Does health insurance pay for check-ups and preventive examinations?

What basic health insurance pays

In principle, basic health insurance pays when you are ill: for diagnosis and treatment (Art. 25 para. 1 of the Federal Health Insurance Act, KVG). Prevention is the exception. Art. 26 KVG obliges basic health insurance to cover certain examinations for the early detection of illnesses and preventive measures for insured persons at particular risk; a physician carries them out or orders them. Art. 12 of the Health Care Benefits Ordinance (KLV) lists which measures these are in five groups. Basic health insurance may not cover other costs (Art. 34 para. 1 KVG).

Art. 12e let. d KLV, as amended on 01.07.2026, gives an exhaustive list of the cantonal colorectal cancer screening programmes without a deductible: Basel-Landschaft, Basel-Stadt, Bern, Fribourg, Geneva, Glarus, Graubünden, Jura, Lucerne, Neuchâtel, Solothurn, St. Gallen, Ticino, Uri, Vaud and Valais. Vaccinations are governed by Art. 12a KLV; what applies there is explained in the guide Which vaccinations does health insurance pay for?. Check-ups during pregnancy are not part of prevention but of maternity benefits.

Where no exception applies, you pay the deductible first, as for any other benefit, and then a 10 % retention fee, at most CHF 700 a year for adults (Art. 64 para. 2 KVG, Art. 103 of the Health Insurance Ordinance, KVV). The exemption from the deductible is based on Art. 64 para. 6 let. d KVG and only applies to services in nationally or cantonally organised prevention programmes; it does not remove the retention fee.

What supplementary insurance pays

A check-up you ask for yourself, prevention outside the intervals set in the KLV or examinations not listed there are paid for at most by supplementary outpatient insurance. It is governed by the Insurance Contract Act (ICA); the law does not prescribe any contribution to prevention. Each insurer sets out in its general terms and conditions:

• whether it contributes to check-ups or preventive examinations and how much,
• at what intervals it pays, for example per calendar year or every few years,
• whether the examination must take place with certain physicians, centres or partners,
• whether laboratory analyses, imaging or performance tests are included.

No supplementary insurance may 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. The general terms and conditions and the information from your insurer are always decisive.

Conditions

• Only what is listed in the KLV: The list in Art. 12–12e KLV is exhaustive. The examination is only covered with the age, interval or risk stated there.
• Carried out or ordered by a physician: Prevention must be carried out or ordered by a physician (Art. 26 KVG).
• Programmes: The exemption from the deductible only applies if the examination takes place within the programme. Before your appointment, ask whether the practice takes part in the cantonal programme.
• Symptoms are not prevention: If you have symptoms or abnormal results, investigating them is a benefit in the event of illness under Art. 25 KVG, at any age, with the deductible and retention fee.
• Travel and work: Basic health insurance does not pay for vaccinations and vaccination advice for work-related or travel medicine reasons (Art. 12a para. 3 KLV).

Sample calculation

Example with fictitious people and assumed costs. Monika is 52, lives in the canton of Bern and has a CHF 2,500 deductible. She has had no other healthcare costs this year. She has three examinations: a gynaecological check-up (assumed at CHF 200.00), a stool test in the Bern colorectal cancer screening programme (assumed at CHF 60.00) and, at her own request, a general check-up with a blood count (assumed at CHF 350.00). The deductible and retention fee follow Art. 64 KVG, Art. 103 KVV and Art. 12e KLV.

Whether a lower deductible pays off depends on the covered costs you expect and the premium; the deductible calculator works out the break-even point, and the premium calculator shows the premiums for each deductible. Which insurer offers which supplementary products is set out in the health insurer profiles.

How to proceed

1. Check your age and the interval: Use the table to see whether the examination is listed in the KLV for your age and at your interval.
2. Ask about the programme: For mammography and colorectal cancer screening, ask whether your canton runs a programme and whether the practice takes part.
3. Mention your risk: If colorectal cancer, melanoma or breast cancer runs in your family, talk to your physician about it; separate rules in Art. 12d KLV apply to risk groups.
4. Clarify a check-up in advance: If you want a general check-up, ask your supplementary insurer beforehand whether and how much it will contribute.
5. Submit your invoices: Submit covered prevention to basic health insurance, even below the deductible, and anything not covered to supplementary insurance.

Common mistakes

• Thinking a check-up is covered. Basic health insurance does not pay for a general health check for adults without symptoms.
• Confusing exemption from the deductible with free of charge. Even within a programme, the 10 % retention fee remains.
• Going below the interval. A screening colonoscopy is covered every ten years, screening mammography every two years.
• Going outside the programme. Without a programme, the deductible applies to colorectal cancer screening, and basic health insurance does not pay for mammography screening at all.

How mammography is billed in detail is explained in the guide Does health insurance pay for mammography?, and colonoscopy in the guide Does health insurance pay for a colonoscopy?. You can find all other benefits in the overview What does health insurance cover?.