Maternity Coverage in Switzerland

What is covered at zero cost-sharing

Under KVG basic insurance, the following maternity services are fully covered with no franchise and no Selbstbehalt:

• Prenatal check-ups: At least 7 prenatal consultations as defined by the BAG schedule, including physical examinations and routine monitoring.
• Ultrasound examinations: 2 standard ultrasounds are covered (typically at 12 and 20 weeks). Additional ultrasounds are covered if medically indicated (high-risk pregnancy, complications, multiple gestations).
• Laboratory work: All pregnancy-related blood tests, urine tests, glucose tolerance test, and screening tests (e.g., first-trimester screening, blood group, infectious disease screening).
• Hospital birth: Delivery in the general ward (Allgemeinstation) of a listed hospital in your canton of residence.
• Cesarean section: Fully covered when medically indicated.
• Postnatal check-up: One examination at 6 -- 8 weeks postpartum.
• Breastfeeding counseling: 3 sessions with a certified lactation consultant (Stillberaterin).
• Midwife home visits: Up to 56 days postpartum, a maximum of 16 visits by a registered midwife. If the mother and newborn leave the hospital within 96 hours of birth, an additional 10 visits are covered (26 total).
• Birth preparation course: A CHF 150 contribution toward a birth preparation course led by a midwife.

Birth options and what KVG covers

Switzerland offers several birth settings, and KVG coverage varies:

• Hospital birth (general ward): Fully covered. This is the standard KVG option. You are admitted to the general ward of a listed hospital in your canton.
• Hospital birth (semi-private or private): NOT covered by KVG. You need hospital supplementary insurance (Spitalzusatzversicherung) for upgraded rooms. Without it, you pay the difference yourself.
• Birth center (Geburtshaus): Covered by KVG if the birth center is a recognized KVG provider. Many birth centers in Switzerland have this recognition. Check with the center directly.
• Home birth: Covered by KVG when attended by a registered midwife (zugelassene Hebamme). The midwife bills KVG directly. All necessary supplies provided by the midwife are included.

What is NOT covered

Some maternity-related costs fall outside KVG basic insurance:

• Fertility treatments: IVF, ICSI, and other assisted reproduction techniques are NOT covered by KVG. Some supplementary insurance plans offer partial coverage, but typically with strict conditions and waiting periods.
• Elective cesarean section: A C-section without medical indication is not standard KVG coverage. In practice, the line between elective and medically indicated can be discussed with your doctor.
• Private or semi-private hospital room: Requires hospital supplementary insurance.
• Non-medically indicated additional ultrasounds: 3D/4D "bonding" ultrasounds for non-medical purposes are at your own cost.
• Prenatal classes beyond CHF 150: The KVG contribution is capped at CHF 150. Any excess is out of pocket.
• Doula services: Not recognized by KVG. Some supplementary insurers cover a portion.

Maternity leave and pay

Maternity leave in Switzerland is separate from health insurance — it is an employment law and social security matter:

• Maternity leave: 14 weeks (98 days) of protected leave starting from the day of birth. Employment cannot be terminated during this period.
• Maternity pay: 80% of your salary, paid through the Erwerbsersatzordnung (EO / income replacement scheme), up to a daily maximum of CHF 220. Your employer may top this up to 100% depending on your employment contract or collective bargaining agreement.
• Paternity leave: 2 weeks (10 working days) within 6 months of the birth, also at 80% salary through the EO (since January 2021).

Insuring your newborn

Your newborn must be insured for basic health insurance within 3 months of birth. Key rules:

• Retroactive coverage: If you register within 3 months, coverage is retroactive to the date of birth. The baby is covered from day one.
• Free choice of insurer: You can choose any KVG insurer for your baby — it does not need to be the same as yours.
• Child franchise: Children's franchise options are CHF 0 to CHF 600. Most parents choose CHF 0 for newborns.
• Supplementary insurance: If you want supplementary insurance for your child (dental, semi-private hospital, alternative medicine), apply immediately after birth. At this age, there are no pre-existing conditions to exclude, and acceptance is essentially guaranteed.

Complications and high-risk pregnancies

If your pregnancy is classified as high-risk or if complications arise, KVG coverage expands:

• Additional ultrasounds and monitoring are covered when medically justified.
• Specialist consultations (perinatologist, cardiologist, etc.) are covered.
• Extended hospital stays for complications (pre-eclampsia, gestational diabetes complications, premature labor) are fully covered in the general ward.
• Neonatal intensive care (NICU) for premature or ill newborns is covered under the baby's insurance from birth.

The maternity exemption from franchise and Selbstbehalt applies to all medically necessary pregnancy-related care. If a non-pregnancy-related condition is treated during pregnancy (e.g., a broken arm), normal franchise and Selbstbehalt rules apply to that treatment.