Does Swiss health insurance pay for chiropractic?

What basic health insurance pays

Chiropractic is a full benefit of basic health insurance. Chiropractors are among the service providers that the Federal Health Insurance Act (KVG) lists exhaustively (Art. 35 para. 2 let. c KVG). There they stand alongside physicians, pharmacists and midwives. Basic health insurance covers their examinations and treatments, both outpatient and in hospital (Art. 25 para. 2 let. a no. 2 KVG). The law does not require a medical referral.

A chiropractor can do more than bill you for manipulations, however. They may also prescribe further services at the expense of basic health insurance. Art. 4 of the Health Care Benefits Ordinance (KLV) lists exhaustively what these are:

Billing is according to the tariff that applies to chiropractic. For basic health insurance services, the practice may not charge more than this tariff (tariff protection, Art. 44 para. 1 KVG). Anything not listed in Art. 4 KLV, such as a medicine outside these groups, must be prescribed by a physician for your insurer to pay.

What supplementary insurance pays

You do not need supplementary insurance for chiropractic itself: basic health insurance pays for it in the same way at all insurers. Supplementary insurance may also not cover your deductible and your retention fee; co-payments may not be insured either with a health insurance fund or with a private insurer (Art. 64 para. 8 KVG).

A supplementary outpatient insurance only becomes important where basic health insurance stops. Typical examples relating to the back and the musculoskeletal system:

• treatment by therapists without admission under the KVG, such as osteopathy or medical massage,
• complementary medicine methods with non-physician therapists,
• contributions to fitness or prevention courses, depending on the product.

Each insurer decides for itself whether and to what extent a product covers such services. We are building a comparison of supplementary products under Supplementary insurance. What counts is the general terms and conditions and the information from your insurer.

Conditions

• Admission: Only admitted chiropractors bill through basic health insurance. They need a cantonal licence under Art. 34 of the Medical Professions Act and proof that they meet the quality requirements (Art. 44 KVV). Chiropractic organisations are admitted under Art. 44a KVV.
• No referral in the standard model: With free choice of physicians, you go directly. The law treats chiropractors in the same way as physicians (Art. 25 para. 2 let. a KVG).
• Insurance model: With a GP, HMO or telemedicine model, you have restricted your choice (Art. 41 para. 4 KVG). Whether you may go directly to the chiropractor or must first contact your GP practice or the telephone advice service is set out in the rules of your model. If you do not follow them, your insurer may reduce or refuse benefits.
• Effective, appropriate, cost-effective: Like every benefit of basic health insurance, the treatment must meet these three criteria (Art. 32 para. 1 KVG). There is no fixed maximum number of chiropractic sessions.
• Deductible and retention fee: The invoice first counts towards your deductible (Franchise). After that, you pay a 10 % retention fee, at most CHF 700 per year for adults and CHF 350 for children (Art. 103 para. 2 KVV). Children have no standard deductible (Art. 64 para. 4 KVG); parents can choose an optional deductible of up to CHF 600 (Art. 93 KVV).
• Accident first: In the event of an accident, basic health insurance only pays insofar as no accident insurance covers it (Art. 1a para. 2 let. b KVG). If the complaints are the result of an accident and you are insured against accidents through your employer, report the accident there first.

Sample calculation

Example with fictitious people. Marco is 45, insured in the standard model and has had no healthcare costs so far this year. Because of back pain, he goes to the chiropractor without a referral. She takes an X-ray, treats him five times and then prescribes nine sessions of physiotherapy. The total costs of CHF 1,500 are assumed; the actual amounts depend on the tariffs. The deductible and retention fee are the statutory values; Marco has chosen a CHF 1,000 deductible.

Which deductible is cheaper for recurring treatment depends on the premium and the expected costs. You can work this out in the deductible calculator; the premium calculator shows the premiums in your municipality. You notify your insurer of a lower deductible for the following year by 30 November; the dates are listed under Deadlines.

How to proceed

1. Check your model: If you have a GP, HMO or telemedicine model, read the rules or call the relevant contact point first. The article GP model and specialists explains how the models differ.
2. Clarify admission: Ask the practice whether it bills through basic health insurance.
3. Check the invoice: Depending on the arrangement, the invoice is sent to you or directly to your insurer. Check the date and items and submit it so that it counts towards your deductible.
4. Keep the prescriptions: For physiotherapy or bandages, you need the chiropractor’s prescription.

Common mistakes

• Confusing chiropractic with osteopathy. Basic health insurance pays for chiropractic; osteopathy is only covered by supplementary insurance.
• Thinking a referral is necessary. In the standard model, you do not need one.
• Overlooking the rules of your model. In the GP or telemedicine model, going directly to the chiropractor may breach the rules.
• Believing the chiropractor may prescribe anything. Only the services listed in Art. 4 KLV are covered.
• Hoping supplementary insurance will cover the retention fee. Co-payments may not be insured.

You will find other benefits in the overview What does health insurance cover?, and key figures and contact details for the insurers in the health insurer profiles.