Spa treatment

What is spa treatment?

Spa treatment is a stay of several days or weeks intended to improve your health, relieve symptoms or aid recovery. In everyday language, the term covers very different things: a course of treatment at a thermal spa, a recuperative stay after a demanding period, or a stay to recover after an illness. For health insurance, the distinction is decisive, because only a small part of this is insured.

Basic health insurance only recognises medicinal spa treatment. This is spa treatment prescribed by a doctor at a medicinal spa that uses a natural medicinal spring. Basic health insurance pays a fixed daily contribution towards it, not the full cost.

A recuperative stay, meaning a stay without medical treatment to recover, is not part of basic health insurance. Some supplementary insurance policies contribute to it.

This must be clearly distinguished from rehabilitation. Rehabilitation is medical treatment, for example after a hospital stay, an operation or an accident, and basic health insurance pays for it as a separate benefit. When people talk informally about a “cure after hospital”, they often mean rehab.

How it works

For basic health insurance to contribute to medicinal spa treatment, three conditions must be met:

1. Doctor’s prescription. A doctor must prescribe the spa treatment because it is indicated for treating an illness.
2. Approved medicinal spa. The spa must be under medical supervision, use a medicinal spring on site, have specialist staff and the necessary facilities, and be approved by the canton. A medicinal spring is a spring whose water has a scientifically recognised healing effect because of its chemical or physical properties; this is checked every three years.
3. Maximum duration. The insurer pays the contribution for a maximum of 21 days per calendar year.

The contribution is CHF 10 per day. It does not cover accommodation, meals or the spa tax. Medical treatment and therapies during the stay, such as physiotherapy prescribed by a doctor, can be covered by basic health insurance as separate benefits. Because the daily contribution is a benefit of basic health insurance, your co-payment from the deductible and the retention fee generally applies to it.

Supplementary insurance covers spa treatment in very different ways: as a daily contribution, as a percentage of the costs or with an annual maximum, often only with a doctor’s prescription and prior cost approval. Some cover both medicinal spa treatment and recuperative stays, others only one of them. The conditions are set out in your policy and the contract terms.

Legal basis

Art. 25 para. 2 let. c KVG lists a contribution towards the cost of spa treatment prescribed by a doctor as a benefit of basic health insurance. The amount is set by Art. 25 KLV: a daily contribution of CHF 10 for a maximum of 21 days per calendar year. Art. 57 KVV determines which medicinal spas are approved, and Art. 58 KVV defines the medicinal spring and requires a control analysis every three years.

Medical rehabilitation is governed as a separate benefit in Art. 25 para. 2 let. d KVG. The KVG makes no provision for recuperative stays. Supplementary insurance is governed by the Insurance Contract Act (ICA); your insurer’s contract terms are decisive. The co-payment in basic health insurance is governed by Art. 64 KVG.

Example: 28 days of medicinal spa treatment

Heidi, 67, has recurring joint problems. Her GP prescribes medicinal spa treatment. Heidi stays 28 days at an approved medicinal spa. The cost of CHF 120 per day is assumed; the daily contribution of CHF 10 and the 21 days come from Art. 25 KLV.

What this means for you

1. Clarify whether it is spa treatment or rehab. After an operation or a hospital stay, rehabilitation is often indicated, and basic health insurance pays for it as treatment.
2. Have the medicinal spa treatment prescribed by a doctor and check whether the spa is approved.
3. Obtain cost approval before the stay starts if you want benefits from supplementary insurance.
4. Compare spa benefits if they matter to you. Contributions and conditions vary widely between supplementary insurance policies. The supplementary insurance comparison shows the differences.

The spa contribution from basic health insurance is the same at every insurer. For basic health insurance, what mainly counts is therefore the premium, which you can compare in the premium calculator. Information on the insurers is under health insurers. Depending on the product, supplementary outpatient insurance also includes spa benefits.

Common mistakes

• Believing basic health insurance pays for the whole stay. It only pays CHF 10 per day, for a maximum of 21 days a year.
• Booking without a doctor’s prescription. Then there is no contribution.
• Confusing spa treatment and rehab. Rehab after a hospitalisation is treatment with its own rules.
• Forgetting cost approval. Some supplementary insurance policies only pay with prior approval.

We explain how we present benefits under how we calculate.