Occupational therapy

What is occupational therapy?

Occupational therapy supports people who are restricted in everyday life because of an illness, an injury or a disability. The aim is for you to carry out activities such as getting dressed, personal hygiene, eating, housework or work as independently as possible again. To this end, the occupational therapist practises specific movements with you, trains strength and fine motor skills, adapts aids and appliances or shows you how to organise tasks differently.

The line with physiotherapy is fluid. Put simply, physiotherapy mainly treats movement and bodily functions, while occupational therapy deals with using them in everyday life. After hand surgery, both may be needed: physiotherapy for mobility and strength, occupational therapy for gripping, writing or handling tools.

For basic health insurance, it is precisely defined when occupational therapy is paid for. The Health Care Benefits Ordinance (KLV) names three cases:

1. Physical illnesses: The therapy improves physical functions and thus helps you become independent in the activities of daily living.
2. Psychiatric treatment: The occupational therapy is part of psychiatric treatment.
3. Risk of falling from 65: Since 01.07.2026, basic health insurance covers assessment, advice and instruction for people who have reached the age of 65 and have a moderate or high risk of falling, provided this follows one of the concepts named in the KLV.

Like physiotherapy, occupational therapy is therefore one of the benefits provided on a physician’s order. It also plays a major role in rehabilitation after a hospital stay.

How it works

For basic health insurance to pay, the following conditions must be met:

1. Physician’s order. Your physician prescribes occupational therapy. Without an order, basic health insurance does not pay.
2. Licensed professional. The occupational therapist needs a cantonal licence to practise and two years of practical experience, and must meet the quality requirements. Licensed occupational therapy organisations can also bill.
3. Start within eight weeks. The first treatment must take place within eight weeks of the order.
4. Nine sessions per order. The insurer pays for at most nine sessions per order. Further sessions require a new order.
5. Report after 36 sessions. If therapy is to continue after 36 sessions, the physician sends the insurer’s medical adviser a report with a reasoned proposal. The medical adviser recommends whether, for how long and to what extent the insurer continues to pay.

The bills count towards your deductible. After that, you pay a 10 % retention fee up to the annual maximum. The cost of the sessions follows the agreed or officially set tariff; the occupational therapist may not charge more for benefits under basic health insurance (tariff protection, Art. 44 KVG).

Legal basis

Art. 25 para. 2 let. a no. 3 of the Federal Health Insurance Act (KVG) allows basic health insurance to pay for services provided by persons acting on a physician’s order. The details on occupational therapy are set out in ordinances:

• Art. 6 para. 1 KLV: cost coverage on a physician’s order for licensed occupational therapists or organisations, for three purposes: physical illness (let. a), psychiatric treatment (let. b) and risk of falling from 65 (let. c, in this version since 01.07.2026).
• Art. 6 paras. 2 and 3 KLV: at most nine sessions per order, first treatment within eight weeks; a new order for further sessions.
• Art. 6 para. 4 KLV: after 36 sessions, a report with a reasoned proposal to the medical adviser, who recommends whether and for how long payment continues.
• Art. 6 para. 5 KLV: for young adults who received IV benefits under Art. 13 IVG until 20, the continuation of occupational therapy that has already begun is governed by para. 4.
• Art. 48 KVV: licensing of occupational therapists (cantonal licence, two years of practice, self-employed activity, quality requirements).
• Art. 64 KVG and Art. 103 KVV: deductible and 10 % retention fee, at most CHF 700 a year for adults and CHF 350 for children.

Example: occupational therapy after hand surgery

Peter is 58 and has the standard deductible of CHF 300. After an operation on his hand, his physician prescribes occupational therapy. For this example, we assume CHF 90 per session; the actual amount depends on the tariff and the duration. Peter has no other healthcare costs during the year. The calculation uses the statutory amounts for the deductible and retention fee.

What this means for you

Before you start occupational therapy, check three things. First: is there a physician’s order, and does therapy start within eight weeks? Second: is the therapist licensed for basic health insurance? You can ask the practice or your insurer. Third: are you counting the sessions? After nine sessions you need a new order, and after 36 sessions a report to the medical adviser.

If you are planning a longer course of therapy, for example after a hospital stay, this affects your choice of deductible. With high expected costs, a low deductible is often cheaper. In the premium calculator you can see what premium each deductible costs at every insurer. You must notify your insurer of a lower deductible for next year by 30 November; the dates are under deadlines.

For disorders of language, speech or swallowing, the responsible discipline is not occupational therapy but speech therapy, with its own rules. Supplementary insurance plays a minor role for occupational therapy ordered by a physician, because basic health insurance pays; what an insurer offers beyond that is shown in the profiles of the health insurers.

Common mistakes

• Starting without a physician’s order. Basic health insurance does not pay for sessions without an order.
• Missing the eight weeks. If therapy starts later, the order is no longer valid; have a new one issued.
• Overlooking the ninth session. From the tenth session, a new order is needed. Ask your physician in good time.
• Choosing a professional who is not licensed. Only licensed occupational therapists and organisations can bill basic health insurance.
• Forgetting the retention fee. Even after the deductible, you pay 10 % of the costs up to the maximum.

We explain how we calculate examples under how we calculate.