Does health insurance pay for nutritional advice?

What basic health insurance pays for nutritional advice

Basic health insurance pays for nutritional advice as therapy on a physician’s order (Art. 25 para. 2 let. a no. 3 of the Federal Health Insurance Act, KVG), but only for certain illnesses. Art. 9b para. 1 of the Health Care Benefits Ordinance (KLV) lists them exhaustively:

The insurer pays for at most 6 sessions per medical prescription; if more are needed, the physician can repeat the prescription (Art. 9b para. 2 KLV). After a total of 12 sessions, a reasoned proposal must be sent to the medical adviser, who recommends to the insurer whether and to what extent the advice continues (Art. 9b para. 3 KLV). The ordinance does not set a fixed amount in francs per session; billing follows the tariff agreed between the professional associations and the insurers.

Diabetes counselling

For diabetes, there is also diabetes counselling by specially trained nurses or by the diabetes counselling centres of the Swiss Diabetes Society, with at most 10 sessions per prescription (Art. 9c para. 1 and 3 KLV). In these counselling centres, licensed dietitians may also provide nutritional advice for metabolic diseases (Art. 9c para. 4 KLV).

What basic health insurance does not pay for

Advice on prevention without an illness, sports nutrition, weight loss where there is no illness, or courses on healthy eating are not among the services under Art. 9b KLV. The prevention measures that basic health insurance pays for are also listed individually in the KLV; general nutritional advice is not one of them.

What supplementary insurance pays

A supplementary outpatient insurance can pay where basic health insurance does not. It is governed by the Insurance Contract Act (ICA); the law does not prescribe a minimum scope for nutritional advice there. What the general terms and conditions typically set out:

• whether advice without an illness from Art. 9b KLV is paid for, for example as health promotion or prevention,
• whether the dietitian needs a licence under the KVG or must be on the insurer’s list,
• how much the insurer pays, for example a percentage, an amount per session or an annual limit,
• whether a medical prescription is required.

Supplementary insurance may not cover the deductible and retention fee of basic health insurance (Art. 64 para. 8 KVG). We are building a comparison of supplementary products under Supplementary insurance. What counts are the general terms and conditions and the information from your insurer.

Conditions

• Medical prescription: Without a physician’s order or instruction, basic health insurance does not pay, even if you have a qualifying illness (Art. 9b para. 1 KLV).
• Licensed professional: Dietitians with a cantonal licence to practise under the Health Professions Act, two years of practical experience with licensed professionals, self-employed practice and proof of meeting the quality requirements may bill (Art. 50a KVV), as may licensed nutritional advice organisations (Art. 52c KVV). More on this on the page Recognised therapists and in the glossary under recognised therapists.
• Session limits: From the 7th session you need a new prescription, from the 13th the review by the medical adviser. The page Cost approval explains how the procedure works.
• Deductible and retention fee: The costs first count towards the deductible; after that a 10 % retention fee applies, up to a maximum of CHF 700 a year, or CHF 350 for children (Art. 103 KVV).
• Other insurance first: If invalidity insurance or accident insurance is responsible for the treatment, it pays; basic health insurance then does not pay in addition.

Sample calculation

Example with fictitious people and an assumed price per session. Reto is 52 years old. Because of an illness listed in Art. 9b KLV, his physician orders nutritional advice, first 6 sessions, then she repeats the prescription for 6 more. We assume CHF 90 per session; the actual amount depends on the tariff and the duration. Reto has no other medical costs in the current year. Two deductibles are compared; the statutory values come from Art. 103 KVV.

You can work out how premium and deductible together affect your annual costs in the deductible calculator. You must report a lower deductible for the following year by 30 November; the dates are listed under Deadlines.

How to proceed

1. Talk to your physician: Ask whether your situation falls under Art. 9b KLV and have the advice prescribed.
2. Check the licence: Ask the dietitian before the first appointment whether she may bill basic health insurance.
3. Count the sessions: After 6 sessions you need a new prescription, after 12 the review by the medical adviser.
4. Check your supplementary insurance: For advice without an illness from the list, read the general terms and conditions of your supplementary insurance to see whether and how much it pays.

Common mistakes

• Starting without a prescription. Then basic health insurance pays nothing, even if you have a qualifying illness.
• Choosing a professional without a KVG licence. A “nutrition coach” title or a course diploma is not enough for billing basic health insurance.
• Overlooking the 6-session limit. You pay for the 7th session yourself if there is no new prescription.
• Expecting basic health insurance to pay for prevention. Advice without an illness from Art. 9b KLV is not one of its benefits.

The benefits of basic health insurance are the same with every insurer; you can find key figures for the insurers in the health insurer profiles and compare the premium in the premium calculator. When your insurer pays for medical foot care is explained on the page Podiatry; you can find all benefits in the overview What does health insurance cover?.