Does health insurance pay for sterilisation and vasectomy?

What basic health insurance pays

Sterilisation is a medical procedure that permanently removes a person’s ability to reproduce (Art. 2 para. 1 of the Federal Act on the Conditions and Procedure for Sterilisation, Sterilisation Act). In women the procedure involves the fallopian tubes, in men the vas deferens; in men it is called a vasectomy. Medical services that basic health insurance does not pay for, or only pays for under certain conditions, are designated on the basis of Art. 33 para. 1 of the Federal Health Insurance Act (KVG); the list is in Annex 1 to the Health Care Benefits Ordinance (Art. 1 KLV). For sterilisation, it is in no. 3 “Gynaecology and obstetrics, reproductive medicine”, edition of 01.07.2026:

Basic health insurance only pays for what the law assigns to it. Contraception as such is not part of this: according to the Federal Council’s opinion on Motion 19.3660, contraceptives serve neither the treatment of an illness nor prevention or maternity. Sterilisation is therefore only covered in the situation described in Annex 1. The entry refers to the “husband” and the “married couple”; it does not expressly regulate anything for other couples. Clarify in writing with your insurer before the procedure how it handles this.

Therapeutic procedures in which the loss of the ability to reproduce is an unavoidable side effect do not count as sterilisation (Art. 2 para. 2 Sterilisation Act). Such procedures serve the treatment of an illness and fall under the general benefits under Art. 25 KVG.

If the sterilisation is covered, the normal co-payment applies: first the deductible (Franchise), then a 10 % retention fee, at most CHF 700 per year for adults (Art. 64 para. 2 KVG, Art. 103 para. 2 of the Health Insurance Ordinance, KVV). If the procedure is done on an outpatient basis, the practice bills under the outpatient tariff; for a hospital stay, basic health insurance pays for the general ward.

What supplementary insurance pays

Supplementary insurance is governed by the Insurance Contract Act (ICA). The law does not require any contribution there towards sterilisation for contraception. Whether a product pays anything is determined by the insurer in its general terms and conditions, for example:

• whether procedures for contraception are expressly excluded,
• whether supplementary outpatient insurance provides a contribution towards medical services that are not covered, with a percentage and a maximum amount,
• whether supplementary hospital insurance covers the semi-private or private ward for a covered sterilisation.

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. What counts are always the general terms and conditions and the information from your insurer.

Conditions

• Minimum age and consent: Sterilising a person under 18 is prohibited (Art. 3 Sterilisation Act). From 18, it may only be carried out if the person has been comprehensively informed and has given free and written consent (Art. 5 para. 1 Sterilisation Act). The procedure is performed by a doctor (Art. 2 para. 3 Sterilisation Act).
• Medical indication in the woman: Payment depends on the conditions in Annex 1, which your doctor documents. The medical decision is made by you and your doctor, not by the insurer and not by us.
• Which insurer pays: For the husband’s vasectomy, under Annex 1 the wife’s insurer pays. Ask that insurer how it handles the bill and the co-payment.
• Ask beforehand: Annex 1 does not require cost approval for this entry. A written request from the doctor before the procedure, however, clarifies whether the insurer considers the conditions to be met.
• Deductible and retention fee: Covered costs count towards the deductible and retention fee. Costs that are not covered do not count towards anything.

Sample calculation

Example with fictitious people and assumed costs. Sara is 38 years old, and her doctor documents the conditions under KLV Annex 1 no. 3. The sterilisation is assumed to cost CHF 2,000.00. Sara has an optional deductible of CHF 1,500 and no costs so far this year. The deductible and retention fee follow Art. 64 KVG and Art. 103 KVV.

If a covered procedure is coming up next year, the deductible calculator works out the break-even point between a low and a high deductible; the premium calculator shows the premiums for each deductible. A lower deductible must reach your insurer by 30 November, and all dates are listed under Deadlines.

How to proceed

1. Get information: Have your doctor inform you comprehensively about the procedure; written consent is mandatory.
2. Clarify the costs: Ask whether, from a medical point of view, the conditions under KLV Annex 1 no. 3 are met. If so, have the doctor send a written request to the insurer before the procedure.
3. Ask for a quote: If the procedure is not covered, ask for a written cost estimate and ask your supplementary insurer whether it contributes anything.
4. Submit the bill: Submit covered bills to basic health insurance, even if they stay below the deductible, and bills that are not covered to supplementary insurance.

Common mistakes

• Thinking sterilisation is a standard benefit. Without a medical indication in the woman, basic health insurance pays neither for female sterilisation nor for a vasectomy.
• Asking the wrong insurer. For a covered vasectomy of the husband, the wife’s insurer pays, not the husband’s.
• Counting costs you paid yourself towards the deductible. Procedures that are not covered do not count towards the deductible and retention fee.
• Having the operation without asking first. A written request before the procedure prevents an unexpected refusal.

You will find further benefits in the overview What does health insurance cover?, and key figures and contact details of the insurers in the health insurer profiles.