Prescription model for psychotherapy

What is the prescription model?

The prescription model is the rule under which basic health insurance has paid for psychotherapy provided by psychological psychotherapists since 01.07.2022. Psychological psychotherapists are not doctors but psychologists with recognised further training in psychotherapy. Since then, they have been allowed to work independently and on their own account at the expense of basic health insurance if a doctor prescribes the therapy.

Before that, the delegation model applied. The psychologist had to be employed in a doctor’s practice and worked under the doctor’s supervision; billing went through the doctor. Delegated psychotherapy no longer exists since 01.01.2023. The prescription model is intended to improve access to psychotherapy, because more therapists can bill basic health insurance directly.

There are three routes to psychotherapy:

• Medical psychotherapy. A psychiatrist is a doctor and bills directly. No prescription is required.
• Psychological psychotherapy under the prescription model. A doctor prescribes, and the psychologist treats you and bills the insurer directly.
• Psychological counselling or therapy without authorisation. Basic health insurance does not pay for treatment by professionals who are not authorised under basic health insurance or who work without a doctor’s prescription. Some supplementary insurance policies make contributions under their contract terms.

Not every doctor may prescribe. Doctors with further training in general internal medicine (often the GP), in psychiatry and psychotherapy, in child and adolescent psychiatry and psychotherapy, in paediatrics, or with a specialisation in psychosomatic and psychosocial medicine are entitled to do so. For crisis intervention or short-term therapy after a serious diagnosis, any doctor may prescribe, but then for at most 10 sessions.

How it works

The prescription model follows fixed steps:

1. Doctor’s prescription. You discuss your situation with an entitled doctor. They issue a prescription for at most 15 assessment and therapy sessions.
2. Therapy. You look for an authorised psychological psychotherapist. The therapist bills their services to your health insurer.
3. Report before the end. Before the prescribed sessions run out, the therapist reports to the prescribing doctor. The doctor can issue a further prescription for at most 15 sessions.
4. After 30 sessions. If therapy is to continue at the expense of basic health insurance after that, the prescribing doctor sends a report with a proposal to the insurer’s medical adviser. The medical adviser reviews it and recommends whether and for how long the insurer continues to pay. If a GP or paediatrician has prescribed the therapy, the report must also include a case assessment by a psychiatrist.

The costs count like any other benefit of basic health insurance: first towards your deductible, after which you pay a 10% retention fee up to the annual maximum of CHF 700 for adults.

Legal basis

Cost coverage is governed by Art. 11b of the Health Care Benefits Ordinance (KLV). Under Art. 11b para. 1 let. a KLV, insurance covers the costs of psychological psychotherapy and the related coordination if it is provided on the prescription of a doctor with one of the further training titles listed. For crisis intervention or short-term therapy for patients with serious illnesses at a new diagnosis or in a life-threatening situation, Art. 11b para. 1 let. b KLV allows any doctor to prescribe; under para. 4, at most 10 sessions apply in this case.

Art. 11b para. 2 KLV limits coverage to at most 15 sessions per prescription and requires a report from the therapist to the prescribing doctor. Under Art. 11b para. 3 KLV, the procedure under Art. 3b KLV applies by analogy for continuation after 30 sessions: the medical adviser reviews a report and recommends whether and for how long the therapy continues to be paid for. Para. 3bis requires a case assessment by a specialist in psychiatry if the therapy was prescribed by a doctor in general internal medicine or paediatrics.

The authorisation of therapists is governed by Art. 50c of the Health Insurance Ordinance (KVV): a cantonal licence to practise under the Psychology Professions Act, three years of clinical experience, including at least 12 months in a recognised psychiatric-psychotherapeutic institution, self-employment on their own account and proof of meeting the quality requirements. The co-payment follows from Art. 64 of the Federal Health Insurance Act (KVG) and Art. 103 KVV.

According to the FOPH, the costs of psychological psychotherapy paid by basic health insurance rose from CHF 528 million to CHF 922 million in the first three years after the change of system.

Example: a course of therapy over 40 sessions

Mia is 26 and has a CHF 300 deductible. Her GP, a specialist in general internal medicine, prescribes psychological psychotherapy. The therapy lasts 40 sessions in total.

What this means for you

The route to psychotherapy under basic health insurance starts at a doctor’s practice.

1. Get a prescription. Talk to your GP or a psychiatrist. If you are insured under a GP or telemedicine model, the rules of your model for the first point of contact also apply.
2. Check authorisation. Ask the therapist whether they are authorised under basic health insurance and bill your insurer directly.
3. Count the sessions. Make sure that the necessary reports and prescriptions are in place in good time before session 15 and before session 30. Otherwise you risk the insurer not paying for individual sessions.
4. Plan your deductible. If you are planning longer therapy, a lower deductible next year may work out cheaper. You must request a lower deductible by 30 November; the dates are listed under deadlines.

You can see which models and premiums your insurer offers in the premium calculator and in the profiles under health insurers. The list of all benefits of basic health insurance is set out in the KLV.

Common mistakes

• Starting without a prescription. Without a doctor’s prescription, basic health insurance does not pay for psychological psychotherapy.
• Overlooking the limit of 15 sessions. Each prescription is valid for at most 15 sessions. The next prescription must be in place beforehand.
• Forgetting the report after 30 sessions. Without a review by the medical adviser, there is no basis for further cost coverage.
• Confusing the prescription model with supplementary insurance. Therapy with professionals who are not authorised is paid for at most by a supplementary insurance, under its own rules.

We explain how we build our examples under How we calculate.