art. 20](https://www.fedlex.admin.ch/eli/cc/24/719_735_717/de#art_20)
- [VVG · Art. 21](https://www.fedlex.admin.ch/eli/cc/24/719_735_717/de#art_21)
- [ZPO · Art. 7](https://www.fedlex.admin.ch/eli/cc/2010/262/de#art_7)
- [ZPO · Art. 113](https://www.fedlex.admin.ch/eli/cc/2010/262/de#art_113)
- [ZPO · Art. 114](https://www.fedlex.admin.ch/eli/cc/2010/262/de#art_114)
- [ZPO · Art. 198](https://www.fedlex.admin.ch/eli/cc/2010/262/de#art_198)
- [ZPO · Art. 243](https://www.fedlex.admin.ch/eli/cc/2010/262/de#art_243)
- [BGer 4A_169/2023 vom 31. Januar 2024, E. 4.2](https://mcp.opencaselaw.ch/entscheid/bger_4A_169_2023#e-4-2)
- [BGer 4A_366/2020 vom 29. September 2020, E. 3.1](https://mcp.opencaselaw.ch/entscheid/bger_4A_366_2020#e-3-1)
- [ZPO · Art. 95](https://www.fedlex.admin.ch/eli/cc/2010/262/de#art_95)
- [ZPO · Art. 106](https://www.fedlex.admin.ch/eli/cc/2010/262/de#art_106)
- [OR · Art. 135](https://www.fedlex.admin.ch/eli/cc/27/317_321_377/de#art_135)

## Official information

- [Health Insurance Ombudsman's Office](https://om-kv.ch/)
- [Cantonal bar associations (free legal information)](https://www.sav-fsa.ch/de/kantonale-anwaltsverb%C3%A4nde)

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Statute texts checked on 28 September 2026. General legal information. It does not replace individual advice.

https://swisslaw.io/en/health/supplementary/ · swisslaw.io, health.supplementary, 2026-09-28 · CC BY 4.0