Prescription Model for Psychotherapy: Insurer Pays Costs
Basic insurance pays for psychotherapies on medical prescription. The prescription model has been in force since July 2022 and replaces the earlier delegation model. Compando explains the new regulation and what is changing for patients.
1. Who pays the psychotherapy?
Since July 2022, the family doctor can prescribe a psychotherapy with a psychologist with psychotherapeutic continued training and cantonal professional practice permit. A previous referral to a psychiatrist thus lapses.
Mandatory basic insurance covers initially 15 sessions. Deductible and co-payment are deducted. With a renewed medical prescription, another 15 sessions are possible.
From the 31st session, the insurer requires a cost commitment. A psychiatric specialist assesses the therapy need and can submit a recommendation for continuation to the insurer. The insurance decides to what extent further sessions are covered.
Is delegated psychotherapy still possible?
No. The delegation model was abolished with the 2022 reform. Only the new prescription model applies.
Until mid-2022, basic insurance paid for psychological psychotherapies only when the therapist was employed by an authorised doctor.
Who pays my medical psychotherapy?
Basic insurance covers medical psychotherapies unchanged. The difference from psychological psychotherapy lies in the treatment being performed by a psychiatrist. The insurer covers up to 40 sessions per year. Further sessions are possible on medical application.
What does supplementary insurance pay?
With the new regulation, psychotherapeutic benefits are covered by basic insurance with medical prescription. If the therapist does not have the recognition for basic insurance, supplementary insurance covers depending on the contract a part of the therapy costs.
Prerequisite: The supplementary insurance recognises the therapist. A medical prescription is not required in this case.
2. What does the new prescription model mean for me?
For patients, the prescription model brings four central advantages:
- Basic insurance covers medically prescribed psychotherapy
- Easier access to outpatient therapies
- Larger selection in therapist search
- Shorter waiting times for a treatment place
Before the new regulation, access to psychotherapy was restricted for many persons in Switzerland. The number of delegated psychotherapy places was limited, and not every affected person found a place via basic insurance. Also the selection of available therapists remained small.
In addition: not every person can afford a supplementary insurance or bear the session costs themselves. Session limits and therapy need with supplementary insurance differ strongly between the Swiss providers.
Training of psychological psychotherapists
Psychological psychotherapists have a diploma or Master's degree in psychology, a four- to six-year continued training in psychotherapy, at least three years of practical experience and a cantonal professional practice permit. The entire training time together with the psychology studies usually amounts to 10 to 12 years.
3. Which requirements must therapy persons meet?
For billing via basic insurance, psychotherapy specialists must meet four requirements:
- Cantonal permit for professional practice in psychotherapy
- Federal or equivalent foreign continued training title in psychotherapy
- At least three years of clinical psychotherapeutic experience
- Independent practice management on own account
Good to know: Psychotherapists who have previously worked delegated today meet the same requirements as their non-delegated colleagues.
4. Which benefits does my insurer cover?
Basic insurance covers all benefits of medically prescribed psychotherapy:
- Initial consultations and assessments
- Diagnoses and treatment planning
- Coordination services between family doctor and therapist
A supplementary insurance for complementary medicine covers additional methods such as mindfulness or relaxation techniques.
Because the psychotherapy is prescribed, the path into therapy begins with an appointment at the family doctor. In the health insurance comparison, you see models and premiums of all Swiss providers at a glance.
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