Long-Term Specialist Treatment

What counts as long-term specialist care?

Long-term specialist care refers to ongoing treatment of a chronic or complex condition under the primary management of a specialist rather than a GP. Examples include:

• Oncology (cancer treatment: chemotherapy, immunotherapy, ongoing monitoring)
• Rheumatology (autoimmune conditions, long-term biologics therapy)
• Cardiology (heart failure, arrhythmia management)
• Neurology (multiple sclerosis, epilepsy, Parkinson's disease)
• Endocrinology (complex diabetes, thyroid disorders)
• Psychiatry (severe mental health conditions, long-term pharmacotherapy)

In these situations, the specialist effectively becomes the primary managing physician, with the GP maintaining a coordinating role.

How KVG handles ongoing specialist costs

KVG covers all medically necessary specialist consultations and treatments on an ongoing basis — there is no defined limit to the number of specialist appointments per year. As long as the treatment is medically indicated and the specialist is KVG-accredited, coverage continues.

Importantly, once you have met your annual franchise and Selbstbehalt cap (CHF 700 for adults), all further KVG-covered costs for the rest of the year are fully paid by your insurer. For patients with chronic conditions requiring frequent visits, this annual cap provides significant protection.

Prior authorisation (Kostengutsprache)

Some treatments require prior written approval from your insurer before they begin. This is called a Kostengutsprache (cost guarantee) or autorisation préalable. It is required for:

• Expensive medications (particularly biologics)
• Treatments not in the standard KVG list
• Certain complex procedures
• Treatment at specialised centres abroad

Your specialist submits the Kostengutsprache request on your behalf. Approval can take 1–4 weeks. You have the right to appeal a refusal.

Medication coverage for long-term conditions

Medications prescribed by specialists are covered by KVG if they appear on the Spezialitätenliste (SL). For expensive long-term medications, the specialist submits an annual renewal request to the insurer.

Second opinions

You always have the right to seek a second opinion from another specialist. KVG covers this. For complex conditions, university hospitals have multidisciplinary tumour boards and specialist consultation services.

Care coordination with your GP

In long-term specialist care, keeping your GP in the loop is important. Ask your specialist to copy your GP on all reports. A well-informed GP is an asset, especially if you ever need emergency care.