Does health insurance pay for the pill and other contraceptives?

What basic health insurance pays

Basic health insurance covers services used to diagnose or treat an illness (Art. 25 para. 1 of the Federal Health Insurance Act, KVG), as well as certain preventive measures, maternity benefits and a few special cases. It may not cover other costs (Art. 34 para. 1 KVG). Contraceptives fall into none of these groups. In its opinion of 21.08.2019 on motion 19.3660, the Federal Council gave this reason: oral contraceptives and IUDs neither serve to prevent or treat an illness nor are they a maternity benefit; reimbursing them therefore does not fall under basic health insurance.

Basic health insurance only reimburses medicines if a physician prescribes them, they are on the List of Pharmaceutical Specialties (SL) and they are used to treat an illness (Art. 25 para. 2 let. b and Art. 52 para. 1 let. b KVG). If a physician prescribes a hormonal product to treat an illness, that is a different question from contraception: reimbursement then depends on whether that exact product is listed in the SL for that use. What the SL means for medicines in general is explained in the glossary. Whether your case falls under it is for your physician and your insurer to assess, not us.

What supplementary insurance pays

Supplementary outpatient insurance is governed by the Insurance Contract Act (ICA). The law does not prescribe any contribution towards contraceptives there. Whether a product pays anything is set by each insurer in its general terms and conditions, for example:

• whether contraceptives are included at all or explicitly excluded,
• whether the contribution only applies to products prescribed by a physician,
• whether there is a percentage, a maximum amount per year or both,
• whether products bought at a pharmacy without a prescription count.

We are building a comparison of supplementary products under Supplementary insurance. The general terms and conditions and the information from your insurer are always decisive. Before taking out a policy, check whether a supplementary premium pays off for such a contribution: if the supplementary insurance costs more per year than it pays back, it is cheaper to pay for contraception yourself.

Conditions

• Not a benefit of basic health insurance: There is no condition under which basic health insurance pays for contraceptives; a prescription does not change this.
• Paying yourself: If you buy a product at a pharmacy without a prescription, that is self-medication. Even with a prescription, you pay for contraception yourself if no supplementary insurance covers it.
• Nothing towards the deductible: Only costs for services of basic health insurance count towards the deductible and the retention fee (Art. 64 para. 2 KVG). So you submit invoices for contraceptives to supplementary insurance at most.
• Check-ups are covered: Basic health insurance pays for the gynaecological check-up at the intervals set out in Art. 12e let. b of the Health Care Benefits Ordinance (KLV), with the deductible and a 10 % retention fee. The provision explicitly excludes testing for human papillomaviruses as part of screening.
• Co-payment cannot be insured: No supplementary insurance may cover the deductible and retention fee of basic health insurance (Art. 64 para. 8 KVG).

Sample calculation

Example with fictitious people, assumed prices and an assumed contract value. Jana is 22 and has the standard deductible of CHF 300. Over the year, she buys four packs of the pill with a prescription at an assumed CHF 60.00 each and goes for one gynaecological check-up, assumed at CHF 180.00. She has no other healthcare costs. The deductible and retention fee follow Art. 64 KVG and Art. 103 of the Health Insurance Ordinance (KVV); the supplementary insurance contribution is a sample contract.

How high your deductible should be depends on the premium and the covered costs you expect; contraceptives do not belong in this calculation. The deductible calculator shows the break-even point between two deductibles, and key figures and contact details of the insurers are in the health insurer profiles.

How to proceed

1. Plan your costs realistically: Budget for the full price of your contraceptive over the whole year, because basic health insurance pays nothing towards it.
2. Look at check-ups separately: Submit the gynaecological check-up to basic health insurance, even if it stays below the deductible.
3. Read your supplementary insurance: If you have supplementary outpatient insurance, search its general terms and conditions for “contraception” or “contraceptives” and submit your receipts there.
4. Ask for support: If your budget is not enough, ask the social counselling service of your municipality or a cantonal counselling centre for sexual health; the Federal Council refers to the cantons and municipalities for this.

Common mistakes

• Thinking a prescription means the costs are covered. Basic health insurance does not pay for contraceptives, even when a physician prescribes them.
• Counting contraception towards the deductible. Contraceptives you pay for yourself do not lower your deductible.
• Assuming all supplementary insurance is the same. Whether and how much supplementary insurance contributes is set by each product.
• Not submitting the check-up. It is a benefit of basic health insurance and counts towards the deductible.

As of 25.09.2026: motions 19.3660 and 22.3270 have been dealt with, and there is no obligation for basic health insurance to cover contraceptives. You can find other benefits in the overview What does health insurance cover?, and terms relating to costs in the glossary.