KLV (Health Care Benefits Ordinance)

What is the KLV?

The KLV is the ordinance of the Federal Department of Home Affairs (FDHA) on benefits in compulsory health insurance, known for short as the Health Care Benefits Ordinance (Krankenpflege-Leistungsverordnung, OPAS in French). It dates from 29.09.1995 and has the number SR 832.112.31 in the Classified Compilation of Federal Legislation. The version published on fedlex is as of 01.08.2026.

The KLV is the reference work for what exactly basic health insurance pays for. The Federal Health Insurance Act (KVG) only lays down which types of benefits are covered, for example medical treatment, physiotherapy on a doctor’s prescription, prevention or maternity benefits. Which examination exactly, how many sessions and up to what amount is set out in the KLV and its annexes.

The KLV sits in a hierarchy of three levels. At the top is the Federal Health Insurance Act (KVG), passed by Parliament. Below it is the KVV, the Federal Council’s ordinance. And below that is the KLV, issued by the FDHA because the Federal Council has delegated this task to it. This means the list of benefits can be adapted to new findings faster than an act could be.

The KLV only applies to basic health insurance. What supplementary insurance pays for is set out in its insurance terms and has nothing to do with the KLV. An overview of all benefits of basic health insurance is given in the entry benefits catalogue.

How it works

Structure

The KLV is divided into three titles. The first and most extensive governs benefits, in chapters:

The second title sets out requirements for service providers, for example for laboratories; the third contains the final provisions.

The annexes

• Annex 1: medical services that have been assessed, and whether basic health insurance covers them, covers them only under conditions, or does not cover them. The FOPH publishes the complete list, most recently as of 01.07.2026.
• Annex 1a: procedures that must in principle be carried out on an outpatient basis. If they are performed on an inpatient basis, the insurer only pays if certain criteria are met or after special cost approval.
• Annex 2: the Aids and Appliances List (MiGeL) with maximum amounts for aids and appliances used for examination or treatment.
• Annex 3: the List of Analyses with laboratory analyses and their tariffs.
• Annex 4: the List of Medicines with Tariff.

The List of Pharmaceutical Specialties, the list of ready-made medicines covered by health insurance, is kept by the FOPH. The KLV governs how a medicine is added to this list and reviewed every three years.

Principle of trust and positive lists

For medical services, the rule is: what a doctor prescribes and performs is in principle paid for by basic health insurance, as long as it is effective, appropriate and cost-effective. Annex 1 only lists the assessed cases with restrictions or exclusions. For non-medical services it is the other way round: the insurer only pays for what the KLV expressly names, for example physiotherapy under Art. 5 or prevention under Art. 12a–12e. These three criteria are summed up as the effectiveness, appropriateness and cost-effectiveness criteria.

Legal basis

The KLV rests on a chain of delegations:

• Art. 32 KVG: benefits must be effective, appropriate and cost-effective; effectiveness must be demonstrated by scientific methods. The criteria are reviewed periodically.
• Art. 33 KVG: the Federal Council designates medical services that are not covered or only covered under conditions (para. 1), and specifies non-medical services, prevention, maternity and dental treatment in more detail (para. 2). It can delegate these tasks to the FDHA or the FOPH (para. 5).
• Art. 33 KVV: after consulting the competent commission, the FDHA designates, among other things, the medical services with restrictions, the non-medical services, prevention, aids and appliances, and the contributions towards spa treatments, transport and rescue costs.
• Art. 1 KLV: Annex 1 designates the services assessed by the Federal Commission for General Benefits and Principles. It does not appear in the Official Compilation but on the FOPH website.

Some examples of specific rules in the KLV:

• Art. 5 paras. 2 and 4 KLV: physiotherapy is limited to nine sessions per prescription; after 36 sessions, continuing requires a report to the insurer’s medical adviser.
• Art. 3b KLV: psychotherapy by a doctor beyond 40 sessions requires a report to the medical adviser; the insurer decides within 15 working days.
• Art. 12e let. c KLV: screening mammography from the age of 50 every two years as part of a cantonal programme, exempt from the deductible.
• Art. 14 and 15 KLV: CHF 150 towards antenatal classes, breastfeeding advice for three sessions.
• Art. 25 KLV: CHF 10 a day towards spa treatments prescribed by a doctor, for no more than 21 days per calendar year.
• Art. 26 KLV: 50% of the costs of medically necessary patient transport, up to CHF 500 per calendar year.
• Art. 27 KLV: 50% of the costs of rescues in Switzerland, up to CHF 5,000 per calendar year.

Example: transport and rescue in one year

Luca is 45. In February, after a fall while hiking in Ticino, he has to be rescued by helicopter; the rescue costs CHF 6,000. In June, he needs medically necessary patient transport to a treatment, which costs CHF 1,200. The contributions of basic health insurance follow Art. 26 and 27 KLV; the invoice amounts are chosen for the example.

Many supplementary insurance policies close exactly these gaps. Which insurers offer which supplementary benefits is shown in the profiles under health insurers.

What this means for you

You do not need to know the KLV by heart, but it helps you understand statements of benefits and ask targeted questions.

1. Ask for the basis if a claim is rejected. If the insurer refuses a benefit, ask which KLV article or which Annex 1 entry it relies on.
2. Keep an eye on the number of sessions for therapies. After nine physiotherapy sessions you need a new prescription, after 36 a report to the medical adviser.
3. Make use of prevention. Some check-ups are covered without the deductible, for example mammography in the cantonal programme. More on this under prevention.
4. Know the gaps in basic health insurance. Where the KLV only provides for contributions, such as for transport and rescue, supplementary insurance can make sense.

The benefits of basic health insurance are the same with all insurers, because the KLV applies to all of them. The differences lie in premium, service and models. Compare them in the premium calculator.

Common mistakes

• Thinking each insurer pays for different basic benefits. The KLV applies equally to all insurers. Differences only exist in supplementary insurance.
• Confusing the KLV with the List of Pharmaceutical Specialties. The KLV governs benefits and procedures; which medicines are covered is set out in the FOPH’s List of Pharmaceutical Specialties.
• Reading an old version. Annex 1 changes several times a year. The version in force on the date of treatment is what counts.
• Taking contributions for full cover. For transport, rescue and spa treatments, basic health insurance only pays contributions with maximum amounts.
• Overlooking session limits. If you continue therapy without a new prescription, you risk having to pay the costs yourself.

How we check legal sources for these pages is explained under how we calculate.