Does Swiss health insurance pay for podiatry?

What basic health insurance pays for podiatry

Podiatry is medical foot care provided by trained podiatrists. Basic health insurance has paid for it since 01.01.2022, but only in one narrowly defined case: for people with diabetes mellitus who have a risk factor for diabetic foot syndrome (Art. 11c para. 1 let. a of the Health Care Benefits Ordinance, KLV). How many sessions are covered depends on the risk factor (Art. 11c para. 2 KLV):

Art. 11c para. 1 let. b KLV lists the services included:

• examination of the foot, skin and nails,
• protective measures, in particular atraumatic removal of calluses and atraumatic nail care,
• instruction and advice on foot, nail and skin care and on the choice of shoes and orthopaedic aids,
• checking the fit of shoes.

The service requires a medical prescription; without one, the podiatrist cannot bill basic health insurance. Basic health insurance pays according to the agreed tariff; the ordinance does not set a fixed amount in francs per session.

What basic health insurance does not pay

Basic health insurance does not pay for cosmetic foot care, pedicures, foot care in old age without a diabetes risk factor or sessions above the annual limit. This also applies if the treatment takes place with an admitted podiatrist.

What supplementary insurance pays

For anything not covered by Art. 11c KLV, you need voluntary supplementary outpatient insurance. It is governed by the Insurance Contract Act (ICA); there, the law does not prescribe any contribution to foot care. What the general terms and conditions typically set out:

• whether medical foot care is covered at all and whether cosmetic foot care is excluded,
• whether a medical prescription is required,
• whether the podiatrist needs admission under the KVG or must be on the insurer’s list,
• how much the insurer pays, for example a percentage with an annual limit.

Supplementary insurance may not cover the deductible and retention fee of basic health insurance (Art. 64 para. 8 of the Federal Health Insurance Act, KVG). 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 prescription: Basic health insurance only pays on a physician’s prescription (Art. 11c para. 1 KLV, Art. 25 para. 2 let. a no. 3 KVG). Each new calendar year requires a new prescription (Art. 11c para. 3 KLV).
• Admitted podiatrist: Podiatrists with a cantonal licence to practise, a diploma from a college of higher education in podiatry or equivalent training, two years of practical experience after the diploma, independent practice and proof that they meet the quality requirements (Art. 50d KVV) may bill basic health insurance, as may admitted podiatry organisations (Art. 52f KVV). The glossary entry recognised therapists explains what “recognised” otherwise means.
• Calendar year: The limit of 4 or 6 sessions applies per calendar year, not to 365 days from the first session.
• Deductible and retention fee: The costs first count towards the deductible (Franchise); after that, a 10 % retention fee applies up to a maximum of CHF 700 per year, CHF 350 for children (Art. 103 KVV).

Sample calculation

Example with fictitious people, an assumed price per session and a sample contract. Ursula is 71 and has diabetes with polyneuropathy and PAOD. Her physician prescribes medical foot care for the calendar year; this covers 6 sessions. Ursula goes to the podiatrist 8 times. CHF 85 per session is assumed; the actual amount depends on the tariff. She has already reached her CHF 300 deductible this year. In the sample contract, her supplementary insurance pays 50 % of medical foot care.

People who regularly need doctors, laboratory tests, medicines and podiatry because of diabetes usually reach their deductible early in the year. You can work out how a different deductible affects your annual costs in the deductible calculator; you notify your insurer of a lower deductible for the following year by 30 November, and the dates are listed under Deadlines.

How to proceed

1. Talk to your physician: Ask whether you have a risk factor under Art. 11c KLV, and have podiatry prescribed for the calendar year.
2. Check admission: Ask the podiatrist whether she may bill basic health insurance.
3. Plan your sessions: Spread the 4 or 6 covered sessions over the year and clarify who pays for any additional sessions.
4. Renew the prescription: Ask your physician for the prescription for the new calendar year before the end of the year.

Common mistakes

• Assuming age is enough. Without diabetes with a risk factor, basic health insurance does not pay for foot care.
• Not renewing the prescription. In the new calendar year, the insurer only pays once there is a new prescription.
• Trying to bill cosmetic foot care to basic health insurance. It does not pay for pedicures; whether supplementary insurance contributes is set out in its general terms and conditions.
• Overlooking the annual limit. You pay for sessions above 4 or 6 per calendar year yourself or through supplementary insurance.

The benefits of basic health insurance are the same at all insurers; you will find the insurers’ key figures in the health insurer profiles, and you can compare premiums in the premium calculator. Continue with nutritional advice and acupuncture; you will find all benefits in the overview What does health insurance cover?.