Maternity

What is meant by maternity?

In health insurance, maternity is a separate insured event, alongside illness and accident. The law does not treat pregnancy as an illness but provides special benefits for it. These are therefore called the “special benefits for maternity”. They cover the time of pregnancy, the birth and the postnatal period.

Basic health insurance pays for these benefits, and they are the same with every insurer. They are listed exhaustively in the law and in the Health Care Benefits Ordinance (KLV): check-ups by a doctor or midwife, delivery at home, in hospital or in a birth centre, breastfeeding advice, a contribution towards antenatal classes and the care of the healthy newborn as long as it stays in hospital with its mother.

The special feature: the insurer may not charge any co-payment on these benefits. There is no deductible and no retention fee, whatever deductible you have chosen. In addition, from the 13th week of pregnancy until eight weeks after the birth, all other benefits for illness are also exempt from co-payment.

Income replacement for working mothers after the birth is not part of health insurance. Your health insurer pays for treatment, not for loss of income.

How it works

The benefits follow the course of the pregnancy:

In the 56 days after the birth, the midwife may make no more than 16 home visits after a premature birth, a multiple birth, a first birth or a caesarean section, and no more than 10 in all other cases. In the first 10 days, up to 5 second visits on the same day are added. Further visits require a doctor’s order.

For illness during pregnancy, there are two phases. Up to the end of the 12th week of pregnancy, you pay the deductible and retention fee as usual for treatment that is not part of the maternity benefits. From the 13th week until eight weeks after the birth, there is no co-payment for this either, for example for flu or a medicine that has nothing to do with the pregnancy.

Legal basis

Art. 29 of the Federal Health Insurance Act (KVG) states that, in addition to the benefits for illness, basic health insurance covers the special benefits for maternity. Para. 2 lists them: check-ups during and after pregnancy (let. a), delivery at home, in hospital or in a birth centre, including obstetric care (let. b), the necessary breastfeeding advice (let. c) and the care and stay of the healthy newborn as long as it stays in hospital with its mother (let. d).

Art. 64 para. 7 KVG prohibits any co-payment on these benefits (let. a) and on all benefits for illness provided from the 13th week of pregnancy, during childbirth and up to eight weeks afterwards (let. b). The details are set out in the KLV: Art. 13 KLV governs check-ups and ultrasound scans, Art. 14 KLV the contribution of CHF 150 towards antenatal classes, Art. 15 KLV the three sessions of breastfeeding advice and Art. 16 KLV the benefits provided by midwives. Under Art. 104 para. 2 let. c of the Health Insurance Ordinance (KVV), women who are exempt from co-payment also do not pay the hospital contribution of CHF 15 a day.

Example: co-payment before and after the 13th week

Sara is 31 years old and has chosen the CHF 2,500 deductible. Various bills come in during her pregnancy. The bill amounts are assumed here; the rules are the statutory ones.

What this means for you

Check your insurer’s statements of benefits. If you are charged a deductible or retention fee on a maternity benefit or from the 13th week, the bill may be missing the note “maternity” or the week of pregnancy. Tell your insurer; it will correct the statement.

A high deductible can still make sense during pregnancy, because most benefits are exempt anyway. But expect costs before the 13th week and after the postnatal period. If you want a lower deductible for the following year, you must tell your insurer by 30 November; the dates are under deadlines.

Your child needs its own basic health insurance. Register your baby within three months of the birth; cover then applies retroactively from birth. You can compare premiums for children in the premium calculator, and you will find an overview of insurers under health insurers. More on registering before the birth is under prenatal registration.

Common mistakes

• Lowering the deductible before the birth because you expect high costs. Most costs around the birth are exempt; a lower deductible costs more in premiums without bringing much.
• Not checking statements of benefits. If the link to the pregnancy is missing, the insurer charges the deductible and retention fee.
• Taking out supplementary insurance too late. If you only look for supplementary hospital insurance during pregnancy, expect reservations.
• Registering your baby too late. After three months, cover only begins from registration, and a premium surcharge may apply.
• Not using midwife visits. Basic health insurance pays for 10 to 16 home visits in the postnatal period without co-payment.