Health insurance for families and children: an overview

Families and health insurance: what applies at which stage of life

A family’s health insurance consists of two separate worlds. Basic health insurance under the Federal Health Insurance Act (KVG) is compulsory for every family member; benefits and rules are the same with every insurer, and only the premium differs. Supplementary insurance under the Insurance Contract Act (ICA) is voluntary; here the insurer may choose whom it accepts, and the benefits are set out in its general terms and conditions.

This matters for families because the deadlines of the two worlds contradict each other: in basic health insurance you have 3 months after the birth, while in supplementary insurance the time before the birth counts. And because the law treats children and pregnant women specially in several places, it is worth seeing the rules set out in order once.

The following sections answer the six questions parents ask most often. Each section gives the answer straight away in the first paragraph and refers to the article that covers the topic in more depth with steps, a sample calculation and special cases.

When must you register your baby with a health insurer?

For basic health insurance, within 3 months of birth at the latest. If you register in time, insurance starts at the time of birth (Art. 3 para. 1 and Art. 5 para. 1 KVG), even if the child spent the first weeks in hospital. Every insurer must accept the child and may not ask any questions about their health (obligation to accept, Art. 5 let. i of the Health Insurance Supervision Act, KVAG).

If you miss the deadline, cover only starts when you register. Costs before that are not covered, and if the delay is inexcusable you also owe a premium surcharge (Art. 5 para. 2 KVG).

Supplementary insurance is different: there is no obligation to accept. After the birth, the insurer may ask health questions, add a reservation or reject the application (Art. 4 ICA). Many insurers accept children without questions if the application arrives before the birth. This prenatal registration is not a law, but a rule of the individual insurer; it is best to have the conditions confirmed in writing.

The article Insuring your baby takes you through registration in six steps, from choosing supplementary insurance during pregnancy to reporting the birth, and calculates the level of costs from which a CHF 0 or CHF 600 deductible pays off.

What does health insurance pay during pregnancy and for the birth?

Basic health insurance pays for check-ups, the birth and care afterwards as special maternity benefits, without a deductible and without a retention fee (Art. 29 para. 2 and Art. 64 para. 7 let. a KVG). From the 13th week of pregnancy until eight weeks after the birth, the co-payment also no longer applies to all other treatment, for example for flu (Art. 64 para. 7 let. b KVG).

During pregnancy

In a normal pregnancy, basic health insurance pays for seven check-ups and two ultrasound scans, the first in weeks 12 to 14, the second in weeks 20 to 23 (Art. 13 of the Health Care Benefits Ordinance, KLV). It pays CHF 150 towards antenatal classes with a midwife (Art. 14 KLV). In a high-risk pregnancy, basic health insurance pays for check-ups and ultrasound scans according to clinical judgement, not just seven and two respectively (Art. 13 KLV).

The article Pregnant: which costs health insurance covers shows all amounts in a table, explains what a miscarriage or treatment before the 13th week costs, and works through an example with a deductible.

Birth and postnatal period

The birth is covered whether it takes place in hospital, in a birth centre or at home (Art. 29 para. 2 let. b KVG). In hospital, you pay no hospital contribution of CHF 15 per day (Art. 104 para. 2 let. c KVV). The flat rate is shared between the insurer and the canton of residence; the canton pays at least 55 % (Art. 49a para. 2ter KVG).

In the 56 days after the birth, the midwife may make 10 home visits, or 16 for a first child, after a caesarean section, a premature or a multiple birth (Art. 16 KLV). In addition, there are three breastfeeding consultations (Art. 15 KLV). You only pay for extras such as a single room yourself, unless supplementary insurance covers them.

Important for the child: as long as a healthy newborn is in hospital with the mother, they are covered by her insurance. If the baby needs treatment of their own, their own basic health insurance pays (Art. 29 para. 2 let. d KVG). By then at the latest, the baby must be insured. What a hospital birth costs, how it is billed and what applies if the newborn needs treatment is set out in the article Birth: what hospital, midwife and postnatal care cost.

What does health insurance cost for your child, and how can you lower the premium?

Every insurer must set a lower premium for children up to 18 than for young adults and adults (Art. 61 para. 3 KVG). In the municipality of Zurich (region 1), children’s premiums in 2026 with a CHF 0 deductible and accident cover were between CHF 120.30 and CHF 185.70 a month; the median was CHF 146.80 (premiums 2026, children, with accident cover; source FOPH). The range shows that comparing insurers is the biggest lever.

The co-payment is also lower for children:

• Deductible: There is no standard deductible for children (Art. 64 para. 4 KVG). You can choose a children’s deductible of CHF 100 to CHF 600 in steps of CHF 100 (Art. 93 para. 1 KVV).
• Retention fee: 10 % of the costs above the deductible, at most CHF 350 a year (Art. 103 para. 2 KVV).
• Hospital contribution: none (Art. 104 para. 2 KVV).
• Siblings: Several children with the same insurer and without an optional deductible together pay at most the co-payment of one adult (Art. 64 para. 4 KVG); with an optional deductible, at most twice the maximum amount per child (Art. 93 para. 3 KVV).

You can lower the premium with five levers: a cheaper insurer, a special type of insurance (GP, HMO, telemedicine), a higher children’s deductible, siblings with the same insurer and the premium subsidy. There is no statutory family discount in basic health insurance; what insurers offer families usually concerns supplementary insurance.

For the deductible, the law limits the saving: an insurer may reduce the premium by at most 70 % of the risk you take on with the higher deductible (Art. 95 para. 2bis KVV). With a CHF 600 deductible, that is at most CHF 420 a year. With the median offers for 2026 in Zurich, a CHF 0 deductible pays off mathematically as soon as your child has more than CHF 426 in costs a year. This is a calculation, not a recommendation.

For households with lower and middle incomes, the cantons reduce children’s premiums by at least 80 % (Art. 65 para. 1bis KVG). Each canton decides for itself where the income limit lies and whether you have to apply; the overview is under Premium subsidy.

The article Lowering children’s premiums: deductible, model and family discount explains all five levers with a sample calculation for two children in Zurich. You can compare the premiums for your municipality in the premium calculator.

Does your child need supplementary insurance?

For children, basic health insurance covers all medically necessary treatment, with a retention fee of at most CHF 350 a year. Supplementary insurance is mainly worthwhile for four items: orthodontic treatment, glasses above the basic health insurance contribution of CHF 180.67, comfort in hospital (two-bed or single room, free choice of physician) and treatment abroad, where basic health insurance pays at most twice the Swiss tariff (Art. 36 para. 4 KVV).

Whether it pays off is a calculation: expected benefits against the premium over the years, and the question of whether you could otherwise bear the costs yourself. Three rules of the ICA apply to every insurer:

1. The insurer may choose. It may ask health questions, add a reservation or refuse (Art. 4 ICA). That is why the application before the birth matters.
2. Only you may cancel. Only the policyholder may cancel supplementary health insurance with ordinary notice (Art. 35a para. 4 ICA). Once taken out, the insurance therefore stays in place, even if the child later becomes ill.
3. Deductible and retention fee cannot be insured. No supplementary insurance may cover the co-payment of basic health insurance (Art. 64 para. 8 KVG).

Basic and supplementary insurance may be with different insurers; if you switch basic health insurance, the supplementary insurance remains in place (Art. 7 para. 7 and 8 KVG). Which components there are and how to weigh premium against benefits is shown in the article Supplementary insurance for your child: which is worthwhile?. What always counts for benefits are the general terms and conditions and the information from the insurer.

Does health insurance pay for the dentist and braces for your child?

As a rule, no. Basic health insurance only pays for dental treatment if it becomes necessary because of a serious, unavoidable disease of the masticatory system, a serious general illness or an accident (Art. 31 KVG, Art. 17–19a KLV). You pay for check-ups, fillings for tooth decay and ordinary braces yourself, or through orthodontics cover in a dental insurance policy.

For recognised congenital disorders of the jaw, such as a cleft lip and palate, invalidity insurance (IV) pays until the age of 20 is reached (Art. 13 IVG). Basic health insurance with accident cover pays for dental accidents, with the co-payment for children (Art. 31 para. 2 KVG).

Dental insurance for children is a contract under the ICA. The insurer may ask about the condition of the teeth and request a dental report (Art. 4 ICA). If the dentist finds a misalignment, the insurer can exclude it. You therefore have to take out the policy before any finding is made. Pay attention to the entry age, waiting period, benefits as a percentage and maximum amount, and to what happens to the contract when the child becomes an adult. You can withdraw the application within 14 days (Art. 2a ICA).

When dental insurance makes sense and how to compare premiums and expected costs over the years is shown in the article Dental insurance for children: from when, and is it worthwhile?.

Who pays for a congenital disorder: IV or health insurer?

For recognised congenital disorders, invalidity insurance covers medical measures until the age of 20 is reached (Art. 13 IVG). Congenital disorders are illnesses that are present when birth is complete. The IV pays if the disorder has been diagnosed by a specialist, impairs health, reaches a certain degree of severity and requires long-term or complex treatment; which disorders are included is set out in the list of the Federal Department of Home Affairs (GgV-EDI).

The benefits of the IV cost you no deductible and no retention fee. Register your child with the IV office early: if you claim the entitlement later, the IV only pays retroactively for the last 12 months (Art. 48 para. 1 IVG). What the IV does not cover is paid by basic health insurance as for an illness, with the co-payment for children. After the 20th birthday, basic health insurance takes over. For basic health insurance, a congenital disorder plays no role on admission; for supplementary insurance it does, if the application is only made after the birth.

Which disorders are on the list, what the IV pays and how registration works step by step is explained in the article Congenital disorders: when the IV pays instead of the health insurer.

Common mistakes parents make

• Applying for supplementary insurance only after the birth. After that, the insurer may ask health questions. If you want supplementary insurance, sort it out during pregnancy.
• Letting the 3-month deadline pass. Then basic health insurance only starts when you register, and costs before that are not covered.
• Spreading siblings across different insurers without doing the maths. The joint cap on the co-payment only applies with the same insurer.
• Not rechecking the premium subsidy. After a birth, the household size changes; a new entitlement may arise.
• Taking out dental insurance too late. Once a misalignment has been found, the insurer can exclude it.

Where to start?

The order differs depending on your situation. This overview shows which step comes first:

1. You are pregnant. First read what basic health insurance pays during pregnancy and for the birth. Then decide whether your child should get supplementary insurance, and submit the application before the birth.
2. The baby has arrived. Register them for basic health insurance within 3 months; the procedure is described under Insuring your baby. Compare the children’s premiums for your municipality in the premium calculator first.
3. The premiums are too high. Go through the five levers under Lowering children’s premiums. You can switch insurer with effect from 1 January; the notice of cancellation must arrive by 30 November. The dates are listed under Deadlines, and the whole procedure is explained in the topic area Switching health insurer.
4. You want to check everything at once. The checklist for parents takes you through basic health insurance, deductible, accident cover and supplementary insurance for the whole family.

If you want to know more about deductibles, models and premium subsidies for the adults in the household, you can find the basics in the topic area Saving money.