Does health insurance pay for a termination of pregnancy?

What basic health insurance pays

In Switzerland, a termination of pregnancy is not punishable under the conditions of Art. 119 of the Swiss Criminal Code (SCC). If it is not punishable, compulsory health insurance covers the costs of the same benefits as for illness under Art. 30 KVG. This applies with every health insurer and in every insurance model. No supplementary insurance or health questions are needed.

The benefits “as for illness” are medical examination and treatment, prescribed medicines and analyses and, if necessary, a stay in the general ward of a hospital (Art. 25 para. 2 KVG). Whether the termination is carried out with medication or surgically is something you decide with your doctor; for the health insurer, both are a benefit under Art. 30 KVG.

The normal co-payment applies to the costs: first the deductible, then a 10 % retention fee up to a maximum of CHF 700 a year for adults (Art. 64 para. 2 KVG, Art. 103 para. 2 KVV). The exemption from the co-payment in the case of maternity concerns the specific maternity benefits (Art. 64 para. 7 let. a KVG), including the two check-ups in the table, and benefits as for illness from the 13th week of pregnancy until eight weeks after delivery (Art. 64 para. 7 let. b KVG). Art. 64 para. 7 KVG does not expressly mention a termination under Art. 30 KVG. The most reliable way to find out how your health insurer bills a termination from the 13th week is therefore to ask it directly.

What supplementary insurance pays

You do not need supplementary insurance for the termination itself, because basic health insurance covers it as a compulsory benefit. Supplementary insurance under the ICA can at most add what basic health insurance does not include, for example a room in the semi-private or private ward during an inpatient stay. Whether and to what extent this applies is set out in your health insurer’s general terms and conditions.

No supplementary insurance may cover the deductible and retention fee of basic health insurance (Art. 64 para. 8 KVG). If you want to look at supplementary hospital insurance, you will find how supplementary products are structured under Supplementary insurance. What always counts are the general terms and conditions and the information from your health insurer.

Conditions

• Not punishable: The health insurer only pays for a termination that is not punishable under Art. 119 SCC. In the first twelve weeks, your written request is required, and you state that you are in a situation of distress (Art. 119 para. 2 SCC).
• Doctor: The termination is carried out by a doctor licensed to practise. The cantons designate the practices and hospitals that can carry it out professionally and provide thorough counselling (Art. 119 para. 4 SCC).
• Consultation and guide: Before a termination in the first twelve weeks, the doctor personally holds a thorough consultation, informs you about the health risks and hands over, against your signature, a guide listing free counselling services, support services and information on adoption (Art. 120 para. 1 let. b SCC).
• Under 16: The doctor makes sure that you have contacted a counselling service specialising in young people (Art. 120 para. 1 let. c SCC). If a woman is not capable of judgement, the consent of her legal representative is required (Art. 119 para. 3 SCC).
• Deductible and retention fee: Adults pay their chosen deductible and a 10 % retention fee. For children up to 18, there is no standard deductible and at most CHF 350 in retention fees per year (Art. 64 para. 4 KVG, Art. 103 para. 2 KVV); however, the parents may have chosen an optional deductible. The parents owe the co-payment of a minor child (Art. 64 para. 1bis KVG).
• Billing and data protection: The practice sends the bill either to you (tiers garant) or directly to the health insurer (tiers payant), and in the second case sends you a copy of the invoice (Art. 42 para. 1–3 KVG). At your request, it must disclose medical information only to the health insurer’s medical adviser (Art. 42 para. 5 KVG).
• Anonymous reporting: The termination is reported to the health authority for statistical purposes, and the woman’s anonymity is guaranteed (Art. 119 para. 5 SCC). The FSO publishes the figures every year.

Sample calculation

Example with fictitious people and assumed costs. Nina is 24 and has had no healthcare costs so far this year. Her termination in the eighth week costs an assumed CHF 800.00; the actual amount depends on the method, the tariff and the place. The deductible and retention fee follow Art. 64 KVG and Art. 103 KVV. Nina has the standard deductible of CHF 300.

Which deductible is cheaper for your year depends on the premium and your expected costs. The premiums of all health insurers for each deductible are shown by the premium calculator with FOPH data, and the deductible calculator works out the break-even point between two deductibles. You change your deductible on 1 January each year; a lower deductible must reach your health insurer by 30 November, see Deadlines.

How to proceed

1. Choose where to go: Contact a doctor, a women’s health practice or a hospital designated by the canton for terminations. The guide you receive there also lists free counselling services.
2. Raise data protection: Tell the practice if medical information should go only to the health insurer’s medical adviser. Ask your health insurer which address it sends statements of benefits to.
3. Submit the bill: Under tiers garant, you pay the bill and submit it to your health insurer, even if it is below the deductible. Under tiers payant, you check the copy of the invoice.
4. Check the statement: The statement of benefits shows the deductible, retention fee and payout. If something is wrong, ask your health insurer first.
5. Sort out payment difficulties: If you cannot pay your share all at once, ask your health insurer about paying in instalments or ask the counselling service for support.

Common mistakes

• Thinking supplementary insurance is necessary. A termination that is not punishable is a compulsory benefit of basic health insurance, the same with every health insurer.
• Expecting an exemption as for maternity. For a termination in the first twelve weeks, the deductible and retention fee apply as for illness.
• Not submitting the bill. Amounts below the deductible only count towards the deductible if the health insurer receives them.
• Not asking for data protection. You must actively ask for information to be disclosed only to the medical adviser; otherwise it goes to the benefits department.

You will find further benefits around family and health in the overview What does health insurance cover?, and the costs of a pregnancy carried to term in the article Pregnant: which costs your health insurer covers. Key figures and contact details of the insurers are in the health insurer profiles.