Massage

What is massage in health insurance?

In health insurance, “massage” is not a benefit area of its own. What matters is who gives the massage and why. Basic health insurance only recognises massage as part of physiotherapy: the Health Care Benefits Ordinance (KLV) lists “muscle and connective tissue massage” among the physical measures that an authorised physiotherapist provides on a doctor’s prescription. It then serves to treat an illness, for example musculoskeletal complaints.

There are also massages that basic health insurance does not pay for:

• Medical massage by a medical masseur with a federal diploma of higher education. The profession is recognised but not authorised as a service provider for basic health insurance.
• Massages from complementary medicine, such as foot reflexology, shiatsu or lymphatic drainage by non-medical therapists. These may be covered by supplementary insurance for complementary medicine.
• Wellness and relaxation massages without a medical reason. No health insurance pays for these.

Lymphological physiotherapy (Art. 5 para. 1 let. b no. 6 KLV) by authorised physiotherapists, on the other hand, is a benefit of basic health insurance if a doctor prescribes it.

How it works

In basic health insurance, massage works like any physiotherapy. The doctor issues a prescription. The first session must take place within five weeks. At most nine sessions are covered per prescription. For further sessions you need a new prescription. After treatments equivalent to 36 sessions, the doctor must report to the insurer’s medical adviser, who decides on continuation. The physiotherapist bills according to the agreed tariff and may not charge you anything beyond it for compulsory benefits (tariff protection, Art. 44 KVG).

In supplementary insurance, the conditions of your contract apply. Many supplementary outpatient insurance policies pay part of the cost of treatment by medical masseurs or complementary therapists if they are listed in a register recognised by the insurer. Typical are a percentage of the costs, an amount per session or an annual maximum. Whether a doctor’s prescription is required is also determined by the contract. You can find out which therapists your insurer accepts under recognised therapists.

Legal basis

Art. 25 para. 2 let. a no. 3 of the Federal Health Insurance Act (KVG) counts among the benefits of basic health insurance treatment by persons who work on the prescription or on behalf of a doctor. Which professions these are follows from Art. 35 para. 2 let. e KVG and the authorisation provisions in Art. 45–52f of the Health Insurance Ordinance (KVV). Physiotherapists are authorised under Art. 47 KVV if, among other things, they hold a cantonal licence to practise and can prove two years of practical experience. Medical masseurs do not appear in these articles.

What physiotherapists may provide at the expense of basic health insurance is governed by Art. 5 KLV. Art. 5 para. 1 let. c no. 6 KLV names muscle and connective tissue massage as a physical measure. Art. 5 para. 2 KLV limits coverage to at most nine sessions per doctor’s prescription, and Art. 5 para. 4 KLV requires a report to the medical adviser after 36 sessions. The co-payment is governed by Art. 64 KVG. Services by non-authorised therapists are a matter for supplementary insurance under the Insurance Contract Act (ICA); their scope is set out in the insurer’s general terms and conditions of insurance.

Example: physiotherapy or masseur

Rahel is 38, has a CHF 1,000 deductible and has had neck pain for weeks. She is considering whether to go to a medical masseur or ask her GP for a physiotherapy prescription. The amounts per session are chosen freely; the rules come from the law and the ordinance.

What this means for you

First clarify the reason for the massage. For complaints that a doctor should treat, physiotherapy with a prescription is the route through basic health insurance. For regular massages without a doctor’s prescription you need supplementary insurance. These questions help:

1. Do you have a doctor’s prescription? Without it, basic health insurance pays nothing.
2. Is the therapist authorised or recognised? Physiotherapists bill basic health insurance; medical masseurs only bill supplementary insurance, if your insurer recognises them.
3. What does your supplementary insurance pay? Check the percentage, the annual maximum and whether a prescription is required.
4. Is the supplementary insurance worth it? Compare the annual premium with what you can realistically expect to get back.

Basic health insurance is the same with all insurers; you can compare premiums in the premium calculator. Key figures on the insurers can be found under health insurers. We are building the comparison of supplementary benefits under compare supplementary insurance, including for supplementary outpatient insurance.

Common mistakes

• Going to physiotherapy without a prescription. Without a doctor’s prescription, basic health insurance does not pay for the sessions.
• Treating masseurs and physiotherapists as the same. Only an authorised physiotherapist bills basic health insurance.
• Not checking recognition. Supplementary insurance often only pays therapists listed in certain registers. Ask before the first session.
• Overlooking the ninth session. After nine sessions you need a new prescription, otherwise you pay for the tenth yourself.

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