Does Swiss health insurance pay for osteopathy?

What basic health insurance pays

In short: nothing. Basic health insurance only pays for treatment by professionals that the Federal Health Insurance Act (KVG) lists as service providers. This list in Art. 35 para. 2 KVG is exhaustive. Among others, it names physicians, pharmacists, chiropractors, midwives, nurses and persons who work on a physician’s prescription. Osteopaths are not on it.

In addition, Art. 34 para. 1 KVG states that under basic health insurance, insurers may not cover any costs other than the statutory benefits. So an insurer may not pay for osteopathy through basic health insurance even as a goodwill gesture.

Physician-provided complementary medicine does not help here either. Art. 4b of the Health Care Benefits Ordinance (KLV) lists exhaustively five disciplines that basic health insurance pays for when practised by physicians with a certificate of proficiency: acupuncture, anthroposophic medicine, drug therapy in traditional Chinese medicine, classical homeopathy and phytotherapy. Osteopathy is not among them.

It is important to distinguish between the profession and the insurance benefit. Since the Health Professions Act, osteopathy has been a health profession regulated at federal level (Art. 2 para. 1 let. g GesBG). Anyone practising it on their own professional responsibility needs a licence from the canton (Art. 11 GesBG) and a Master of Science in Osteopathy from a university of applied sciences or an equivalent qualification (Art. 12 para. 2 let. g GesBG). However, a recognised profession is not automatically a service provider under basic health insurance. That is decided by the KVG alone.

What supplementary insurance pays

Osteopathy is a typical case for supplementary outpatient insurance. Many insurers include it in the complementary or alternative medicine module, some as a separate item. Supplementary insurance is governed by the Insurance Contract Act (ICA); the law does not prescribe a minimum contribution. In its general and special terms and conditions, each insurer decides for itself:

• whether osteopathy is covered at all,
• what share of the invoice it pays, for example a percentage,
• what maximum amount per session or per calendar year it reimburses,
• whether the number of sessions per year is limited,
• which therapists it recognises: its own list or registers such as EMR or ASCA,
• whether a medical prescription is required.

Supplementary insurance is a private contract. Before you sign, the insurer may ask health questions, add reservations or reject the application. You must answer the questions truthfully (Art. 4 ICA). Complaints you already have may therefore be excluded from the contract. The article Health questions in the application explains more.

We are building a comparison of supplementary products under Supplementary insurance. The article Which supplementary insurance do I need? shows which modules exist. What always counts is the general terms and conditions and the information from your insurer.

Conditions

For basic health insurance, there are no conditions you could meet: it does not pay for osteopathy in any case. For supplementary insurance, check these points before the first session:

• Cover in the contract: Is osteopathy listed in your policy or in the general terms and conditions of your supplementary product? A “complementary medicine” module does not automatically include it.
• Recognised therapist: Most insurers only pay recognised therapists. What counts is your insurer’s list, not that of another insurer.
• Cantonal licence: Anyone practising independently needs a licence from the canton (Art. 11 GesBG). If in doubt, ask.
• Prescription: Some contracts require a medical prescription or recommendation, even though the treatment itself does not need one.
• Limits: The percentage, the maximum amount per session or per year and the number of sessions are set out in the general terms and conditions.
• Deductible and retention fee: The statutory deductible (Franchise) of basic health insurance plays no role, because basic health insurance pays nothing. However, some supplementary products have their own retention fee; this is also set out in the general terms and conditions.
• Accident: If an accident is the cause, the accident insurance is responsible first. Clarify with it whether it covers osteopathy before you send the invoice to your health insurer.

Sample calculation

Example with fictitious people. Nina is 41 and goes to an osteopath five times because of neck tension. The price of CHF 140 per session is assumed. The supplementary insurance benefit is a sample contract (75 % of costs, at most CHF 500 per calendar year, therapist recognised) and does not correspond to any specific insurer.

Whether supplementary cover for osteopathy pays off is a calculation of annual premium against expected reimbursement: the premium is due every month, even in years without treatment. You can work out your choice of deductible for basic health insurance in the deductible calculator; the page Physiotherapy explains physiotherapy as an alternative.

How to proceed

1. Read your policy: Check your policy and the general terms and conditions to see whether osteopathy is covered and with what limits.
2. Check the therapist: Ask your insurer whether the osteopath is on its list, and get the answer in writing.
3. Collect the invoices: The osteopath invoices you directly. Pay the invoice and submit it to your supplementary insurance, not to basic health insurance.
4. Know the alternatives: If you need manual treatment through basic health insurance, the routes are chiropractic without a referral and physiotherapy prescribed by a physician. You will find the insurers’ key figures in the health insurer profiles.

Common mistakes

• Submitting osteopathy invoices to basic health insurance. They are rejected and do not count towards the deductible.
• Thinking a medical prescription is enough. Under basic health insurance, it changes nothing; only some supplementary insurance policies require one.
• Not checking recognition. If the therapist is not on your insurer’s list, the supplementary insurance pays nothing either.
• Taking out supplementary cover only once you have complaints. The insurer may exclude existing complaints or reject the application.
• Confusing osteopathy with chiropractic. Basic health insurance pays for chiropractic, but not for osteopathy.

You will find other benefits, from glasses to psychotherapy, in the overview What does health insurance cover?, and the differences between therapist lists in the article Recognised therapists.