Hi,

I wasn't sure where to put this, either in Insurance or Family matters/health.
I found it veeeery interesting and relevant to say the least, and I had not heard about it until now (Sorry if everyone knows already and I seem to have been living in a solitary forest hut until now...)

Turns out that before March 1st 2014, not everything was covered by pregnancy insurance. People always said it was, but that wasn't actually accurate. Any complications (extra medicine or treatments, eg Iron injections, anticoagulants, extra ultrasounds...) would come under sickness and you'd have to participate some cost up to your franchise and then the 10%.

Now, since March 2014, everything seems covered when you're pregnant. Even non-pregnancy related sickness (flu??). But not that trisomy blood test Prendia (coz that's not covered by Lamal), from what I've been told - perhaps more knowledgeable people can confirm.

Here's the text:

05. What about pregnancy and childbirth - does cost sharing still apply? No, only in the case of a normal pregnancy. Treatment of complications during pregnancy (for example prescription of compression stockings and pharmaceuticals and hospital stays necessitated by complications) is regarded as an illness and subject to the cost-sharing rule.
In June 2013 parliament decided to change this regulation. Women are now no longer obliged to contribute to the cost of general medical services from the 13th week of pregnancy until eight weeks after the birth. They must therefore no longer contribute to the cost of treatment, regardless of any diseases occurring during pregnancy. This change will take effect from 1 March 2014.

Here's the source.

Fantastic news

That's really good news! I just got an extra series of tests for complications and have been wondering how much we'd be out of pocket. It is a nice relief to stop worrying about it and start worrying about the...uh...complication instead...

ok im sure im being dumb but just to clarify

pregnancy and complications are completely covered full stop under basic insurance ?

complications count as 'illness' and so are covered under the march 14 changes?

wow CH ! good news i think

After the 13-week mark, yes. And the standard limitations of basic insurance still apply: private rooms and most alternative medicine not covered, ambulance transport normally only 50% covered, etc. Note also that if you plan to give birth in a private clinic, or a hospital that isn't on your canton's approved list (google "Spitalliste" + canton name), basic insurance will cover you only up to the cost of equivalent treatment in a hospital that is listed - the rest is out of pocket for you.

Hello All,
I wanted to ask a question about pregnancy and health insurance that doesn't seem to have been answered in the posts previously.

Are things such as normal sickness (Flu during pregnancy, visit to dermatologist due to bad melasma (pregnancy mask), pain in ribs, gum issues, etc. covered?

As far as i can see , alll the extra charges were paid separately included in the franchise even if i knew they were triggered by pregnancy. Do you have to inform your health insurance first? or is the doctor supposed to write a note in the bill?


Kind Regards

I had some special blood test due to complications during my pregnancy, it happened three months after giving birth. Will this be covered too? I already paid so much for it.

Here is what I found on comparis on the March 2014 changes:
https://en.comparis.ch/krankenkassen...terschaft.aspx :

According to the law (Art. 5 of the General Part of the Social Insurance Act ATSG), maternity or motherhood includes pregnancy and delivery as well as the subsequent recovery period of the mother. No out-of-pocket payments are due for maternity benefits from basic insurance. This applies to benefits explicitly listed in the Health Insurance Act such as check-ups, ultrasound scans, antenatal classes, delivery, midwifery care and breastfeeding consultations.
The amendment to the law, which was decreed by the Federal Council, entered into force on 1 March 2014. It stipulates that women who fall ill during or after pregnancy (e.g. in case of complications) are no longer liable to any out-of-pocket payments starting from the 13th week of pregnancy until 8 weeks after birth. This encompasses, for example, hospitalisation to avoid premature birth, treatment of gestational diabetes and infections or psychotherapy due to post-natal depression.
According to the Federal Social Insurance Office, there is no clear-cut jurisdiction regarding caesarean delivery on maternal request. If you are planning a pregnancy and want to be on the safe side, opt for the lowest possible deductible of CHF 300 in order to keep costs as low as possible should an elective C-section not be fully covered by your health insurance provider.
Often it is not obvious to the health insurance company whether expenses are due to maternity. It is therefore advisable to mention the presence of a pregnancy on the invoices sent to them.

This is indeed good news, but too late for me... When I lost my first child back in 2013 in the 10th week, I had to pay 1500CHF for the curettage afterwards... Because it was treated as sickness!!!! Not that I was already punnished loosing my "Wunschkind" (planned child), I also had to pay for the aftermath... Incredible!!! Back then, it was only paid after the 23rd week.