Does health insurance pay for your gym membership?

What basic health insurance pays

Basic health insurance pays nothing towards a gym membership. In basic health insurance, insurers may only cover costs for the services listed in Art. 25–33 of the Federal Health Insurance Act, KVG (Art. 34 para. 1 KVG). Training at the gym, classes at a club or running groups are not among them, even if they are good for your health. A medical certificate does not change this.

Medical training therapy: This is the only form of equipment-based training that basic health insurance pays for. It requires a medical prescription for physiotherapy, and a licensed physiotherapist provides it. Training therapy is preceded by an individual physiotherapy session; it starts with an introduction to the equipment and ends at most three months after that (Art. 5 para. 1ter of the Health Care Benefits Ordinance, KLV). It may also take place in groups (Art. 5 para. 1bis KLV). Per prescription, the insurer pays for at most nine sessions, the first within five weeks (Art. 5 para. 2 KLV). The details are on the page Physiotherapy.

Prevention: Basic health insurance only pays for prevention if a physician carries out or orders certain examinations or measures listed in the KLV (Art. 26 KVG, Art. 12–12e KLV). General fitness or health programmes are not among them.

No discount for sport: The premium for basic health insurance does not depend on how much you train. Bonus insurance does lower the premium step by step, but only for calendar years in which you have not claimed any benefits (Art. 96 para. 1, Art. 98 KVV), not for training.

What supplementary insurance pays

A fitness contribution is only available from supplementary insurance. Health insurers may offer supplementary insurance alongside basic health insurance; it is governed by the Insurance Contract Act (Art. 2 para. 2 of the Health Insurance Supervision Act, KVAG). The law does not prescribe any fitness benefit there. Whether there is a contribution and how high it is, each insurer sets in its general terms and conditions, usually in a supplementary outpatient insurance or a prevention add-on.

Typical points that a contract can set out:

• Amount: a percentage of the membership cost, a fixed amount or both, with a maximum amount per calendar year,
• Providers: only gyms or classes with a certain quality label or from a list kept by the insurer,
• Proof: a copy of the invoice or the membership contract, submitted within a deadline,
• Combination: contributions for fitness, classes and other prevention offers sometimes share a joint annual amount.

Before you take out a policy, the insurer must inform you about the scope of cover and the premium (Art. 3 para. 1 of the Insurance Contract Act, ICA). We are building a comparison of the benefits of supplementary products under Supplementary insurance. What counts are the general terms and conditions and the information from your insurer.

Conditions

• Basic health insurance: Training therapy only on a physician’s order, with a licensed physiotherapist, for at most three months after the introduction. The deductible and a 10 % retention fee up to CHF 700 a year apply (Art. 64 KVG, Art. 103 KVV).
• Supplementary insurance taken out: You only receive the contribution with a contract that provides for it. For admission, insurers usually ask health questions; there is no obligation to accept you as there is in basic health insurance. What to watch out for when filling in the form is explained in the article Health questions in the application.
• Recognised provider: Before buying the membership, check whether the insurer recognises the gym or class.
• Contract term: You can cancel supplementary insurance with ordinary notice at the earliest at the end of the third year, with three months’ notice, unless the contract provides for a shorter period; in supplementary insurance, only the policyholder has this right (Art. 35a para. 1 and 4 ICA). Details are under Cancelling supplementary insurance.

Sample calculation

Example with fictitious people and assumed amounts from a sample contract. Luca is 29 and buys an annual membership for CHF 900.00 (assumed). He is considering supplementary insurance that, according to a sample contract, pays 50 % of the membership cost, up to CHF 200.00 per calendar year, and costs CHF 25.00 a month. Basic health insurance pays nothing towards the membership.

Without supplementary insurance, Luca would have paid CHF 900.00. On the fitness contribution alone, the contract does not pay off in this example; it may pay off if Luca needs other benefits from it. Which ones those could be is covered in the article Which supplementary insurance do I need?.

You can compare the basic health insurance premiums of all insurers where you live in the premium calculator. If you switch basic health insurance, you can keep your supplementary insurance, and the insurer may not cancel it for that reason (Art. 7 para. 7 and 8 KVG); the steps are under Switching health insurer.

How to proceed

1. Read the general terms and conditions: Look for the section on prevention or fitness in your contract. If there is nothing there, there is no contribution.
2. Check the provider: Ask your insurer before buying whether it recognises the gym or class.
3. Keep the invoice: Submit the invoice with proof of payment within the deadline stated in the contract.
4. Do the maths: Compare the annual premium for the supplementary insurance with the expected contribution. The needs check helps you clarify your own needs.
5. If you have symptoms, ask your physician: Basic health insurance pays for prescribed training therapy, not for a membership.

Common mistakes

• Buying the membership before asking. If the insurer does not recognise the gym, you pay for everything yourself.
• Taking out supplementary insurance just for fitness. In the example, the premium costs more than the contribution brings in, and the contract may tie you in for three years.
• Confusing training therapy with a gym membership. Basic health insurance only pays for prescribed therapy with a physiotherapist, limited to three months.
• Missing the submission deadline. Contracts may set a deadline for invoices; after that, the entitlement may lapse.

What your insurer pays for speech and swallowing therapy is on the page Speech therapy, and when it covers a second medical opinion on the page Second opinion. You can find all benefits in the overview What does health insurance cover?.