A child must have their own health insurance. For basic insurance, the law allows time after the birth. For complementary insurance, on the other hand, timing matters: what is simple before the birth can become difficult afterwards, depending on the child's health.
Basic insurance: within three months of the birth
Anyone domiciled in Switzerland must be insured for healthcare in the event of illness, and for a child it is the legal representative who insures them, within three months of the birth. When the child is enrolled within this deadline, the insurance takes effect from birth: treatment received in the first few weeks is covered.
Basic insurance asks no health questions, and no basic insurer may refuse the child. Priminfo also states that the premium is divisible: insurers must calculate it by the day in the event of a birth. Nothing therefore requires basic insurance to be taken out before the birth, even though many parents prepare it in advance.
Parents are free to choose the child's insurer: it does not have to be the parents' own. The law also provides that insurers set a lower premium for children than for other insured people. Comparing children's premiums in your canton can therefore be worthwhile, independently of the parents' insurance.
The child's premium is calculated to the day in the first year: for a child born on the 20th of a month, insurers bill only the remaining days of that month. The health insurance ombudsman's office also recommends preparing the written application for basic insurance before the birth, so that it can be sent without delay once the child is born.
Who pays for the newborn's care at birth
Among the maternity benefits, the mother's basic insurance covers the care given to a healthy newborn and its stay, as long as it remains in hospital with its mother. A newborn who is ill, on the other hand, falls under their own insurance: this is a concrete reason not to let the three-month deadline pass.
A child born with a health problem is therefore always covered by basic insurance, from birth, if their parents enrol them within three months: this right depends neither on their state of health nor on the insurer chosen. What can be refused to them, or limited by a reservation, is only complementary insurance applied for after the birth.
Complementary insurance: why timing matters
Complementary insurance falls under the insurance contract law (VVG/LCA). The person applying for it must declare to the insurer, by means of a questionnaire or in answer to any other question, all the facts relevant to assessing the risk that they know or ought to know. The insurer can then ask about their state of health, impose reservations or refuse the application.
An inaccurate answer has consequences: if a relevant fact was not declared, the insurer may terminate the contract within four weeks of learning of it. For a child born with a health problem, complementary insurance applied for after the birth can therefore be refused, or come with a lasting reservation.
A reservation is not a refusal: the contract exists, but a specific illness is excluded from it. For a child, a reservation imposed from the outset may apply for the whole duration of the contract, depending on its terms. This is the risk that enrolment before the birth makes it possible, for certain products, to avoid.
Prenatal enrolment
It is for this reason that some insurers offer enrolment before the birth for certain complementary products, often without a health questionnaire. The health insurance ombudsman's office considers it useful for avoiding exclusions of benefits later on, while noting that insurers do not offer admission without reservation for all of their products.
Whether it is worthwhile depends on what you want to cover. For costs that basic insurance does not reimburse, such as glasses, certain therapies, alternative medicine or orthodontics, complementary insurance taken out early prevents a health problem that appears at birth or in the first months from closing the door afterwards. For hospital, the question concerns the room and the choice of doctor, not the treatment, which is covered by basic insurance.
What is decided before, and what can wait
- Before the birth: decide whether complementary insurance is wanted for the child, and check with the insurer which products are open to prenatal enrolment, and on what conditions.
- Also before the birth: prepare the application for basic insurance, so as not to miss the three-month deadline.
- After the birth: take out basic insurance within three months, and compare children's premiums in your canton.
- In every case: answer any health questions accurately, and keep a copy of the application.