Chiropractic

What is chiropractic?

Chiropractic is a medical field that assesses and treats functional disorders of the musculoskeletal system, especially of the spine, pelvis and joints. Chiropractors work mainly with targeted manual techniques, supplemented by exercises, advice and, where necessary, imaging. Typical reasons for a consultation are back and neck pain, complaints after strain or restricted mobility.

In Switzerland, chiropractic is a medical profession regulated by the Medical Professions Act (MedBG). To be authorised to practise under basic health insurance, a chiropractor needs a cantonal licence to practise under Art. 34 MedBG and must meet the quality requirements. For health insurance, this is decisive: chiropractors are among the service providers listed exhaustively in the Federal Health Insurance Act (KVG). They are listed there alongside doctors, pharmacists and midwives.

This leads to the most important difference from other manual treatments. Basic health insurance pays for physiotherapy only if it is prescribed by a doctor or a chiropractor. It does not pay for osteopathy at all; for that you need supplementary insurance. Chiropractic, by contrast, is a direct benefit of basic health insurance: you can go without a referral, and the insurer reimburses the treatment according to the tariff.

How it works

For complaints of the musculoskeletal system, a chiropractor can do largely what a doctor does. They examine you, make a diagnosis, treat you and, if necessary, prescribe further services. What they may prescribe at the expense of basic health insurance is listed in the Health Care Benefits Ordinance (KLV):

Depending on the arrangement, the chiropractor’s bill goes to you or directly to the insurer. It counts towards your deductible; after that, you pay a 10% retention fee. Tariff protection applies to services under the KVG: the practice may not charge more than the set tariff.

Legal basis

The position of chiropractic is governed by the Federal Health Insurance Act and its ordinances:

• Art. 35 para. 2 let. c KVG: chiropractors are service providers in basic health insurance.
• Art. 25 para. 2 let. a KVG: basic health insurance covers examinations and treatments by doctors (no. 1) and by chiropractors (no. 2), as well as services by persons working on their instructions (no. 3).
• Art. 25 para. 2 let. b KVG: analyses, medicines, and aids and appliances prescribed by chiropractors under the conditions set by the Federal Council are covered.
• Art. 4 KLV: the exhaustive list of these prescriptions (analyses, groups of medicines, MiGeL product groups, imaging procedures, physiotherapy).
• Art. 44 KVV: authorisation with a cantonal licence under Art. 34 MedBG and proof that the quality requirements are met.
• Art. 41 para. 4 KVG: with an alternative insurance model, you restrict your choice to the service providers that the insurer designates under your model.
• Art. 64 KVG and Art. 103 KVV: deductible and 10% retention fee, no more than CHF 700 per year for adults.

Example: back pain in the standard model

Sandra is 38, insured under the standard model and has no other health costs during the year. Because of back pain, she goes to a chiropractor without a referral. The chiropractor takes an X-ray, treats Sandra five times and then prescribes nine sessions of physiotherapy. For the example, we assume total costs of CHF 1,500; the actual amounts depend on the tariffs. The calculation uses the statutory values for the deductible and retention fee.

What this means for you

If you have musculoskeletal complaints, you can go directly to an authorised chiropractor in the standard model. Check three things first:

1. Your insurance model. In a GP, HMO or telemedicine model, read the rules first or contact the responsible body. You can see which models exist and what they cost in the premium calculator.
2. The authorisation. Only authorised chiropractors bill through basic health insurance. If in doubt, ask the practice or your insurer.
3. Your deductible. With recurring treatments, the costs add up. With a high deductible, you usually pay them yourself. You must notify a lower deductible for the following year by 30 November; the dates are listed under Deadlines.

Services that basic health insurance does not cover, such as osteopathy or certain massages, are covered through supplementary insurance. The profiles of the health insurers show which insurers offer such products.

Common mistakes

• Confusing chiropractic with osteopathy. Basic health insurance pays for chiropractic, but not for osteopathy.
• Thinking you need a doctor’s referral. In the standard model, you do not need one. The law puts chiropractors on the same footing as doctors.
• Overlooking the rules of your model. In a GP or telemedicine model, going directly to a chiropractor may break the rules.
• Believing the chiropractor may prescribe anything. Only the analyses, medicines, aids and examinations listed in Art. 4 KLV are covered.
• Forgetting the retention fee. After the deductible, you pay 10% up to the annual maximum.

We explain how we calculate examples under How we calculate.