What does my basic insurance pay in case of maternity?

According to the law (Art. 5 of the General Part of the Social Insurance Act ATSG), maternity includes pregnancy, delivery and the recovery period of the mother thereafter.

Before birth:
  • 7 check-ups
  • 2 ultrasonic check-ups (11th to 14th and 20th to 23rd week of pregnancy)
  • Contribution of CHF 100 toward antenatal classes held in a group and conducted by a midwife
During birth:
  • Full coverage in the general ward of a hospital or in a birthing centre according to the hospital list of the canton of residence. The same applies in case of a home birth.
After birth:
  • Care at home by a midwife up to 10 days after birth
  • 3 breastfeeding consultations with a midwife or a lactation consultant
  • 1 check-up (6–10 weeks after delivery)
High-risk pregnancy

In case of a high-risk pregnancy, basic insurance covers further measures if deemed clinically necessary.

Out-of-pocket expenses

The amendment to the law, which was decreed by the Federal Council, entered into force on 1 March 2014. It stipulates that women who fall ill during or after pregnancy (e.g. in case of complications) are no longer liable to any out-of-pocket payments starting from the 13th week of pregnancy until 8 weeks after birth. This encompasses, for example, hospitalisation to avoid premature birth, treatment of gestational diabetes and infections or psychotherapy due to post-natal depression.

Caesarian section

According to the Federal Social Insurance Office, there is no clear-cut jurisdiction regarding caesarean delivery on maternal request. If you are planning a pregnancy and want to be on the safe side, opt for the lowest possible deductible of CHF 300 in order to keep costs as low as possible should an elective C-section not be fully covered by your health insurance provider.

Good to know

Often it is not obvious to the health insurance company whether expenses are due to maternity. It is therefore advisable to mention the fact that you are pregnant on the invoices you submit.