Pregnancy Health Insurance: Benefits, Costs and Supplementary Insurance
Which insurer benefits are covered during pregnancy? Compando explains maternity benefits, cost exemption and which supplementary insurance is worthwhile for expectant parents.
1. How much does pregnancy cost?
For medical services related to maternity, usually no cost participation arises. With the mandatory basic insurance, neither deductible nor co-payment nor hospital contribution is charged, provided the services are legally listed maternity benefits.
Maternity in the law
The term maternity comprises, under Art. 5 ATSG, three phases: pregnancy, delivery (birth) and the subsequent recovery period of the mother. The exemption from deductible in basic insurance is anchored in Art. 64 Para. 7 KVG and applies to all three phases.
From the 13th week of pregnancy until eight weeks after birth, cost participation is also waived in case of illness, accident and birth defects, for example during hospital stays to prevent premature birth or gestational diabetes. Two exceptions remain: prevention (cancer smear test) and dental treatments.
The following overview shows the periods of exemption from deductible:
Period | Own contribution | Meaning |
|---|---|---|
Week 1 to 12 | Yes | Regular* |
Week 13 to birth | No | None |
At birth | No | None |
8 weeks after birth | No | None |
From 9th week after birth | Yes | Regular |
*Specific maternity benefits such as the first gynaecological pregnancy check-up are exempt from deductible from day 1.
For medications and items, the time of dispensing decides: After the 13th week of pregnancy, cost participation is waived, for example for compression stockings or prescribed medications in case of illness.
Compare health insurance premiums
Even during pregnancy, comparing insurers pays off. Premiums for identical benefits differ significantly between providers, regions and models.
2. Which benefits does the insurer pay for pregnancy and birth?
During maternity, the essential medical costs are covered by basic insurance. The benefits of basic insurance are legally uniform, but premiums differ between providers.
3D ultrasound and baby TV without medical indication are not covered. The non-invasive prenatal test (NIPT) is only covered with elevated risk after first-trimester screening.
3. What does the insurer pay for high-risk pregnancy?
In case of high-risk pregnancy, more frequent and additional examinations are covered. The exemption from deductible from week 13 also applies here.
Example calculation high-risk pregnancy
An insured person expects twins, has premature contractions with two-week hospital stay in the 32nd week, premature birth in the 36th week by caesarean section and a ten-day hospital stay of the twins in intensive care. Total costs: estimated CHF 30'000 to 50'000 (guideline depending on hospital and course). The cost participation of the insured person is CHF 0, because treatment takes place after week 13. For comparison: Without exemption from deductible, around CHF 3'200 would be due (CHF 2'500 deductible + CHF 700 co-payment).
4. What does the insurer pay for caesarean section?
Basic insurance covers the medically necessary caesarean section fully. Indications are for example unfavourable child position, multiple pregnancy, pre-existing conditions of the mother or acute birth complications.
For an elective caesarean section without medical indication, typical own costs lie between CHF 2'000 and CHF 5'000 in addition to deductible and co-payment. A written cost commitment with tariff differences compared to a natural birth creates clarity. A hospital supplementary insurance covers these additional costs partially or fully.
The hospital stay after a caesarean section is covered in basic insurance and usually lasts five to seven days (compared to three to four days for a natural birth). The newborn is co-insured during this time via the mother, provided it is healthy.
5. Who pays for a termination of pregnancy?
Health insurance distinguishes between medically indicated and non-medically indicated termination of pregnancy.
Costs for termination without medical indication
Non-medically indicated terminations of pregnancy count with the insurer as illness. A termination is only allowed in Switzerland within 12 weeks after the last period. Since the intervention thus does not fall in the period of cost exemption from week 13, basic insurance covers the costs only after deduction of deductible and co-payment.
Different for medically indicated termination: From the 13th to the completed 23rd week of pregnancy, cost participation is waived fully. Treatments for complications as well as a check-up examination and up to ten home visits by a midwife are also covered.
6. Is supplementary insurance worthwhile for pregnancy?
Basic insurance covers all medically necessary services related to pregnancy and birth. With a supplementary insurance you expand the protection by comfort, free choice of hospital or supplementary therapies. Special supplementary insurance for pregnancy covers midwife support, birth preparation and postpartum benefits.
Important: For maternity benefits, waiting periods of 9 to 12 months usually apply. With an existing pregnancy, the protection for this birth often no longer applies.
Which supplementary insurance suits one's own situation depends on personal needs, canton of residence and family size. With several children, families additionally benefit from family discounts from the second or third child.
Compare supplementary insurance
Mother and child have different needs in supplementary insurance. The comparison by benefits package and family situation shows the suitable building blocks.
