Does health insurance pay for a childbirth preparation course?

What basic health insurance pays

Childbirth preparation is one of the specific maternity benefits. Art. 14 of the Health Care Benefits Ordinance (KLV) sets a fixed contribution: basic health insurance pays CHF 150. This is the same with every insurer, regardless of model and deductible.

Offer	Who leads it	Basic health insurance
Childbirth preparation course, individually or in a group	midwife or organisation of midwives	CHF 150 (Art. 14 let. a KLV)
Consultation about the birth, the postnatal period at home and preparing for breastfeeding	midwife or organisation of midwives	CHF 150 (Art. 14 let. b KLV)
Course with a physiotherapist, yoga teacher, fitness centre	other providers	nothing
Course fee above CHF 150	–	nothing, you or a supplementary insurance pay the remaining amount

The KLV speaks of one contribution, either towards a course or towards a consultation. If a doctor carries out all the check-ups alone, she must point out to you under Art. 13 let. a KLV that a consultation with a midwife under Art. 14 KLV is advisable in the second trimester.

Without deductible or retention fee

Your insurer may not charge any co-payment on specific maternity benefits (Art. 64 para. 7 of the Federal Health Insurance Act, KVG); the FOPH expressly includes the contribution towards childbirth preparation. You therefore receive the full CHF 150, even with a deductible of CHF 2,500 and even if you have not yet submitted any other invoice in the same year.

What supplementary insurance pays

Anything the course costs above CHF 150, and courses by other providers, is paid for, if at all, by voluntary supplementary insurance under the Insurance Contract Act (ICA). The law does not prescribe any contribution there. The insurer sets out in its general terms and conditions:

• whether it pays anything at all towards childbirth preparation, and how much,
• whether the contribution applies per pregnancy, per course or per calendar year,
• which providers it recognises, for example also physiotherapists or pregnancy yoga courses,
• whether the contribution is part of a maternity or prevention package.

Supplementary insurance may not cover the co-payment of basic health insurance (Art. 64 para. 8 KVG); in any case there is none for childbirth preparation. When you take out a policy, the insurer may ask health questions (Art. 4 ICA). If you only look for supplementary insurance during pregnancy, you should expect reservations. We are building a benefits comparison under Supplementary insurance. What counts is always the general terms and conditions and the information from your insurer.

Conditions

• Midwife as course leader: Basic health insurance only pays if a midwife approved under Art. 45 of the Health Insurance Ordinance (KVV) or an approved organisation of midwives provides the course or consultation (Art. 14 and 16 KLV). Ask before registering whether the course can be billed to basic health insurance.
• Individually or in a group: Both are covered. The KLV does not specify the number of lessons.
• No prescription: You do not need a prescription or a referral from the doctor.
• Submitting the invoice: The course leader issues you an invoice, which you submit to basic health insurance, or she bills the insurer directly. The insurer reimburses you at most CHF 150.
• Other providers: Basic health insurance pays nothing for courses without a midwife, even if the content is similar.
• Insurance model: In the GP, HMO or telemedicine model, the model conditions set out what applies without first contact. If in doubt, ask your insurer.

Sample calculation

Example with fictitious people, an assumed course fee and a contract example. Sofia is 34, expecting her first child and has a CHF 1,000 deductible. She attends a group course run by a midwife, assumed to cost CHF 320. According to the contract example, her supplementary insurance pays CHF 100 towards childbirth preparation per pregnancy. The basic health insurance contribution comes from Art. 14 KLV, the exemption from co-payment from Art. 64 para. 7 KVG.

Around the birth, you will face further costs, most of which basic health insurance pays in full. An overview is given in Pregnant: which costs health insurance covers. You compare the premium for your child in the children’s premium calculator or in the premium calculator.

How to proceed

1. Choose a course: Look for a course led by a midwife or an organisation of midwives. Check course dates and registration deadlines early.
2. Clarify billing: Ask the course leader whether she bills the insurer directly or issues you an invoice.
3. Check your supplementary insurance: Look up in your general terms and conditions whether and how much it pays towards childbirth preparation and which providers count.
4. Submit the invoice: Submit the invoice to basic health insurance; the insurer then checks any supplementary insurance.
5. Plan for after the birth: At the same time, arrange care during the postnatal period with the midwife and register your child in good time, as described in Insuring your baby.

Common mistakes

• Expecting the full course fee. Basic health insurance pays CHF 150, not the shop price.
• Booking a course without a midwife. Then basic health insurance pays nothing.
• Factoring in the deductible. There is no deductible or retention fee on the CHF 150; there is no reason to hold back the invoice.
• Not submitting the invoice. Even with a high deductible, the insurer pays out the CHF 150, but only for an invoice that has been submitted.

What happens after the birth is explained in Does health insurance pay for breastfeeding advice?. You will find other benefits under What does health insurance cover?, and the insurers’ profiles in the health insurer profiles.