Recognised therapists

What are recognised therapists?

Recognised therapists are professionals whose treatments a health insurer covers. In Switzerland the term has two meanings, and the distinction determines who pays.

In basic health insurance (KVG), “recognised” means the same as “authorised”. The law sets out exhaustively which professions may work at the expense of basic health insurance on a doctor’s prescription and which requirements they must meet: a cantonal licence to practise, several years of practical experience and quality requirements. This authorisation applies in the same way at all insurers.

In supplementary insurance (ICA), each insurer decides for itself which therapists and methods it recognises. This mainly concerns complementary medicine provided by non-medical therapists, such as naturopathy, shiatsu, kinesiology or classic massage. Here, the same therapist can be recognised by one insurer and not by another.

How it works

Basic health insurance: The Health Insurance Ordinance lists the professions that may provide services on a doctor’s prescription:

Exactly which services these professions may bill is set out in the Health Care Benefits Ordinance (KLV). For physiotherapy, the insurer covers at most 9 sessions per doctor’s prescription; the first must take place within 5 weeks. Further sessions require a new prescription, and after 36 sessions a report to the insurer’s medical adviser is also required. As with any benefit of basic health insurance, you pay the deductible and retention fee.

Complementary medicine is only covered by basic health insurance if it is provided by a doctor with recognised further training. This applies to five disciplines: acupuncture, anthroposophic medicine, drug therapy in traditional Chinese medicine, classical homeopathy and phytotherapy.

Supplementary insurance: For non-medical therapies you need a supplementary outpatient insurance that includes complementary medicine. The insurer keeps a list of recognised therapists and methods. Some insurers rely on private registers such as ASCA or EMR, others keep their own lists. How much the supplementary insurance pays, for example a percentage per session or an annual maximum, is set out in the contract terms.

Legal basis

Art. 25 para. 2 let. a no. 3 KVG lists as a benefit of basic health insurance examinations and treatments by persons who provide services on the prescription or on behalf of a doctor. The authorisation requirements for these professions are governed by Art. 47–50d KVV. The permitted services and quantities are set out in the KLV, for physiotherapy in Art. 5 KLV. Medical complementary medicine is governed by Art. 4b KLV, with the five disciplines and the certificate of proficiency required for each.

For supplementary insurance there is no statutory list of recognised therapists. It is governed by the Insurance Contract Act (ICA); what counts are your insurer’s general and special terms and conditions of insurance.

Example: physiotherapy and massage in the same year

Sara, 29, has a CHF 300 deductible and has already used it up this year. Her doctor prescribes 9 sessions of physiotherapy. She would also like massages with a therapist who is not authorised under the KVV. The costs are assumed amounts; the retention fee of 10% is the statutory value.

What this means for you

1. Check recognition before the first session. Ask the therapist about their authorisation (basic health insurance) or check your insurer’s list of therapists (supplementary insurance).
2. Have therapies under basic health insurance prescribed by a doctor. Without a prescription, the insurer does not pay for physiotherapy, occupational therapy or psychological psychotherapy.
3. Compare supplementary insurance according to your needs. If you regularly use complementary medicine, it is worth looking at the cover and annual limits in the comparison of supplementary insurance.
4. Keep basic and supplementary insurance separate when choosing. Since basic health insurance pays for the same therapists everywhere, you only compare the premium there, in the premium calculator. You can have your supplementary insurance with a different insurer; information on the insurers is available under health insurers.

With psychotherapy, it is worth taking a close look: psychological psychotherapists bill through basic health insurance if a doctor prescribes the therapy.

Common mistakes

• Assuming recognition applies at all insurers. In supplementary insurance, only your insurer’s list counts.
• Starting without a doctor’s prescription. Even authorised physiotherapy is not paid for without a prescription.
• Overlooking the limit of 9 sessions. After 9 sessions a new prescription is needed, otherwise you are left to pay for the further sessions.
• Not checking the therapist again after switching insurer. If you change your supplementary insurance, your therapist may not be on the new insurer’s list.

We explain how we compare benefits under How we calculate.