Prevention

What is prevention?

Prevention means taking steps in advance. In health insurance, it refers to measures that prevent an illness or detect it so early that it can be treated more effectively. The law speaks of “medical prevention”. Typical examples are vaccinations, check-ups for children and screening programmes for breast or colorectal cancer.

Normally, basic health insurance only pays when you are ill. Prevention is the exception: here it pays even though there is no illness yet. That is why its scope is narrowly limited. Only what the Health Care Benefits Ordinance (KLV) expressly lists is covered, and mostly only for certain age groups, intervals or risk groups.

This must be distinguished from health promotion in the broader sense: a gym membership, a yoga course, a stop-smoking course or a check-up without a reason. Basic health insurance does not pay for such offers. Some supplementary insurance policies contribute to them, for example with a fitness contribution.

How it works

The KLV divides prevention into five groups:

Clear rules apply to early detection in the general population:

• Gynaecological check-ups: the first two examinations with a cervical smear at one-year intervals, then every three years if the findings are normal.
• Screening mammography: every two years from the completed age of 50, as part of a breast cancer screening programme. No deductible is charged on this benefit.
• Colorectal cancer screening: from age 50 to 74, either a test for hidden blood in the stool every two years (followed by a colonoscopy if the result is positive) or a colonoscopy every ten years. No deductible is charged in the cantonal screening programmes; in the version of 01.07.2026, Art. 12e let. d KLV names sixteen cantons: Basel-Landschaft, Basel-Stadt, Bern, Fribourg, Geneva, Glarus, Graubünden, Jura, Lucerne, Neuchâtel, Solothurn, St. Gallen, Ticino, Uri, Vaud and Valais.

For vaccinations, the health insurer also pays for the vaccination advice. The condition is that the vaccine is on the List of Pharmaceutical Specialties (SL) for the age group concerned. Since 01.01.2026, no deductible has been charged on vaccinations covered by basic health insurance and on vaccination advice; the retention fee still applies (FOPH reference document on Art. 12a KLV). Basic health insurance does not pay for travel and occupational vaccinations.

Where no exemption applies, preventive benefits go through your normal co-payment: they count towards the deductible, and above it you pay a 10 % retention fee.

Legal basis

Art. 26 of the Federal Health Insurance Act (KVG) requires basic health insurance to cover the costs of certain examinations for the early detection of illnesses and of preventive measures for insured persons at increased risk; a doctor must carry them out or prescribe them. Art. 33 para. 2 KVG leaves the detailed designation to the Federal Council, which has delegated it to the Federal Department of Home Affairs (FDHA).

The FDHA lists the measures exhaustively in Art. 12–12e KLV. Art. 12a para. 3 KLV excludes occupational and travel-medicine vaccinations, and para. 4 exempts vaccinations in national prevention programmes from the deductible; according to the FOPH reference document, this has applied to all vaccinations under Art. 12a KLV since 01.01.2026. Art. 12e let. c and d KLV exempt programme mammography and colorectal cancer screening in the cantonal programmes named there from the deductible. The exemption only applies to the deductible under Art. 64 KVG; these provisions do not exclude the retention fee.

Example: colorectal cancer screening with a high deductible

Beat, 55, lives in the canton of Bern and has the CHF 2,500 deductible. He has not had any costs yet this year. He has a colonoscopy for early detection. The costs of CHF 1,000 are assumed; the 10 % retention fee is the statutory value.

What this means for you

1. Know the age limits. From age 50, mammography screening and colorectal cancer screening are covered; for children, the check-ups at pre-school age.
2. Ask about the programme. If your canton runs a screening programme, you save the deductible.
3. Distinguish between basic and supplementary insurance. Check-ups, fitness or nutritional advice without a medical prescription are paid for, if at all, only by supplementary insurance.
4. Factor in your deductible. Preventive benefits without an exemption count towards the deductible. You can see how the deductible affects the premium in the premium calculator.

Since basic health insurance pays for the same prevention with every health insurer, health insurers only differ here in their supplementary products. Information on the insurers is available under Health insurers.

Common mistakes

• Assuming a check-up is covered. A general health check for adults without symptoms is not part of basic health insurance.
• Submitting travel vaccinations. Basic health insurance does not pay for vaccinations for holidays or work.
• Overlooking the interval. A colonoscopy for early detection is covered every ten years, not every year.
• Confusing exemption from the deductible with free of charge. Even in the programme, you usually pay the retention fee.

We explain how we calculate costs and the deductible under How we calculate.