Birth defect

Hereditary conditions or congenital diseases are also referred to as birth defects. These are medical conditions a child suffers from after its birth. A mere predisposition to a disease is not considered a birth defect.

Reimbursement of costs in case of birth defect

If a child is born with a birth defect, it needs to be registered with the disability insurance office at the canton of residence.

The cost of medical treatment of birth defects is paid by the disability insurance (DI) until the age of 20. Under the DI policyholders do not have to pay anything as it reimburses the full costs.

Starting from the age of 20, the cost of treatment is covered by basic insurance if it falls within the statutory scope of benefits. However, unlike with the DI, the benefits under health insurance are subject to out-of-pocket payments (deductible and coinsurance). The Health Insurance Act contains a list (in German, French and Italian only) of all recognised birth defects.