Pregnancy

What are the pregnancy benefits?

In health insurance, “pregnancy benefits” are the benefits that basic health insurance covers during and after a pregnancy. The law speaks of maternity. Basic health insurance pays two kinds of benefits: on the one hand all the benefits it also pays in the event of illness, and on the other hand special benefits that exist only for maternity.

The special benefits include check-ups with a doctor or midwife, ultrasound scans, a contribution towards antenatal classes, the birth at home, in a birth centre or in hospital, breastfeeding advice and the care of the healthy newborn baby as long as it stays in hospital with the mother. These benefits are the same at all insurers and exempt from the co-payment for you.

The term must be distinguished from maternity compensation. That replaces income during maternity leave and is not a benefit of the health insurer. The termination of pregnancy is also separate: it is billed like treatment for an illness.

How it works

Basic health insurance covers these special benefits:

The co-payment is regulated in two stages. On the special maternity benefits you never pay a deductible or a retention fee, not even in the first twelve weeks. From the 13th week of pregnancy, during the birth and until eight weeks afterwards, all other benefits of basic health insurance are exempt as well, such as a doctor’s visit for flu or medicines. In hospital, the hospital contribution of CHF 15 per day also does not apply during this period.

For the insurer to bill correctly, it needs to know that you are pregnant and since when. Check every statement of benefits and tell your insurer if a deductible or retention fee has been charged on exempt benefits.

Legal basis

Art. 29 para. 1 KVG provides that in the case of maternity, basic health insurance covers the special maternity benefits in addition to the benefits paid for illness. Art. 29 para. 2 KVG lists them: check-ups during and after pregnancy, delivery at home, in hospital or in a birth centre, the necessary breastfeeding advice, and the care and stay of the healthy newborn in hospital.

The details are set out in the Health Care Benefits Ordinance (KLV): Art. 13 KLV governs the check-ups (seven in a normal pregnancy) and the ultrasound scans, Art. 14 KLV the contribution of CHF 150 towards antenatal classes, Art. 15 KLV breastfeeding advice with at most three sessions and Art. 16 KLV the benefits provided by midwives, including home visits after childbirth. Art. 64 para. 7 KVG prohibits any co-payment on the benefits under Art. 29 para. 2 KVG (let. a) and on the benefits under Art. 25 and 25a KVG from the 13th week of pregnancy, during delivery and until eight weeks afterwards (let. b). Art. 104 para. 2 let. c KVV also exempts you from the hospital contribution during this period. Under Art. 3 para. 1 KVG, a child must be insured within three months of the birth; if the child joins in time, cover starts at birth under Art. 5 para. 1 KVG.

Example: costs in the year of pregnancy and the baby’s premium

Elena is 32, has a deductible of CHF 2,500 and lives in the city of Bern. In the 8th week she needs treatment for an infection costing CHF 200, and in the 20th week treatment for flu costing CHF 180. On top come the check-ups and the birth. The treatment amounts are chosen freely; the exemptions follow the law.

Elena compares the premiums for her child. 2026 premiums, municipality of Bern (region 1), child born in 2026, with accident cover; median of all offers; source FOPH:

What this means for you

1. Inform your insurer early. Tell your insurer about the pregnancy and the expected date of birth so that it applies the exemption correctly.
2. Check the statements. Check-ups may never trigger a deductible, and from the 13th week no benefit may do so.
3. Insure your child in time. The deadline is three months from the birth. Registration before the birth is possible earlier. You can see the children’s premiums of all insurers in the premium calculator, and the insurers’ key figures under health insurers.
4. Think about next year’s deductible. You can choose a lower deductible until 30 November; the dates are listed under deadlines.

Common mistakes

• Paying the deductible on check-ups. The special maternity benefits are always exempt from the co-payment. Complain about incorrect statements.
• Overlooking the 13th week. From then on, treatment for illness is also exempt, not only from the birth.
• Missing the deadline for the child. After three months, cover only starts when the child joins, and a premium surcharge may apply.
• Taking out supplementary insurance too late. During pregnancy, the insurer may add reservations or refuse.

We explain how we analyse premiums under How we calculate.