Pregnant: which costs your health insurer covers

Pregnancy and health insurance: what applies

In health insurance, pregnancy is not an illness but an insured event of its own: maternity. Basic health insurance pays two kinds of benefits for it. First, everything it also pays in the event of illness. Second, the specific maternity benefits, which are listed exhaustively in the law (Art. 29 KVG). These benefits are the same with every health insurer, whatever model and deductible you have.

What matters most for you is the co-payment, meaning the deductible, retention fee and hospital contribution. It is regulated in two stages:

The eight-week period ends at midnight on the 56th day after the birth (Art. 105 para. 3 KVV). A stillbirth after the 23rd week of pregnancy counts as a birth (Art. 105 para. 2 KVV).

The costs your health insurer covers during pregnancy

The details are set out in the Health Care Benefits Ordinance (KLV). The following overview shows what basic health insurance pays with every health insurer:

Whether an examination is medically indicated is something you decide with your doctor or midwife; we only describe what insurance pays. For tests such as NIPT or amniocentesis, the KLV sets conditions: risk values, counselling and the specialist who orders the test. If they are not met, you pay for the test yourself.

Everything that is not on this list is paid by basic health insurance as in the event of illness: doctor’s visits because of complaints, medicines on the List of Pharmaceutical Specialties (SL), laboratory analyses, hospital stays. The only difference is the co-payment.

Step by step through pregnancy

1. Read the model conditions. In the GP, HMO or telemedicine model, your health insurer’s conditions determine whether you may go directly to a gynaecologist or midwife. Read them before the first check-up; the models available are explained on the page Insurance models.
2. Choose a midwife. Midwives are service providers in their own right and bill basic health insurance directly (Art. 35 para. 2 let. d KVG). Clarify early on who will visit you at home after the birth.
3. Check the start of the 13th week on the bill. The doctor who supervises the pregnancy determines the probable start of the 13th week and states it on the bill (Art. 105 para. 1 KVV). If the date is missing, the health insurer may charge the deductible.
4. Book childbirth preparation. The CHF 150 contribution applies to courses or a counselling session with a midwife or an organisation of midwives, not to courses by other providers.
5. Register your child before the birth if you want supplementary insurance. For basic health insurance, you have up to three months after the birth. The procedure is shown in the article Insuring your baby.
6. Check your deductible for next year. You can choose a lower deductible by 30 November for 1 January, and a higher one by the end of the year. The dates are listed under Deadlines.
7. Check your statements. Complain to your health insurer about any statement of benefits that charges a deductible or retention fee on a maternity benefit or from the 13th week.

The rules in detail

Specific benefits without co-payment. Art. 29 para. 2 KVG lists the specific maternity benefits: check-ups during and after pregnancy (let. a), delivery at home, in hospital or in a birth centre (let. b), the necessary breastfeeding advice (let. c) and care and stay of the healthy newborn as long as it is in hospital with its mother (let. d). Under Art. 64 para. 7 let. a KVG, the health insurer may not charge a co-payment on these, not even in the first twelve weeks.

Exemption from the 13th week. Under Art. 64 para. 7 let. b KVG, all benefits under Art. 25 and 25a KVG provided from the 13th week of pregnancy, during the birth and up to eight weeks afterwards are also exempt. This includes doctor’s visits, medicines and care services that have nothing to do with the pregnancy.

No hospital contribution. Anyone exempt from the co-payment also does not pay the hospital contribution of CHF 15 per day (Art. 104 para. 2 let. c KVV).

No insurance of the co-payment. You may not insure the deductible and retention fee, neither with a health insurer nor with a private insurer (Art. 64 para. 8 KVG). So supplementary insurance cannot reimburse your deductible before the 13th week.

The amounts at a glance

Sample calculation: deductible during pregnancy

Example with fictitious people. Nora is 30, lives in Zurich and has a deductible of CHF 2,500 without accident cover, because she is insured against accidents through her employer. She is expecting her child in April of next year. The amounts of the bills are assumed; the rules are the statutory ones.

Nora is considering switching to a CHF 300 deductible for the year of the birth. Premiums 2026, municipality of Zurich (region 1), adults, without accident cover, median of all offers; source FOPH: CHF 542.90 per month with a CHF 300 deductible, CHF 424.65 with a CHF 2,500 deductible.

The calculation shows the break-even point, not a recommendation: the FOPH publishes next year’s premiums at the end of September, and you do not know your costs after the postnatal period in advance. Work it out with your own figures.

Special cases

High-risk pregnancy

In a high-risk pregnancy, basic health insurance pays for check-ups and ultrasound scans at clinical discretion, not just seven and two (Art. 13 let. a and b KLV), plus examinations with cardiotocography where indicated (Art. 13 let. c KLV). These benefits are also exempt from the co-payment. If the midwife works in a high-risk pregnancy with manifest pathology, she needs a doctor’s order (Art. 16 para. 1 let. a KLV).

Miscarriage

After a miscarriage or a medically indicated termination of pregnancy between the 13th and the completed 23rd week, basic health insurance pays for a follow-up check-up (Art. 13 let. f KLV) and up to 10 midwife home visits; further visits require a doctor’s order (Art. 16 para. 1 let. abis KLV). Benefits from the 13th week remain exempt from the co-payment. A stillbirth after the 23rd week counts as a birth, with all benefits and the exemption until 56 days afterwards (Art. 105 para. 2 KVV).

Supplementary hospital insurance

You do not need supplementary insurance for the birth: basic health insurance pays for it in the general ward of a listed hospital. Depending on the contract, supplementary hospital insurance pays for a two-bed or single room and the free choice of doctor in hospital. If you only apply for it during pregnancy, the health insurer may ask health questions under Art. 4 ICA and refuse the application or add a reservation for the pregnancy. Whether and from when an existing supplementary insurance pays maternity benefits is set out in its general terms and conditions; what counts are the general terms and conditions and the information from your health insurer. What the birth costs and who pays which part is explained in the article Birth: costs and who pays.

Changing health insurer during pregnancy

You may change your basic health insurance even when you are pregnant: the new health insurer must accept you, without health questions. Maternity benefits are the same with every health insurer. What a notice of cancellation triggers and by when it must arrive is shown on the page Switching health insurer. You will find the health insurers’ key figures in the health insurer profiles.

Common mistakes

• Paying the deductible on check-ups. Check-ups, ultrasound scans, childbirth preparation and breastfeeding advice are never subject to the co-payment. Complain about an incorrect statement.
• Overlooking the 13th week. From then on, every benefit of basic health insurance is exempt, not only from the birth. If the date is missing on the bill, ask the doctor’s practice.
• Lowering the deductible by reflex in the year of the birth. Most costs around the birth are exempt; the higher premium can cost more than it saves.
• Booking a childbirth preparation course with someone who is not a midwife and expecting the contribution. Basic health insurance only pays CHF 150 for courses and sessions by midwives.
• Forgetting supplementary insurance for the child. After the birth, the health insurer may ask health questions about the child. If you want it, sort it out before the birth.

What to do for your child after the birth is shown in the article Insuring your baby, and you can compare the children’s premiums in your municipality in the premium calculator. All topics around pregnancy, children and family are in the section Family and children.