Does Swiss health insurance pay for a midwife?

What basic health insurance pays

Under the Federal Health Insurance Act (KVG), the midwife is a service provider in her own right (Art. 35 para. 2 let. d KVG). She does not need a doctor’s prescription and bills basic health insurance directly. Her services are among the specific benefits for maternity under Art. 29 para. 2 KVG. How much she may bill is listed in Art. 16 of the Health Care Benefits Ordinance (KLV). This is the same for every insurer.

Phase	What basic health insurance pays	Legal basis
Pregnancy, normal	seven check-ups, which can be done entirely by the midwife; she points out that a medical examination should take place in the first trimester	Art. 16 para. 1 let. a KLV
High-risk pregnancy	cooperation with the doctor; in the case of manifest pathology on a doctor’s order	Art. 16 para. 1 let. a no. 2 KLV
Pregnancy, other	arranging laboratory analyses, ordering an ultrasound from the doctor, cardiotocography in a high-risk pregnancy	Art. 16 para. 1 let. b, para. 2 and 3 KLV
Preparation	CHF 150 towards an antenatal class or a counselling session	Art. 14 KLV
Birth	assistance at the birth at home, in a birth centre or in hospital	Art. 29 para. 2 let. b KVG
Postnatal period	up to 10 home visits in the 56 days after the birth; up to 16 after a premature or multiple birth, for a first birth and after a caesarean section	Art. 16 para. 1 let. c no. 1 KLV
Postnatal period, first 10 days	in addition, at most five second visits on the same day	Art. 16 para. 1 let. c no. 2 KLV
Breastfeeding	three breastfeeding advice sessions	Art. 15 KLV
Postnatal check-up	one check-up between the 6th and 10th week after the birth	Art. 13 let. e, Art. 16 para. 1 let. b KLV
After a miscarriage from the 13th to the end of the 23rd week	at most 10 home visits, more on a doctor’s order	Art. 16 para. 1 let. abis KLV

Basic health insurance only pays for further home visits within the 56 days, or visits after that, with a doctor’s order (Art. 16 para. 1 let. c no. 3 KLV). According to the Federal Office of Public Health (FOPH), these ordered visits also count as maternity benefits and are free of co-payment.

No deductible, no retention fee

The insurer may not charge any co-payment on the specific maternity benefits (Art. 64 para. 7 let. a KVG). This applies whatever your deductible, even with CHF 2,500. From the 13th week of pregnancy until eight weeks after delivery, the general benefits in the event of illness are also exempt (Art. 64 para. 7 let. b KVG); this period ends at midnight on the 56th day after the birth (Art. 105 para. 3 of the Health Insurance Ordinance, KVV). You also do not pay the hospital contribution of CHF 15 per day during this period (Art. 104 para. 2 let. c KVV).

What supplementary insurance pays

For anything beyond Art. 16 KLV, you need a voluntary supplementary insurance under the Insurance Contract Act (ICA). The law does not prescribe anything there; the insurer sets out in its general terms and conditions whether and how much it pays. Typical topics in the terms are:

• a contribution towards the part of an antenatal class that exceeds CHF 150, or towards classes not run by a midwife,
• household help after the birth,
• postnatal recovery classes or other classes after the postnatal period,
• benefits of a supplementary hospital insurance, for example a semi-private or private ward for the birth.

Supplementary insurance may not cover the deductible and the retention fee of basic health insurance (Art. 64 para. 8 KVG); for midwife services, these do not apply anyway. When you take out the insurance, the insurer may ask health questions (Art. 4 ICA). If you only look for supplementary insurance during pregnancy, expect reservations or a refusal. We are building a comparison of the benefits of supplementary products under Supplementary insurance. What always counts are the general terms and conditions and the information from your insurer.

Conditions

• Approved midwife: The midwife needs a cantonal licence to practise, two years of practical experience and must meet the quality requirements (Art. 45 KVV). Midwives’ organisations need their own approval (Art. 45a KVV). Ask self-employed midwives whether they bill basic health insurance.
• No prescription: For check-ups in a normal pregnancy, assistance at the birth, home visits after the birth within the set numbers and breastfeeding advice, you do not need a doctor’s prescription.
• Doctor’s order for more: Basic health insurance only pays for more than 10 or 16 home visits within the 56 days, or for visits after that, with a doctor’s order.
• Insurance model: In the GP, HMO or telemedicine model, the conditions of the model set out which services are allowed without first contact. Clarify this with your insurer before the first check-up.
• Billing: The midwife bills according to the tariff, depending on the contract directly with the insurer (tiers payant) or through you. Because no co-payment applies, you get the full amount back.
• Insuring your child: You must insure your newborn within three months of the birth; cover then applies retroactively from birth (Art. 3 para. 1 and Art. 5 para. 1 KVG).

Sample calculation

Example with fictitious people and assumed prices. Lea is 31, is expecting her first child and has a deductible of CHF 2,500. She has some check-ups with the midwife and some with the gynaecologist, attends an antenatal class run by a midwife for an assumed CHF 280 and gives birth in hospital. Afterwards, the midwife comes to her home 16 times, and Lea has three breastfeeding advice sessions. In the 20th week of pregnancy, she goes to her GP with a cold, an assumed CHF 150. The basic health insurance amounts come from Art. 14–16 KLV and Art. 64 para. 7 KVG.

You do not need supplementary insurance for the birth itself, as long as you choose the general ward of a listed hospital, a birth centre or a home birth. More on the costs around the birth in Birth: what hospital, midwife and postnatal care cost. You can compare your child’s premium in the premium calculator or in the children’s premium calculator.

How to proceed

1. Look for a midwife early: Already during pregnancy, clarify who will look after you at home after the birth, and ask whether the midwife bills basic health insurance.
2. Check the conditions of your model: Clarify with your insurer whether your insurance model requires first contact for midwife services.
3. Choose a class: For the CHF 150, the class must be run by a midwife or a midwives’ organisation. Details in Does health insurance pay for antenatal classes?.
4. Register your child: Register your child with a basic health insurer within three months, ideally before the birth. The steps are in Insuring your baby.
5. Check the invoices: If an invoice for maternity benefits shows a deductible or a retention fee, complain to your insurer.

Common mistakes

• Counting on the deductible. Midwife services within Art. 16 KLV are free of deductible and retention fee, even with a CHF 2,500 deductible.
• Too many postnatal visits without an order. Beyond 10 or 16 visits, a doctor’s order is required, otherwise you pay yourself.
• Booking the class with the wrong provider. Classes without a midwife receive no contribution from basic health insurance.
• Looking for supplementary insurance too late. During pregnancy, the insurer asks health questions and can add reservations.
• Missing the deadline for registering your child. After three months, cover only starts when your child joins, and a premium surcharge may be charged (Art. 5 para. 2 KVG).

Breastfeeding advice is explained in detail in Does health insurance pay for breastfeeding advice?, the breast pump on this page. You will find all other benefits under What does health insurance cover? and profiles of the insurers in the health insurer profiles.