Psychotherapy

What is psychotherapy?

Psychotherapy is a treatment of mental and psychosomatic illnesses. The Health Care Benefits Ordinance (KLV) describes it precisely: it pursues a defined therapeutic goal, is based mainly on verbal communication, does not exclude supporting medication, builds on a diagnosis and takes place in regular, planned sessions. It can take the form of individual, couples, family or group therapy.

In basic health insurance, there are two routes:

• Medical psychotherapy. Doctors, especially those with specialist training in psychiatry and psychotherapy, provide the treatment themselves. No prescription is required.
• Psychological psychotherapy. Psychological psychotherapists with a cantonal licence to practise and three years of clinical experience provide treatment on medical prescription. This route is called the prescription model. It has applied since 01.07.2022.

Not every talking therapy is psychotherapy within the meaning of the Federal Health Insurance Act (KVG). Basic health insurance does not pay for coaching, life counselling or couples counselling without an illness. Methods must be scientifically proven, and the professional must be authorised under the KVG. The term recognised therapists explains who counts as authorised.

How it works

Prescription. For psychological psychotherapy, the prescription is issued by a doctor with one of the following specialist titles: General Internal Medicine, Psychiatry and Psychotherapy, Child and Adolescent Psychiatry and Psychotherapy, Paediatrics, or the specialisation in Psychosomatic and Psychosocial Medicine. One prescription covers at most 15 sessions, including the assessment. Before they run out, the therapist reports to the prescribing doctor, who issues a second prescription if needed.

After 30 sessions. If therapy is to continue, the prescribing doctor sends a report with a proposal to the health insurer’s medical adviser. If a GP or a paediatrician issued the prescription, a case assessment by a specialist in psychiatry is also required. The health insurer informs you within 15 working days of receiving the report whether and for how long it will continue to pay.

Crisis intervention. In a crisis, or for short-term therapy after a serious new diagnosis or in a life-threatening situation, any doctor may issue the prescription. The health insurer then pays for at most 10 sessions.

Medical psychotherapy. The health insurer initially covers at most 40 sessions. After that, the same reporting procedure with the medical adviser applies.

Costs for you. Psychotherapy is a normal benefit of basic health insurance. You pay the deductible and a 10 % retention fee, up to the maximum of CHF 700 per year for adults. The report to the medical adviser may only contain the information needed to decide on the obligation to pay.

Legal basis

Art. 2 KLV describes psychotherapy and requires scientifically proven methods. Art. 3 KLV initially limits medical psychotherapy to 40 assessment and therapy sessions, and Art. 3b KLV governs the procedure with the medical adviser for continuation, including the response deadline of 15 working days.

Art. 11b KLV governs psychological psychotherapy: para. 1 names the doctors who may issue prescriptions and the exception for crisis intervention; para. 2 limits one prescription to 15 sessions; paras 3 and 3bis require a report after 30 sessions, with a psychiatric case assessment if the prescription was issued by a GP or paediatrician; para. 4 limits crisis intervention to 10 sessions. These rules have applied since 01.07.2022. Art. 50c of the Health Insurance Ordinance (KVV) governs the authorisation of therapists. The deductible and retention fee follow from Art. 64 KVG and Art. 103 KVV.

Example: therapy over one year

Noah, 29, has been under heavy strain for months. His GP prescribes psychological psychotherapy. He has a deductible of CHF 1,000. The cost per session depends on the tariff; here a total of CHF 5,400 for 36 sessions in the year is assumed.

Step	Sessions	What happens
1st prescription by the GP	1 to 15	the therapist reports to the GP before session 15
2nd prescription	16 to 30	report to the medical adviser with a psychiatric case assessment
Health insurer’s decision	–	within 15 working days of receiving the report
Continuation	from 31	only with the health insurer’s approval

The premium calculator shows how the deductible affects you during regular therapy, with the premiums for all levels.

What this means for you

1. Start with the prescription. Talk to your GP or a psychiatrist. Without a prescription, basic health insurance does not pay for psychological psychotherapy.
2. Check the authorisation. Ask the therapist whether they may bill through basic health insurance.
3. Reconsider your deductible. For therapy lasting several months, the costs often exceed the deductible. You must notify a lower deductible by 30 November; the dates are listed under Switching health insurer.
4. Bear your model in mind. In the GP or HMO model, clarify beforehand whether the prescription must go through your chosen practice. You can find your health insurer’s conditions via the profiles under Health insurers.
5. Use supplementary insurance. Benefits outside basic health insurance may be covered by supplementary outpatient insurance.

Common mistakes

• Starting without a prescription. Basic health insurance does not pay for sessions before the medical prescription.
• Forgetting the second prescription. After 15 sessions, a new prescription is required, otherwise further sessions are not covered.
• Confusing coaching with psychotherapy. Counselling without an illness is not a compulsory benefit.
• Believing therapy is free. The deductible and retention fee apply here too.