Maternity is not an illness, and the law treats it separately. Basic insurance covers, in addition to the same benefits as in the case of illness, specific maternity benefits. And for these, it asks for neither deductible nor co-payment.
What maternity benefits cover
The law gives the list: check-ups carried out by a doctor or a midwife during and after pregnancy; childbirth at home, in a hospital or in a birth centre, with the assistance of a doctor or a midwife; the necessary advice on breastfeeding; and care for the healthy newborn for as long as it stays in hospital with its mother.
How many check-ups and scans
The ordinance sets the numbers. In a normal pregnancy, insurance covers seven check-ups and two ultrasound scans: one between the 12th and 14th week, the other between the 20th and 23rd week. In a high-risk pregnancy, examinations are repeated according to the clinical assessment. A postnatal check-up is provided for between the sixth and tenth week after the birth.
In addition, there is a contribution of 150 francs towards an antenatal class or a counselling session with a midwife, and breastfeeding advice, limited to three sessions. These numbers apply to a normal pregnancy: when a complication arises, the examinations and treatment it makes necessary fall under the general benefits for illness, with the cost-sharing rules described below.
The midwife at home after the birth
During the 56 days following the birth, the midwife may make at most sixteen home visits in the case of a premature birth, a multiple birth, a first child or a caesarean section, and at most ten visits in other cases. These visits are part of the maternity benefits.
The midwife can also follow the pregnancy herself. The law provides that check-ups are carried out by a doctor or a midwife, or prescribed by a doctor. In a normal pregnancy the midwife may carry out the seven covered check-ups, provided she tells the insured woman that a medical consultation is advisable during the first trimester. In a high-risk pregnancy she works with the doctor. Choosing a doctor or a midwife for antenatal care therefore makes no difference to the reimbursement of check-ups, as long as the numbers set by the ordinance are respected.
No deductible or co-payment, and for what period
The insurer may not levy any cost-sharing on specific maternity benefits. The law goes further: general benefits for illness provided from the 13th week of pregnancy, during childbirth and up to eight weeks afterwards are also exempt from the deductible and co-payment.
General benefits are the examinations and treatment used to diagnose or treat an illness: consultations, prescribed medicines, laboratory tests. A bout of flu treated in the twentieth week of pregnancy, for example, therefore costs neither deductible nor co-payment, even though it has nothing to do with the pregnancy.
Where to give birth: a condition to check
Basic insurance covers childbirth at home, in a hospital or in a birth centre. For the last two, the Federal Office of Public Health specifies a condition: the establishment must be on the hospital list of the canton of residence. Choosing a birth centre or a clinic not on that list may therefore leave part of the costs to the parents.
Insuring the newborn
The child must be insured in their own right, within three months of birth. If they are enrolled within that period, cover takes effect from birth, and care received in the meantime is covered. If enrolment is late, cover only takes effect from enrolment, and a premium supplement is due if the delay is not excusable.
What basic insurance does not cover
Basic insurance covers hospitalisation in the general ward. Free choice of doctor in hospital, a single or double room, or benefits beyond the numbers set by the ordinance are a matter for complementary insurance, taken out under the rules of the Insurance Contract Act (VVG/LCA). For maternity, these contracts often have a waiting period: they generally need to be taken out well before the pregnancy.
- Check that the chosen birth centre or clinic is on your canton's hospital list.
- Keep the invoices for check-ups: they must be reimbursed with no deductible or co-payment.
- Insure the newborn within three months of the birth, without waiting for the deadline to run out.