What is reimbursed under odonto-stomatological treatment?

Odonto-stomatological treatment refers to the branch of medicine and dentistry that focuses on the diagnosis, prevention, and treatment of conditions affecting the teeth, gums, mouth, and related structures (i.e., the oral cavity). It covers both odontology (dental care and treatment) and stomatology (medical treatment of the mouth and its associated structures).

Covered treatments include dental procedures such as fillings, crowns, root canals, implants, laboratory charges for dentures, prosthetic dental fees, and radiology/radiography fees.

Cosmetic procedures, such as teeth whitening, are not covered as they are not deemed medically necessary.

Dental treatment is reimbursed at 80% up to the dental credits available at the time when the treatment has been done.
The amount changes at the beginning of each year, since credits may be accumulated for two years only: for the current year and the previous year.

What exactly is my dental credit balance? 

The dental credit of each member is CHF 2,500.- per year, cumulative over 2 years. Therefore, it is a total maximum of CHF 5,000.-, except for new members during the first year of affiliation, for whom the calculation is made pro rata, on a monthly basis, and the credits of upcoming months may not be used in advance.

It is imperative to note that expenses will always erode the credit of the ongoing year first (the year when the expenses were incurred). Should this be insufficient, any carryover credits from the previous year will be further eroded.  This means that if you have expenses of CHF 2,500.- or more in any given year, you will not carry over any credits to the next year.

You may check your up-to-date dental credit balance on the eClaims portal and in the UNSMIS mobile app.

I have a temporary contract for less than three months, am I still entitled to reimbursement for dental care? 

For temporary staff with a contract of less than 3 months, dental treatment is not covered, except for emergency treatments approved by the Medical Adviser. These are reimbursed at 80% up to a maximum of CHF 500.-.

For further details, see: Internal Rules, Annex V (available here)

I have a secondary dependent. Do they have the same coverage as me? 

Dental treatments are not covered in the first year following enrolment for secondary dependents. After the first year, dental treatments are reimbursed at 80% up to an annual ceiling of CHF 1,000.- (non-cumulative).

For further details, see: Internal Rules, Annex IV (available here)

What is reimbursed under orthodontic treatment? 

Orthodontic treatment is a specialized field within dentistry that concentrates on the diagnosis, prevention, and correction of dental and jaw misalignments (malocclusions). Eligible treatments include braces, clear aligners (such as Invisalign), retainers, and more advanced procedures like jaw surgery.

Orthodontic treatments do not require prior authorization. These treatments are reimbursed at a rate of 80%, subject to the dental credits available at the time of treatment. The cost of orthodontic appliances is also eligible for reimbursement.

Please be aware that invoices are only accepted once the treatment has been completed. However, orthodontic procedures are typically prolonged and may involve advance payments. We suggest you request the clinic/orthodontist to issue invoices for treatment phases occurring over defined intervals (for example, every three to six months). Additionally, obtaining a treatment plan will allow you to submit claims periodically.

When submitting a claim, it is essential to attach all relevant documentation to each individual claim. The Claims Team can only access the supporting documents attached to the specific claim being processed. Documents attached to previous claim reimbursement submissions should be resubmitted if necessary for the reimbursement of other claim submissions.