Health

Pregnancy and birth: 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, there are many open questions. One of them being: How does insurance actually work in this situation – what do we pay, what does the health insurer pay? 

During a pregnancy, a regular visit to the gynecologist or midwife is a matter of course. Precautionary checks are aimed at early recognition 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 from then on, approximately every six weeks. 

Maternity benefits under basic insurance

The benefits under basic insurance are regulated by law and are the same for all providers. Pregnancy complications until 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 (German only) is waived. This means that you pay neither the excess nor the deductible. You can benefit from the following before, during, and after the birth:

  • Pregnancy check-ups: During pregnancy, you 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 your 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.
  • Follow-up examination / 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 also covers the costs of three breastfeeding consultations with an expert trained for this purpose.

Greater privacy after the birth thanks to supplementary insurance

Depending on the service catalog, supplementary insurance pays other contributions, for example doctor-prescribed vitamin products during pregnancy and breastfeeding, birth preparation and postnatal exercise classes, or for the additional costs of a family room or birthing pool. Some supplementary insurances also pay for breastfeeding if a midwife confirms in writing that the mother breastfeeds exclusively.

With supplementary hospital insurance, mothers enjoy greater privacy in a one-bed or two-bed room. If desired, the physician can also be chosen freely or your own gynecologist can accompany the birth. However, supplementary insurance often includes a qualifying period (waiting period). At AXA, there is a waiting period of one year from the beginning of “Hospital Flex”, “Hospital Private”, or “Hospital Semi-Private”. If your pregnancy begins within the waiting period, the supplementary insurance does not pay maternity benefits.

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 its 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 greatly, it is worthwhile to compare premiums. To do so, 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 at any time. However, in this case you will always have to fill out a health questionnaire. This means: If your child is not completely healthy, the supplementary insurance may reject the application for your child or insist on a restriction or benefit exclusion. The Swiss supplementary insurance market is very complex because health insurers offer numerous products with entirely different benefits. This makes comparisons difficult.

Conclusion: It’s worth insuring the baby before the birth!

To sum up, then: The basic insurance covers all the necessary services with regard to pregnancy and birth. In Switzerland, mother and child are thus generally well protected and cared for. It is a good idea to take out supplementary insurance for the mother if she wishes for more comfort and privacy and/or would like to benefit from additional contributions. However, 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 supplementary insurance after the minimum contractual term – usually one year – if they discover a more suitable product in the meantime. Tip: Make a note in your calendar right away so that you don’t miss the three-month notice period.

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