Acupuncture

What is acupuncture?

Acupuncture is a method of treatment from Traditional Chinese Medicine (TCM). Fine needles are inserted into the skin at specific points. In Switzerland, acupuncture is offered by two professional groups: doctors with the relevant further training, and non-medical therapists, such as TCM therapists.

For health insurance, this distinction is exactly what matters. Acupuncture is part of complementary medicine. Basic health insurance only covers services provided by doctors, and only if the doctor holds a specific certificate of competence. Everything else is a matter for supplementary insurance.

The current rules have a political history: on 17.05.2009, the people and the cantons approved the constitutional article on complementary medicine. Since then, the Confederation and the cantons have had to take complementary medicine into account within the scope of their responsibilities. Since 01.08.2017, acupuncture by doctors has been expressly regulated as a compulsory benefit in the Health Care Benefits Ordinance (KLV), together with anthroposophic medicine, TCM drug therapy, classical homeopathy and phytotherapy.

How it works

Acupuncture by doctors (basic health insurance):

• The doctor has completed further training under the “Acupuncture – Chinese Drug Therapy – TCM (ASA)” certificate programme of the Swiss Institute for Medical Education (SIWF).
• The treatment is billed under the outpatient medical tariff, like any other medical service.
• The costs count towards your deductible; above it, you pay a 10% retention fee up to the annual maximum.
• Like every benefit of basic health insurance, the treatment must be effective, appropriate and cost-effective.

Acupuncture by non-medical therapists (supplementary insurance):

• If a TCM therapist without a medical licence treats you, basic health insurance pays nothing.
• If you have supplementary insurance for complementary medicine, it pays according to its conditions. A percentage of the costs or an amount per session, capped by an annual limit, is common.
• Many insurers require the therapist to be recognised for the method used by a register such as ASCA or EMR. Each insurer decides for itself which registers and methods it accepts.

Supplementary insurance is a private-law contract under the Insurance Contract Act (ICA). Unlike basic health insurance, an insurer does not have to accept you for it. It may ask health questions and impose reservations.

Legal basis

Art. 4b let. a KLV provides that basic health insurance covers the costs of acupuncture if the doctor has completed further training corresponding to the SIWF certificate programme “Acupuncture – Chinese Drug Therapy – TCM (ASA)” of 01.07.2015, revised on 23.06.2017. The section “Complementary medicine services provided by doctors” has applied since 01.08.2017.

Like all benefits of basic health insurance, acupuncture must be effective, appropriate and cost-effective under Art. 32 of the Federal Health Insurance Act (KVG). Art. 64 KVG applies to co-payment: the deductible and a 10% retention fee.

The constitutional basis is Art. 118a of the Federal Constitution (Cst.): the Confederation and the cantons ensure, within the scope of their responsibilities, that complementary medicine is taken into account. The article was approved in the popular vote of 17.05.2009.

There is no statutory obligation to pay for acupuncture by non-medical therapists. What counts are the general and special insurance conditions of your supplementary insurance under the Insurance Contract Act (ICA). Under Art. 3 ICA, the insurer must inform you before the contract is concluded about, among other things, the insured risks and the scope of the insurance cover.

Example: eight sessions with a doctor or a therapist

Lukas, 42, has a CHF 300 deductible and has had no other costs so far this year. He is planning eight acupuncture sessions. For the calculation, we assume CHF 120 per session, CHF 960 in total; this is a figure for illustration, not a tariff.

What this means for you

• Look for a doctor with ASA: If you want acupuncture to be billed to basic health insurance, choose a doctor with the ASA certificate of competence.
• Consider your deductible: With a high deductible, you will usually pay for acupuncture by a doctor yourself too. The premium calculator compares all deductibles so you can see which one suits your expected costs.
• Check your supplementary insurance: If you want to be treated by a non-medical therapist, check the percentage, limit and recognised registers of your supplementary insurance. You can compare supplementary insurance benefits under compare supplementary insurance; the needs check tells you whether complementary medicine insurance is worthwhile for you.
• Have the recognition confirmed: Ask the therapist to show you which methods she is recognised for and by which register. Your insurer’s list of recognised therapists is what counts.
• Compare insurers: The profiles under health insurers show which insurers offer which supplementary insurance.

Common mistakes

• Thinking all acupuncture is a compulsory benefit. Basic health insurance only pays for acupuncture by doctors with the ASA certificate of competence.
• Forgetting the deductible. Acupuncture by a doctor also counts towards your deductible. With a CHF 2,500 deductible, you often pay for shorter courses of treatment entirely yourself.
• Choosing a therapist without the right recognition. If she is not recognised by your insurer or for the method, supplementary insurance will not pay either.
• Overlooking the annual limit. Supplementary insurance often caps its benefits per year. Count how many sessions you have planned.

We explain how we make supplementary insurance benefits comparable under how we calculate.