Does health insurance pay for spa treatment?

What basic health insurance pays

In everyday language, “spa treatment” (Kur) covers a lot. Basic health insurance only recognises one form of it: spa treatment in a healing spa, ordered by a physician and taken in a recognised healing spa that uses a natural healing spring. Basic health insurance pays a contribution towards this treatment (Art. 25 para. 2 let. c KVG), not the costs. More on the term in the glossary under spa treatment.

The daily contribution is fixed and the same at every insurer. At most, it comes to CHF 210 a year (21 × CHF 10). It does not cover accommodation, meals or the visitor’s tax. The deductible and the 10 % retention fee apply to the contribution, as they do to every benefit of basic health insurance (Art. 64 para. 2 KVG).

Which spa establishments are recognised

For basic health insurance, only healing spas recognised by the Federal Department of Home Affairs (FDHA) count as service providers (Art. 40 KVG). A healing spa is admitted if it (Art. 57 para. 1 KVV):

• is under medical supervision,
• uses a healing spring on site for therapeutic purposes,
• has the necessary specialist staff and diagnostic and therapeutic facilities,
• is authorised under cantonal law.

A healing spring is water that has a scientifically recognised healing effect because of particular chemical or physical properties. This must be proven by analyses and checked every three years by the cantonal authority (Art. 58 KVV). The FDHA can grant exceptions to the requirement of a healing spring on site (Art. 57 para. 2 KVV). A wellness hotel with a thermal bath is therefore not automatically a recognised healing spa. Ask your insurer before you book whether the establishment you have chosen is admitted.

Spa treatment or rehab?

After an operation or a hospital stay, rehabilitation rather than spa treatment is often appropriate. It is medical treatment and a separate benefit of basic health insurance (Art. 25 para. 2 let. d KVG), paid according to the tariff and not with a fixed daily contribution. The rules that apply there are explained on the page Does health insurance pay for rehab?.

What supplementary insurance pays

Anything beyond the daily contribution can only be covered by voluntary supplementary insurance, usually supplementary outpatient insurance or a separate spa module. It is governed by the Insurance Contract Act (ICA); the law does not prescribe any spa benefit. Each insurer sets out in its general insurance conditions:

• whether it contributes to spa treatment, recuperative stays or both,
• in what form it pays: a fixed daily contribution, a percentage of the costs or an annual maximum,
• how many days per year or over several years it covers,
• which spa establishments it recognises,
• whether a physician’s prescription and prior cost approval are required.

Supplementary insurance may not cover the deductible and retention fee of basic health insurance (Art. 64 para. 8 KVG). It only pays towards the part that basic health insurance does not reimburse at all, such as accommodation, meals or the days from the 22nd day of the stay onwards. We are building a comparison of supplementary products under Supplementary insurance. The general insurance conditions and the information from your insurer are always decisive.

Conditions

• Ordered by a physician: Without a physician’s order, basic health insurance pays no contribution (Art. 25 KLV). The physician orders the spa treatment because it is indicated for treating an illness.
• Recognised healing spa: The treatment must take place in a healing spa admitted by the FDHA (Art. 40 KVG, Art. 57 KVV). A hotel with a wellness area is not enough.
• Maximum duration: The contribution applies for at most 21 days per calendar year. A stay that runs over New Year spreads the days across two calendar years.
• Cost approval for supplementary insurance: Some supplementary insurance policies only pay if they have given written approval before the stay starts.
• Deductible and retention fee: The daily contribution first counts towards the deductible; after that, a 10 % retention fee applies up to a maximum of CHF 700 a year for adults (Art. 103 KVV).
• Supplementary benefits: If you receive supplementary benefits, the canton reimburses documented costs of spa and recuperative stays ordered by a physician (Art. 14 para. 1 let. c ELG). The canton decides which costs and up to what amount.

Sample calculation

Example with fictitious people, assumed costs for the stay and an assumed contractual contribution from supplementary insurance. Heidi, 67, has recurring joint problems. Her GP orders spa treatment; Heidi stays 14 days in a recognised healing spa that charges an assumed CHF 150 per day for accommodation, meals and bath treatments. She has already used up her deductible this year. According to the sample contract, her supplementary insurance pays CHF 30 per day of the stay, for at most 21 days a year. The daily contribution of basic health insurance comes from Art. 25 KLV.

The spa contribution is the same at every insurer. For basic health insurance, what matters is therefore the premium, which you compare in the premium calculator; the insurers’ key figures and supplementary products are listed in the health insurer profiles.

How to proceed

1. Clarify what is being prescribed: Ask your physician whether spa treatment, a recuperative stay or rehabilitation is indicated. That determines who pays.
2. Get a prescription: Have the spa treatment ordered by a physician, including its duration.
3. Check the healing spa: Ask your insurer whether the establishment you have chosen is admitted as a healing spa and whether your supplementary insurance recognises it.
4. Obtain cost approval: Submit the prescription to your supplementary insurer before the stay starts and wait for the written approval.
5. Submit the bill: After the stay, submit the bill and the prescription; the insurer first checks basic health insurance, then supplementary insurance.

Common mistakes

• Believing that basic health insurance pays for the whole stay. It pays CHF 10 per day, for at most 21 days a year.
• Booking without a physician’s order. Basic health insurance then pays nothing; whether supplementary insurance pays without an order is set out in its general insurance conditions.
• Confusing a wellness hotel with a healing spa. Only healing spas admitted by the FDHA count for basic health insurance.
• Confusing spa treatment with rehab. Rehab after an operation is treatment with its own rules; do not let it be prescribed as spa treatment.
• Forgetting the cost approval. Without prior approval, supplementary insurance can refuse to pay.

You can find further benefits, from physiotherapy to Spitex, in the overview What does health insurance cover?, and how cost approvals work in the article Cost approval.