Vaccinations

What are vaccinations in health insurance?

In basic health insurance, vaccinations are part of medical prevention. The law obliges insurers to pay for preventive measures, but only those that the Federal Department of Home Affairs (FDHA) expressly designates. This list is in Art. 12a of the Health Care Benefits Ordinance, KLV for short.

In the version of 01.07.2026, the list comprises twenty items with vaccinations against diphtheria and tetanus, pertussis (whooping cough), poliomyelitis, measles, mumps and rubella, Haemophilus influenzae type b, influenza, hepatitis B, pneumococci, meningococci A, C, W, Y, meningococci B, tick-borne encephalitis (TBE), varicella, human papillomavirus (HPV), hepatitis A, rabies, Covid-19, herpes zoster, mpox, rotavirus and respiratory syncytial virus (RSV).

The fact that a disease is on the list does not mean that every vaccination against it is paid for. What counts is the FOPH’s “Reference document on prophylactic vaccinations”. It sets out for whom the vaccination is indicated, which schedule is used and which restrictions apply. It is based on the FOPH’s Swiss vaccination schedule.

How it works

Basic health insurance pays for two things: the vaccination itself and vaccination counselling. Counselling includes taking your vaccination history and checking your vaccination status, clarifying whether the vaccination is indicated for you, and informing you and obtaining your consent.

Since 01.01.2026, no deductible has been charged for covered vaccinations and vaccination counselling. From the first franc, you only pay the 10% retention fee, even if you have not yet reached your deductible this year. Until the end of 2025, vaccinations counted towards the deductible like other benefits.

Two reasons for a vaccination are excluded. If you need a vaccination because of your job, for example in healthcare, basic health insurance pays for neither the vaccination nor the counselling. And you pay for travel vaccinations, for example against yellow fever or typhoid, yourself or through supplementary insurance. A vaccination against hepatitis A or rabies is also only covered if it is not given for travel medicine reasons.

The insurer also only pays if the vaccine used is on the List of Pharmaceutical Specialties for your age group and indication and its limitations are complied with. The vaccinations against HPV and mpox are an exception to this.

Legal basis

Art. 26 of the Federal Health Insurance Act (KVG) obliges basic health insurance to cover the costs of certain examinations for early detection and of preventive measures for insured persons who are particularly at risk. The FDHA designates which ones in the KLV.

Art. 12a para. 1 KLV contains the list of 20 vaccination items and refers to the FOPH reference document in the version of 01.07.2026. Para. 2 names the vaccination counselling services that are paid for, and para. 3 excludes occupational and travel medicine indications. Under para. 4, no deductible is charged if the services are provided as part of a national prevention programme; according to the FOPH reference document (chapter 2), all vaccinations under Art. 12a KLV and the related counselling have been exempt from the deductible since 01.01.2026, while the retention fee remains. Para. 5 requires the vaccine to be on the List of Pharmaceutical Specialties, except for HPV and mpox. The legal basis for waiving the deductible for prevention is Art. 64 para. 6 let. d KVG.

Example: three vaccination situations in 2026

Lea is 34 and has the standard deductible of CHF 300. For the calculation, the cost of the vaccine, administration and counselling is assumed to be CHF 80 per vaccination. The deductible and retention fee are the statutory values.

Situation	Rule	Lea’s share
Covered vaccination, deductible not yet reached	no deductible, 10% retention fee	CHF 8.00
Covered vaccination, deductible already reached	10% retention fee	CHF 8.00
Travel vaccination	basic health insurance does not pay	CHF 80.00

The exemption applies regardless of the level of your deductible, so also with CHF 2,500. You can see how the deductible otherwise affects your premium in the premium calculator.

What this means for you

Before a vaccination, clarify three questions with your doctor or pharmacy:

1. Is the vaccination indicated for you? Only then is it covered. The recommendations are set out in the FOPH’s Swiss vaccination schedule (available in German, French and Italian).
2. Is the vaccine on the List of Pharmaceutical Specialties? Only then does the insurer pay, except for HPV and mpox. If the vaccination is covered, there is no deductible; you pay a 10% retention fee.
3. Is it a travel or occupational vaccination? Then basic health insurance does not pay. Check whether your supplementary insurance contributes, or compare offers under compare supplementary insurance.

For travel abroad, it is also worth looking at travel insurance, which covers emergencies abroad but not the vaccination before the trip. You can find an overview of the insurers under health insurers.

Common mistakes

• Thinking every vaccination is covered. It is not just the disease that counts, but also whether the vaccination is indicated for you according to the reference document.
• Forgetting the retention fee. Covered does not mean free. The deductible no longer applies since 2026, but you still pay the 10% retention fee.
• Submitting travel vaccinations to basic health insurance. They are expressly excluded, even if the disease is on the list.
• Leaving invoices lying around. Submit small vaccination invoices too: under the tiers garant system, the insurer refunds you 90%, even if your deductible has not yet been reached.

The glossary explains other benefits of basic health insurance.