Does Swiss health insurance pay for massage?

What basic health insurance pays

In basic health insurance, massage is not a benefit area of its own. It is part of physiotherapy. Art. 5 of the Health Care Benefits Ordinance (KLV) lists “muscle and connective tissue massage” among the physical measures that approved physiotherapists provide on a medical referral (Art. 5 para. 1 let. c no. 6 KLV). The treatment must serve an illness of the musculoskeletal system, the nervous system or the internal organs and vessels.

Why the medical massage therapist is missing: basic health insurance only pays people who work on a medical referral and are approved to do so (Art. 25 para. 2 let. a no. 3 and Art. 35 para. 2 let. e of the Federal Health Insurance Act, KVG). Which professions these are is set out exhaustively in Art. 45–52f of the Health Insurance Ordinance (KVV): among others, physiotherapy, occupational therapy, speech therapy, nutritional advice, psychological psychotherapy and podiatry. Massage therapists are not included.

The physiotherapist bills according to the agreed tariff and may not charge you anything more for compulsory benefits (tariff protection, Art. 44 para. 1 KVG). A chiropractor may also prescribe physiotherapy (Art. 4 let. e KLV); more on this on the page Chiropractic.

What supplementary insurance pays

For massages outside physiotherapy, you need supplementary outpatient insurance, often with a module for complementary or alternative medicine. This is where the word “recognised” comes in. It has two meanings:

• In basic health insurance, recognised means “approved under the KVV”. This is the same with all insurers.
• In supplementary insurance, recognised means “on this insurer’s list”. Each insurer decides for itself which therapists and methods it pays for. Many rely on private registers such as the EMR (Register for Experiential Medicine of Eskamed AG) or the ASCA Foundation. Neither EMR nor ASCA is a public authority.

The same massage therapist can therefore be recognised by one insurer and not by another. The exact rules are in the general and special terms and conditions: what share of the invoice, what maximum amount per session or year, which methods and whether a medical prescription is required. The article Recognised therapists explains how the lists differ.

Supplementary insurance may not cover the deductible and retention fee of basic health insurance (Art. 64 para. 8 KVG). So it does not pay towards the physiotherapy massage on prescription, only towards massages that basic health insurance does not cover at all. 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

• Medical referral: Without a prescription from a physician or chiropractor, basic health insurance pays for no physiotherapy, including massage.
• Deadlines and sessions: The first session must take place within five weeks of the referral. A maximum of nine sessions is covered per referral; further sessions need a new referral (Art. 5 para. 2 and 3 KLV). After 36 sessions, the physician reports to the insurer’s medical adviser, who decides on continuation (Art. 5 para. 4 KLV).
• Approved professional: The physiotherapist needs a cantonal licence and two years of practical experience (Art. 47 KVV). If in doubt, ask whether they bill basic health insurance.
• Deductible and retention fee: Physiotherapy counts towards your deductible; after that you pay a 10 % retention fee, at most CHF 700 per year for adults (Art. 64 KVG, Art. 103 KVV).
• Supplementary insurance: Before the first session, check whether the massage therapist is on your insurer’s list and whether the contract covers the method. If you take out new supplementary insurance, you answer a health questionnaire; the insurer can exclude existing complaints with a reservation (Art. 4 of the Insurance Contract Act, ICA).
• Accident: If it concerns the consequences of an accident, first check whether an accident insurer is responsible.

Sample calculation

Example with fictitious people. Rahel is 38, has a CHF 1,000 deductible and has had neck pain for weeks. She compares two options: physiotherapy with massage on a medical referral, or nine sessions with a medical massage therapist. The price of CHF 80 per session is assumed. The supplementary insurance benefit is a sample contract (75 % of costs, at most CHF 500 per calendar year, massage therapist recognised).

Whether a supplementary module for massages is worth it is a calculation of annual premium versus expected reimbursement. You can work through the deductible of basic health insurance in the deductible calculator, and the premium calculator shows the premiums in your municipality.

How to proceed

1. Clarify the reason: If your complaints should be treated by a physician, ask for a physiotherapy prescription.
2. Choose the professional: Physiotherapists bill basic health insurance. For a massage therapist, ask your insurer whether they are on its list.
3. Submit invoices: Physiotherapy to basic health insurance, massages to supplementary insurance. The insurer checks the two separately.
4. Count the sessions: Before the tenth session, you need a new referral.

Common mistakes

• Expecting “recognised” to apply with all insurers. In supplementary insurance, only your own insurer’s list counts.
• Treating massage therapists and physiotherapists as the same. Only the approved physiotherapist bills basic health insurance.
• Starting without a prescription. Basic health insurance does not pay for sessions before the medical referral.
• Overlooking the ninth session. Without a new referral, you pay for the tenth yourself.
• Not checking again after switching insurer. Your massage therapist may be missing from the new supplementary insurer’s list.

Other benefits, including psychotherapy and lymphatic drainage, are in the overview What does health insurance cover?, and key figures for insurers in the health insurer profiles.