According to the law (Art. 5 of the General Part of the Social Insurance Act ATSG), maternity includes pregnancy and delivery as well as the subsequent recovery period of the mother. Maternity benefits under basic insurance are not subject to any out-of-pocket payment. This applies to benefits that are specifically listed in the Health Insurance Act. These are the following:Before birth:
- 7 check-ups
- 2 ultrasonic check-ups (11th to 14th and 20th to 23rd week of pregnancy)
- Prenatal care: Insurers will contribute 150 francs towards antenatal classes led by a midwife on a one-to-one basis or in a group, or towards a consultation with a midwife covering the birth, the planning and organization of postnatal care at home and breastfeeding advice.
- 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.
- Care at home by a midwife up to 56 days after birth. Unless prescribed otherwise by a doctor, 10 home visits are included.
- 3 breastfeeding consultations with a midwife or a lactation consultant
- 1 check-up (6–10 weeks after delivery)
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 eight weeks after birth. This encompasses, for example, hospitalization to avoid premature birth, treatment of gestational diabetes and infections or psychotherapy due to post-natal depression.
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 300 francs in order to keep costs as low as possible should an elective C-section not be fully covered by your health insurance provider.
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.