Therapists recognised by health insurers: what “recognised” means

What basic health insurance pays: approved therapists

Under basic health insurance, “recognised” means the same as “approved”. The law sets out exhaustively who may bill basic health insurance (Art. 35 para. 2 of the Federal Health Insurance Act, KVG). This includes people who work on the prescription or on behalf of a physician or a chiropractor (Art. 35 para. 2 let. e and Art. 25 para. 2 let. a no. 3 KVG). This approval is the same at all insurers. The glossary entry recognised therapists summarises the distinction briefly.

Depending on the profession, approval requires a cantonal licence to practise, recognised training, usually two or three years of practical work with approved professionals and proof that the quality requirements are met. Titles such as “coach”, “therapist” or a course diploma are not enough.

Complementary medicine only from physicians

Basic health insurance pays for complementary medicine in five disciplines: acupuncture, anthroposophic medicine, traditional Chinese medicine drug therapy, classical homeopathy and phytotherapy (Art. 4b of the Health Care Benefits Ordinance, KLV). The requirement is that a physician with the relevant certificate of proficiency treats you. Basic health insurance does not pay for the same method provided by a non-medical therapist.

What supplementary insurance pays: your insurer’s list

For non-medical methods such as naturopathy, classical massage, shiatsu, kinesiology or osteopathy, you need supplementary outpatient insurance with complementary medicine. Supplementary insurance is governed by the Insurance Contract Act (ICA). There is no statutory list of recognised therapists there: each insurer decides itself

• which methods it pays for at all,
• which therapists it recognises for these methods,
• how much it pays, for example a percentage per session, a maximum amount per session or an annual limit.

Many insurers base their recognition on private registers. The ASCA foundation and the Register for Experiential Medicine EMR check the training and further training of therapists. Neither is an authority. An entry with ASCA or EMR does not mean that every insurer pays: what counts are your insurer’s general terms and conditions and its list of therapists. We are building a comparison of supplementary products under Supplementary insurance.

Conditions

• Medical prescription: The insurer only pays for basic health insurance therapies such as physiotherapy, occupational therapy or psychological psychotherapy on a physician’s prescription. For physiotherapy, the first session must take place within five weeks of the prescription (Art. 5 para. 2 KLV), for occupational therapy within eight weeks (Art. 6 para. 2 KLV).
• Who may prescribe: Psychological psychotherapy is prescribed by physicians with certain postgraduate titles, for example in general internal medicine or psychiatry; for crisis intervention, any postgraduate title is sufficient (Art. 11b para. 1 KLV).
• Session limits: When a prescription has been used up, a new one is needed. After 36 sessions of physiotherapy or occupational therapy, the insurer’s medical adviser reviews whether therapy continues; how the procedure works is explained on the page Cost approval.
• Deductible and retention fee: The costs count towards the deductible, after which a 10 % retention fee applies up to a maximum of CHF 700 a year, CHF 350 for children (Art. 103 KVV).
• Supplementary insurance: The insurer only pays if the method and the therapist are on its list at the time of treatment. Contracts can also require a medical prescription or limit the number of sessions; what counts are the general terms and conditions.
• Acceptance: Under basic health insurance, every insurer must accept you (Art. 5 let. i KVAG). This does not apply to supplementary insurance; the insurer may ask health questions and turn down an application.

Sample calculation

Example with fictitious people, assumed prices and a contract example. Marco is 41, has a CHF 300 deductible and has already reached it this year. His physician prescribes 9 physiotherapy sessions. He also goes to a naturopath 6 times. We assume CHF 55 per physiotherapy session and CHF 120 per naturopathy session. In the contract example, his supplementary insurance pays 75 % up to CHF 1,500 a year for recognised therapists.

You can have your supplementary insurance with a different insurer from your basic health insurance. You choose basic health insurance by premium, because the approved therapists are the same everywhere; you can find key figures on the insurers in the health insurer profiles.

How to proceed

1. Ask before the first session: Can the therapist bill under basic health insurance, or only under supplementary insurance?
2. Get a prescription: Have physiotherapy, occupational therapy, nutritional advice or psychotherapy prescribed by a physician and keep an eye on the session limit.
3. Check your insurer’s list: For complementary medicine, ask your supplementary insurer whether the method and the therapist are recognised, ideally in writing.
4. Check again when you switch insurer: If you switch basic health insurance, the approved therapists stay the same. If you switch supplementary insurance, check the new insurer’s list before cancelling the old one. Deadlines and the procedure are explained under Switching health insurer.

Common mistakes

• Assuming recognition applies at all insurers. For supplementary insurance, only your insurer’s list counts.
• Confusing ASCA or EMR with a commitment from your insurer. The registers are private; whether your insurer pays is set out in the general terms and conditions.
• Starting without a medical prescription. Even an approved physiotherapist is not paid by basic health insurance without a prescription.
• Cancelling supplementary insurance first. With new health questions, the new insurer can turn you down or add reservations.

When basic health insurance pays for nutritional advice is explained on the page of the same name; you can find all benefits in the overview What does health insurance cover?.