Nutritional advice

What is nutritional advice?

Nutritional advice is a therapy in which a trained professional works with you to adapt your diet to an illness. The aim is not general well-being, but the treatment of a specific illness: lowering blood sugar levels, correcting deficiencies, reducing weight in the case of obesity or avoiding allergens in everyday life. As a rule, this includes an assessment of your eating habits, specific changes and follow-up appointments.

In health insurance, there are two cases. Nutritional advice as a benefit of basic health insurance: it is ordered by a physician, concerns an illness from a fixed list and is provided by a licensed dietitian. Basic health insurance then pays, minus your co-payment. Nutritional advice without these conditions: for example advice on prevention, sports nutrition or weight loss without a medical reason. You pay for this yourself, or supplementary insurance covers part of it according to its terms.

Dietitian is a regulated health profession in Switzerland. Anyone practising it on their own professional responsibility needs a cantonal licence and a Bachelor of Science in Nutrition and Dietetics from a university of applied sciences or an equivalent qualification. To bill basic health insurance, a licence under the Health Insurance Ordinance (KVV) is also required. The professional title is thus clearly distinguished from offers such as “nutrition coaching”, which do not require such training.

Nutritional advice is one of the services that professionals provide on a physician’s order, similar to physiotherapy or occupational therapy. It is set out in the Health Care Benefits Ordinance (KLV).

How it works

Which illnesses?

Basic health insurance pays for nutritional advice for these illnesses (Art. 9b para. 1 KLV):

• metabolic diseases
• obesity with a body mass index (BMI) of 30 or more, and overweight with a BMI of 25 or more if there is a secondary illness that weight loss can improve
• obesity and overweight in children and adolescents as part of structured, multiprofessional therapy under Annex 1 KLV
• cardiovascular diseases
• diseases of the digestive system
• kidney diseases
• malnutrition and nutritional deficiencies
• food allergies and allergic reactions to food components

Procedure

1. Physician’s order: Your physician establishes that you have one of these illnesses and orders nutritional advice.
2. Choose a licensed professional: The advice must be provided by a dietitian licensed under the KVV or by a licensed nutritional advice organisation. Ask before your first appointment.
3. Up to 6 sessions per order: Basic health insurance covers at most six ordered sessions. If more are needed, the physician can repeat the order.
4. Medical adviser from 12 sessions: If the advice is to continue after twelve sessions, the treating physician sends the insurer’s medical adviser a reasoned proposal. The medical adviser recommends to the insurer whether and for how long it continues to pay.

Costs

Nutritional advice is billed like any other benefit of basic health insurance: the costs count towards your deductible, and after that you pay a 10 % retention fee up to at most CHF 700 a year (children CHF 350). Billing follows the agreed tariff; surcharges beyond it are not allowed because of tariff protection.

Diabetes advice

For diabetes, there is also diabetes advice from specialised nurses or diabetes advice centres, with at most ten sessions per physician’s order. At the diabetes advice centres of the Swiss Diabetes Society, dietitians can also provide nutritional advice for metabolic diseases.

Legal basis

• Art. 25 para. 2 let. a no. 3 KVG: Basic health insurance covers examinations and treatment by persons who provide services on a physician’s order or on a physician’s behalf.
• Art. 9b KLV: list of illnesses (para. 1), at most six sessions per order with the possibility of repetition (para. 2), proposal to the medical adviser after twelve sessions (para. 3).
• Art. 9c KLV: diabetes advice with at most ten sessions per order; nutritional advice at diabetes advice centres (para. 4).
• Art. 50a KVV: licensing of dietitians: cantonal licence under the Health Professions Act, two years of supervised practical experience, practising on their own professional responsibility and quality requirements.
• Art. 52c KVV: licensing of nutritional advice organisations.
• Art. 12 para. 2 let. e GesBG: a Bachelor of Science in Nutrition and Dietetics from a university of applied sciences is required for the licence to practise.
• Art. 64 KVG: co-payment with deductible and retention fee.

Example: two orders in the same year

Nadia is 47, has a CHF 300 deductible and has already had CHF 300 in medical costs this year; her deductible is therefore used up. Her GP orders nutritional advice because of an illness from the list in Art. 9b KLV. The amount per session is an assumption for the calculation; the actual costs depend on the tariff and the duration.

If Nadia had no physician’s order or no illness from the list, she would have to pay for the advice entirely herself. She cannot submit invoices from a dietitian without a licence under the KVG to basic health insurance.

What this means for you

1. Talk to your physician. Ask whether your situation falls under the illnesses in the KLV, and have an order issued.
2. Check the licence. Before your first appointment, ask the dietitian whether they are allowed to bill basic health insurance.
3. Count the sessions. After six sessions you need a new order, and after twelve a review by the medical adviser.
4. Think about your deductible. With a high deductible, you may pay for the first sessions entirely yourself. If a longer course of therapy is coming up next year, it is worth looking at your deductible; you must notify your insurer of a lower deductible by 30 November, and the dates are under deadlines.
5. Check your supplementary insurance. For advice on prevention without an illness, supplementary insurance may contribute according to its terms.

The benefits of basic health insurance are the same at every insurer. What differs are the premiums, which you can compare in the premium calculator, and the insurers’ offers, whose key data you will find under health insurers.

Common mistakes

• Starting without a physician’s order. Basic health insurance then does not pay, even if you have a qualifying illness.
• Choosing a professional without a KVG licence. Titles such as “nutrition coach” are not enough for billing basic health insurance.
• Overlooking the limit of six sessions. From the seventh session, a new order is needed.
• Expecting nutritional advice for prevention to be covered. Basic health insurance only pays for the illnesses listed in Art. 9b KLV.

We explain how we build examples under how we calculate.