Fitness contribution

What is the fitness contribution?

The fitness contribution is a voluntary benefit that health insurers pay towards the cost of exercise and health promotion. Typical examples are an annual gym membership, a yoga or Pilates course, or a back-care course. The insurer pays part of it, usually as a percentage of the cost up to an annual maximum.

The contribution is not part of basic health insurance. The Federal Health Insurance Act (KVG) only allows basic health insurance to pay for the benefits defined by law. A gym membership without a doctor’s prescription is not one of them. The fitness contribution therefore always comes from supplementary insurance, usually from supplementary outpatient insurance or a separate prevention add-on. Some insurers also link it to a bonus programme.

The fitness contribution must be distinguished from medical training therapy. That is part of physiotherapy, requires a doctor’s prescription, is supervised by a licensed physiotherapist and is limited in time. Basic health insurance pays for it. Training on your own at the gym afterwards, on the other hand, is a matter for supplementary insurance or for you.

Statutory prevention is something else again: basic health insurance pays for certain vaccinations, check-ups and early detection measures listed in the Health Care Benefits Ordinance (KLV). Sport and fitness are not among them.

How it works

Most insurers follow a similar procedure, but the details vary widely:

1. Check your entitlement. You need supplementary insurance whose conditions provide for a contribution towards fitness or health courses. Some contracts require you to have been insured for a minimum period before they pay.
2. Choose a recognised provider. Many insurers only pay for gyms or courses with certain quality labels or from their own list.
3. Submit the receipt. You submit the invoice or membership confirmation, often via the insurer’s app or customer portal.
4. Reimbursement. The insurer pays the agreed percentage up to the annual maximum. The deductible and retention fee of basic health insurance play no part here; only the rules of the supplementary contract apply.

Several benefits often share one annual maximum, for example fitness, courses and preventive care. If you have already claimed other prevention benefits, you will then receive less towards your gym membership.

Legal basis

There is no statutory rule for the fitness contribution. It is based solely on the insurance contract. The framework is formed by:

• Art. 34 para. 1 KVG: Basic health insurance may not cover any costs other than the benefits under Art. 25–33 KVG. A gym membership is not mentioned there.
• Art. 26 KVG: Basic health insurance only covers certain early detection examinations and preventive measures for people at particular risk, carried out or prescribed by a doctor.
• Art. 5 para. 1 let. b no. 5 and para. 1ter KLV: Medical training therapy is part of physiotherapy under basic health insurance. It begins with an introduction to the equipment and is completed at the latest three months later; before that, an individual physiotherapy treatment is required.
• Art. 2 para. 2 of the Health Insurance Supervision Act (KVAG): Health insurers may offer supplementary insurance alongside basic health insurance; it is subject to the Insurance Contract Act (ICA).
• Art. 3 ICA: Before the contract is concluded, the insurer must inform you clearly about the insured risks, the scope of cover and the premium.
• Art. 35a ICA: You can cancel the supplementary contract at the end of the third or any subsequent year with three months’ notice; in supplementary health insurance, the insurer may not cancel with ordinary notice (para. 4).

Example: training therapy and gym membership

Tim is 44 years old, has the CHF 2,500 deductible and, after back surgery, has received a doctor’s prescription for physiotherapy with medical training therapy. Afterwards he wants to keep training on his own at a gym. The figures of his supplementary contract are fictitious, because every insurer sets different contributions.

What this means for you

Treat the fitness contribution as a side benefit, not as a reason to take out supplementary insurance. These questions will help you:

1. What other benefits do you need? Glasses, complementary medicine or travel cover are more likely to justify supplementary outpatient insurance.
2. How high are the percentage and the maximum? Compare them with your membership and include the annual premium in your calculation.
3. Is your gym recognised? Ask before you sign up for the membership.
4. Do you share the maximum with other benefits? Then there may be less left for fitness.

You can compare basic health insurance separately in the premium calculator; its content is the same at every insurer. Key figures on the insurers’ service and finances are under health insurers. We are building the comparison of supplementary benefits under Compare supplementary insurance. If you switch your basic health insurance, your current insurer may not cancel your supplementary insurance because of it; more under switching insurer.

Common mistakes

• Thinking basic health insurance is responsible. Without supplementary insurance there is no fitness contribution, whichever insurer you are with.
• Signing up for the membership before checking. If the gym is not recognised, the insurer pays nothing.
• Submitting receipts too late. Many contracts set a deadline for claims. Submit the invoice in the same year.
• Taking out the add-on just for fitness. The premium often exceeds the contribution. Calculate with the premium minus the reimbursement.
• Confusing medical training therapy with fitness. The therapy requires a doctor’s prescription and ends at the latest three months after the introduction.

We explain how we build our examples under How we calculate.