Pregnancy: What does the health insurer pay?

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Baby on the way? For parents-to-be, holding a positive pregnancy test in their hands marks the start of an exciting but also challenging time. During this time of great anticipation before the birth, there are many open questions. One of them being: How does insurance work in this situation – what do we pay ourselves, what does the health insurer pay with regard to pregnancy and birth?

During a pregnancy, a regular visit to the gynecologist or midwife is a matter of course. Precautionary checks are aimed at early detection of possible diseases or risks associated with the expectant mother and the unborn baby. The first routine examination usually takes place during the second or third month of pregnancy, and after that approximately every six weeks.

Maternity benefits under basic insurance

Firstly: All basic insurance policies cover the same benefits; this is  governed by law (only in german). Even in the case of free choice of hospitals, there is no difference between the mandatory healthcare insurance benefits. These are governed in the cantonal hospital lists.

It’s important to know that pregnancy complications up to the end of the 12th week of pregnancy are considered as illness. If treatment is necessary, the expectant mother must pay the excess and the deductible. As of the 13th week of pregnancy until eight weeks after birth, the cost contribution is waived. This means that you pay neither the excess nor the deductible.

These medical services are covered during pregnancy and the first few weeks after the birth:

  • Pregnancy check-ups: Pregnant women are entitled to seven examinations with a physician or midwife, two medical ultrasounds and lab analyses. In the case of a high-risk pregnancy, there is no limit to the number of examinations. If your doctor prescribes compression tights or medication because of the pregnancy, basic insurance will pay for these too.
  • Birth preparation class: Pregnant women who take a birth preparation class at a hospital or with a midwife receive CHF 150 from their basic insurance. These classes give you valuable information on childbirth as well as practical exercises. The best time to start a class is between the 24th and 28th week of pregnancy.
  • Childbirth: At the birth, services are covered for the general ward in a contractual hospital or birthing center in your own canton of residence as well as at home. The birth can be accompanied by a doctor or midwife.
  • Hospital stay: The mother’s basic insurance pays for the hospital stay of the mother as well as of the newborn child, provided the child is healthy. Five days of inpatient care after a spontaneous delivery and eight days after a cesarean section are provided for.
  • Postnatal care: Basic insurance pays for postnatal care provided by a freelance midwife. Depending on the birth situation, a maximum of ten to 16 home visits are granted within eight weeks.
  • Postnatal checkup/breastfeeding advice: Six to ten weeks after birth is time for a follow-up examination of the new mother with her physician. The health insurer covers the costs of three breastfeeding consultations with an expert trained for this purpose.

Pregnancy and supplementary insurance: Is it worth it?

Basic insurance covers many services for pregnant women and mothers. If you want greater privacy, to be able to choose your doctor, or benefit from special services, you should take advantage of additional insurance coverage.

Here are some examples for additional contributions that supplementary insurance covers depending on the service catalog:

  • Vitamin products: With a doctor’s prescription, you can receive contributions for vitamin products during pregnancy and breastfeeding.
  • Birth preparation and postnatal exercise classes: Here, you receive additional contributions for a birth preparation or postnatal exercise class.
  • Birth according to your wishes: Would you prefer to give birth at home or in a birthing pool? Here, too, supplementary insurance contribute to the costs.
  • Greater privacy: With supplementary hospital insurance, mothers and their newborn enjoy greater privacy in a one-bed or two-bed room. Contributions for a family room are often covered.
  • Free choice: Would you prefer to give birth at a hospital outside of your canton of residence? Would you like to have your gynecologist or midwife with you? With semi-private or private supplementary hospital insurance, the costs are covered. 

However, private insurance policies often include a waiting period within which no maternity benefits are paid out. AXA specifies a waiting period of one year from the start of Supplementary hospital insurance. This period is lifted if the insured woman switches from a comparable hospital insurance.

Insuring the baby: Tips on health insurance

Mandatory basic insurance

After giving birth, you have three months’ time to conclude health insurance for your baby. You child is covered from day one, retroactively and regardless of their health. Every health insurer must cover the baby unconditionally. You are therefore not required to insure your child with your own health insurance company, but rather you have free choice from among the approved health insurers.

As basic insurance benefits are stipulated by law, but the premiums vary, it is worthwhile to compare premiums. A tip: Use our independent comparison platform. Of course, you can also register your baby with your health insurer of choice even before the birth – then you will have your mind free and it will be enough to submit the first name and date of birth after your baby is born.

Voluntary supplementary insurance

If your baby is to be accepted without a health check, you must register the child for a supplementary insurance before the birth. Some health insurers have additional conditions for prenatal acceptance without a risk check: For example, at least one parent must already have a basic or supplementary insurance policy with the same insurer. Even after the birth, you can apply for your baby to be accepted to a supplementary insurance policy at any time. However, in this case you will have to fill out a health questionnaire. In other words: If your child is not completely healthy, the insurance may reject the application for your child or insist on a restriction or benefit exclusion.

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In short: Listen to your needs

Basic insurance covers all the necessary services with regard to pregnancy, birth and the beginning of motherhood. In Switzerland, mother and child are thus generally well protected and insured. It is a good idea to take out supplementary insurance for pregnant women if you wish to have more comfort and privacy and/or would like to benefit from additional contributions.

Pre-birth registration of a child for supplementary insurance is definitely recommended if you have a lot to gain and little to lose: If, after the birth, it should turn out that the baby has health problems, the contract is already concluded and the insurer cannot rescind it. On the other hand, if the child is completely healthy, the parents can easily terminate or switch the policy after the minimum contractual term – usually one year – if they discover a more suitable product in the meantime. Please note: Make a note in your calendar right away so that you don’t miss the three-month notice period.

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