What maternity benefits does the health insurer cover?

What maternity benefits does the health insurer cover?

If the pregnancy and birth progress without complications, Sanitas covers the following benefits:

Check-ups:  Sanitas covers the cost of 7 check-ups and 2 ultrasound scans before the birth. In the event of a high-risk pregnancy, invasive and non-invasive tests and ultrasounds are performed and the costs covered as deemed clinically necessary (see below).

Antenatal courses: Sanitas pays CHF 150 towards individual or group antenatal courses given by a midwife.

Hospital list: If the hospital or maternity facility of your choice is not on the list, please check whether Sanitas will cover the costs.

Delivery in hospital: Under basic insurance Sanitas pays all costs of the birth and after-birth care on a general ward, provided that the hospital of your choice is on the list of hospitals. A cost share (deductible and copayment) is not applied.

Home birth: The costs for a midwife are covered; the deductible and copayment are not applied.

Birth at a maternity facility: For home births or births at a hospital or maternity facility, basic insurance pays benefits according to the contractual provisions and tariff rules agreed with midwives, doctors and hospitals.

Cost share: From the 13th week of pregnancy up to 8 weeks after the birth, the cost share under mandatory basic health insurance is waived, with the exception of the following treatments:

  • Medical prevention (some benefits are excluded from the deductible)
  • Congenital defects
  • Accidents
  • Legal abortion
  • Dental treatment

Child sickness: If the newborn falls ill, the child’s health insurance pays and a cost share (deductible and copayment) is applied.

After-birth care: In case of an outpatient birth or home birth, home care provided by a midwife is covered. A medical prescription is needed from the 11th day after birth.

Breastfeeding advice: Sanitas covers the cost of three breastfeeding sessions with a midwife or trained breastfeeding consultant.

Check-up: The cost of the gynaecological check-up carried out between the 6th and 10th week after the birth of your baby.

Excluded from cover: Drugs, medical aids (e.g. compression socks) and equipment (e.g. milk pump) are subject to the deductible and copayment.

Insurance for your baby: If your child is born healthy, the costs of the birth are covered by the mother’s insurance. If your child is born with complications, the child’s insurance pays.

Therefore, it’s a good idea to take out health insurance for your child before the birth, particularly supplementary insurance.

Costs covered for invasive and non-invasive tests

Non-invasive prenatal screening: Blood is taken from the mother to screen for chromosomal abnormalities in the child. Costs are covered provided that a first-trimester test has been performed, with results indicating a risk of 1:1000 or higher for trisomy 21, 18 or 13.

First-trimester test: During this test, the risk of trisomy 21, 18 or 13 is calculated by measuring the nuchal translucency using ultrasound (12th to 14th week), determining the PAPP-A and free ß-hCG in the mother’s blood and taking into account additional maternal and foetal factors.

Amniocentesis, chorionic villus sampling, cordocentesis: These invasive tests are covered under basic insurance under the following conditions:

  • To confirm the results of non-invasive prenatal screening or a first-trimester test indicating that the foetus has a risk of 1:380 or higher for trisomy 21, 18 or 13 or in cases where there is a strong suspicion that this is the case.
  • If an ultrasound scan, family history or other applicable reason indicates that the foetus has a risk of 1:380 or higher for a genetic condition.
  • If the foetus is at risk as a result of pregnancy complications, mother’s illness or a non-genetic illness or development disorder of the foetus.
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