Ophthalmology

Direct access to ophthalmologists

Like gynaecologists, ophthalmologists (Augenärzte, ophtalmologues) can be accessed directly without a GP referral in most insurance models. Note that opticians (Optiker) are not medical doctors and bill separately from KVG.

What KVG covers in ophthalmology

KVG covers medically necessary eye care — diagnosis and treatment of eye diseases and conditions, including:

• Diagnosis and treatment of glaucoma
• Diabetic retinopathy screening and treatment
• Age-related macular degeneration (AMD) treatment
• Cataract surgery (when vision is clinically impaired)
• Treatment of infections (conjunctivitis, keratitis)
• Investigation of acute visual disturbance, flashes, or floaters
• Strabismus treatment in children
• Retinal detachment and other surgical emergencies

What KVG does not cover

• Routine refraction tests (glasses prescription check-ups in a healthy eye) — not covered unless clinically indicated
• Glasses and frames — not covered by KVG. Some supplementary insurance includes a contribution every two years.
• Contact lenses — generally not covered. Exception: lenses prescribed for specific medical conditions.
• Laser vision correction (LASIK, PRK) — considered elective, not covered.
• Cosmetic eye procedures

Children's eye care

Children's eye care is covered by KVG as part of the paediatric preventive schedule. Amblyopia treatment and glasses for children with a medical indication may receive a KVG contribution.

Supplementary insurance for eyes

Several supplementary insurance products include optical benefits: a contribution of CHF 200–400 every 1–2 years toward glasses or contact lenses, and contributions toward laser vision correction. Calculate whether the premium cost is worth the contribution.