Pregnancy: what does health insurance cover?

We describe which pregnancy and childbirth-related benefits are covered under basic health insurance and explain the deductible and excess.

Special maternity benefits

Under Swiss law, maternity refers to pregnancy, childbirth and the postnatal recovery period. In the case of maternity, compulsory health insurance offers the same benefits as for illness: medical treatment, medication and the hospital stay. Basic health insurance also offers the following special maternity benefits:

Check-ups and ultrasound scans:

• 7 prenatal check-ups by a doctor or midwife
• 2 ultrasound scans
• 1 check-up between the 6th and 10th week postpartum
• First-trimester testing to assess the risk of trisomy 13, 18 and 21 in the foetus

Antenatal classes:

• 150 francs for midwife-led one-on-one or group antenatal classes
• Or for a consultation with the midwife about the birth, planning and organisation of the postpartum period at home

Hospital, birthing centre or home delivery:

• Full reimbursement of the costs of delivery on the general ward of a hospital in the canton of residence or at a birth centre listed on the cantonal hospital list.
• The obstetric services of a doctor or midwife are also covered.

Breastfeeding advice:

• 3 breastfeeding consultations with a midwife or specialist nursing professional

Postnatal midwifery services:

• 10 home visits by a midwife in the first 56 days after the birth. 16 home visits for premature or multiple births, first-time mothers or following a caesarean delivery.
• 5 additional same-day home visits by a midwife in the first 10 days after the birth.

1st to 12th week of pregnancy

• The special maternity benefits are covered under basic health insurance from the first pregnancy check-up without a co-payment; that is, without any payment of a deductible or excess.

13. week of pregnancy until 8 weeks postpartum

• The special maternity benefits are covered under basic health insurance without any payment of a deductible or excess.
• Basic health insurance also covers the cost of general medical and care services for illnesses not directly related to maternity (e.g. influenza) without requiring any co-payment.
• Vaccinations are considered preventive and not special benefits in the context of maternity or illness. The deductible and excess are therefore payable.

For women diagnosed with a high-risk pregnancy or aged 35 or above, basic health insurance covers the following tests, provided the medical requirements are met. In all other cases, these benefits are only covered under supplementary health insurance. If you have any questions, please contact your KPT Customer Centre team.

• Additional check-ups and ultrasound scans as required and ordered by the gynaecologist
• Non-invasive prenatal testing (NIPT) if the foetus is at high risk of trisomy 13, 18 or 21
• Amniocentesis, chorionic villus sampling (CVS) or percutaneous umbilical cord blood sampling (PUBS) if an earlier screening test has suggested that there is a higher chance of the baby having trisomy 13, 18 or 21 or a genetic condition, or there is a risk to the foetus due to a complication of pregnancy, maternal condition, non-genetic condition or foetal development disorder
• 1 check-up after a miscarriage or medically indicated abortion from the 13th to the end of the 23rd week of pregnancy

There are many different supplementary health insurance products available from different insurers, which all cover different maternity-related benefits. If you are looking for more than is offered under basic health insurance, it is worth comparing the different products.

We recommend taking out supplementary insurance as early as possible because the payment of maternity-related benefits is often subject to a waiting period of close to a year following contract conclusion.

The following KPT supplementary insurance products offer the following maternity-related contributions:

Supplementary hospital insurance supplements basic health insurance for overnight hospital stays. Semi-private or private hospital insurance offers a range of benefits and extras that are not covered under basic health insurance, such as the privacy of a twin room or a free choice of doctor for the delivery.

Semi-private supplementary hospital insurance

• A twin room on a semi-private ward
• Free choice of doctor for the hospital delivery
• Free choice of hospital throughout Switzerland (including outside of the canton of residence)
• Rooming in: 50 francs per day for an accompanying person to stay with the patient in hospital

Private supplementary hospital insurance

• A single room on a private ward
• Free choice of doctor for the hospital delivery
• Free choice of hospital throughout Switzerland (including outside of the canton of residence)
• Rooming in: 50 francs per day for an accompanying person to stay with the patient in hospital

If you would like to have your baby at a birth centre, please contact your KPT Customer Centre team to clarify which costs will be covered under supplementary health insurance. Basic health insurance only covers the costs for a birth centre based in the canton of residence and listed on the cantonal hospital list.

Flex supplementary hospital insurance

With Flex supplementary hospital insurance , you decide before each hospital stay whether you want to be treated on a general, semi-private or private ward.