Pregnancy & costs: health insurance benefits
Pregnancy involves medical costs. What does basic health insurance during your pregnancy? Comparis explains which maternity benefits are provided by your insurer.
21.07.2022
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1. How much does a pregnancy cost?
As a rule, you do not have to pay any contribution to the costs of medical services relating to maternity. This means that with mandatory basic insurance, you will not be liable for an excess, deductible or contribution to hospital costs This applies to benefits that are specifically listed in the Health Insurance Act.
Out-of-pocket expenses in the event of illness
From the 13th week of pregnancy until the 8th week after birth, you no longer owe any additional costs in the event of illness, accident or congenital anomalies. This treatment includes, for example, hospitalisation to avoid premature birth, treatment of gestational diabetes or psychotherapy due to post-natal depression.
There are, however, two exceptions to this rule: you must continue to pay some of the cost of preventive treatment (e.g. PAP smear) and dental treatments.
Definition of maternity
According to the law (Art. 5 of the Federal Act on General Aspects of Social Security Law, ATSG), maternity includes pregnancy and delivery as well as the subsequent recovery period of the mother.
2. How can I report incorrect maternity-related bills?
Often it is not obvious to the health insurance company whether expenses are due to pregnancy. It is therefore advisable to mention the fact that you are pregnant on the invoices you submit.
If your health insurance sent you incorrect bills, you can object to them. You can also reclaim money retroactively and have incorrect invoices corrected for up to five years. Comparis can help:
3. What will my health insurance cover during pregnancy and childbirth?
Essential medical costs are covered by basic insurance. However, there are limitations.
7 check-ups (covered from the first week of pregnancy)
2 ultrasounds (11th–14th and 20th–23rd week of pregnancy)
150 francs for antenatal courses
This applies to courses conducted by a midwife individually or in a group. Or you can have a consultation with a midwife covering the birth, the planning and organization of postnatal care at home and breastfeeding preparation.
The health insurance company pays for the birth if you give birth in one of the following places:
General ward of a hospital
Birth centre according to the hospital list for the canton of residence
At home (home birth)
Care at home by a midwife up to 56 days after birth
As a rule 10 visits are included
After a premature birth, a multiple birth, after a caesarean and in the case of a first-time mothers, the midwife can make up to 16 home visits
3 breastfeeding consultations with a midwife or a lactation consultant
1 check-up (6–10 weeks after delivery)
In the case of medicines and medical products, the time of prescription plays a role. Anything you receive before the 13th week of pregnancy is not exempt from the co-pay.
If you receive medicines or items such as compression stockings after the 13th week of pregnancy, you do not owe any out-of-pocket expenses. This only applies if it is a sickness benefit.
You are not exempt from out-of-pocket expenses in the event of a miscarriage or medically indicated termination prior to the 13th week of pregnancy. This means that basic insurance pays for the treatments only after deduction of the deductible and excess.
You do not have to pay out-of-pocket expenses in the event of a miscarriage or medically indicated termination between the 13th and end of the 23rd week of pregnancy. This includes treatment for complications.
Your health insurance also pays for:
1 check-up
10 home visits by a midwife to care for and monitor the insured person
Health insurers class pregnancy terminations that are not medically indicated as an illness. Terminations are only permitted within 12 weeks of the last period. Therefore, the termination does not fall within the period during which you do not owe any co-pay, even in the event of illness. The resulting costs are assumed by basic insurance, less the deductible and excess.
4. High-risk pregnancy: what will my insurance cover in case of complications?
In case of a high-risk pregnancy, if your doctor thinks it is necessary your insurance may cover more than would otherwise be the case. In addition, basic insurance also covers a CTG scan to check your unborn baby's heartbeat. Under certain conditions, insurance might also cover:
First trimester screening
Non-invasive prenatal test (NIPT):
Amniocentesis, chorionic biopsy, cordocentesis
5. What will my insurance cover in case of a caesarean section?
Basic insurance covers the costs of a medically necessary caesarean section. In the case of an elective caesarean section that is not medically necessary, the health insurance can refuse to pay additional costs compared to natural birth.
6. Is it worth taking out supplemental insurance for pregnancy?
Basic insurance covers all medically necessary benefits relating to pregnancy and birth. However, if you want more flexibility, service or comfort, you will need special supplemental insurance. Depending on your needs, it is worth considering this. Find out more about the best health insurer for pregnant women in the article entitled Supplemental insurance during pregnancy.
