Pregnancy & Birth
Two insurance policies, many benefits — and sometimes it isn't clear who is responsible for what. From the first check-up to the postnatal recovery class, we explain what goes through which policy.
Register before birthAt a glance
As for the mother, it's covered by her health insurance. As for the baby, it's covered by the baby's health insurance. It sounds simple—but there are important details to consider where the two overlap.
The mother's health insurance
The baby's health insurance
From start to finish
From the first check-up to postnatal recovery exercises: here you can see which insurance is responsible in which phase.
The mother's health insurance
Special case
If a child is born with a congenital illness or disability, it is not only the health insurance company and the baby's policy that step in — disability insurance (IV) does too.
Congenital disorders are congenital malformations, genetic diseases and prenatally or perinatally acquired conditions that exist when the birth is completed. The Federal Department of Home Affairs (EDI) maintains an exhaustive list of more than 200 recognized diagnoses.
If the disorder is on the IV list, disability insurance (IV) covers all necessary treatment costs up to the age of 20 — with no deductible for the family.
Sources: AHV/IV glossary ↗ · BSV ↗
Important detail
Basic insurance is clearly regulated — it always applies from birth. With supplementary insurance, the start of cover depends on when and how the baby was registered.
Anyone taking out supplementary insurance normally has to answer questions about their state of health. The health insurance company then decides whether it accepts your baby — and on what terms. It can also exclude benefits or reject the application altogether. With a registration before birth without a health check, all of that falls away: the baby is accepted without exclusions — no matter how the birth goes, no matter whether complications arise. The contract is concluded and binding before anyone knows how the child will come into the world.
| Situation | Basic insurance | Supplementary insurance |
|---|---|---|
| Registered before birth — without health check Insurer offers the product without a check, contract concluded and binding | From birth | From birth, without exclusions |
| Registered before birth — with health check, accepted Check carried out before the birth and accepted | From birth | From birth |
| Before birth — with health check, with exclusions Certain benefits were excluded | From birth | From birth, with benefit exclusions |
| Registered after birth — health check passed Application submitted after the birth and accepted | Retroactive from birth (within 3 months) | From the application date or the 1st of the following month (depending on the insurer) |
| After birth — health check not passed Insurer rejects the application or imposes significant exclusions | Retroactive from birth (within 3 months) | Rejected or severely restricted |
Questions & answers
In a normal birth, the entire hospital stay — including that of the healthy newborn — goes through the mother's health insurance. If the baby needs its own medical treatment (e.g. premature birth, complications), the baby's health insurance steps in. The baby's basic insurance applies from the day of birth — even if registration only happens later.
Yes. A medically indicated cesarean section is fully covered by the mother's basic insurance — without franchise and deductible. The hospital stay is set at up to 8 days (vs. 5 days for a spontaneous birth). An elective cesarean section without medical indication can result in costs that are not covered by basic insurance.
A doula is not a recognized midwife within the meaning of the KVG — her services are not covered by basic insurance. Some supplementary insurance policies contribute toward the cost, but this varies greatly from insurer to insurer. The midwife, by contrast, is fully integrated into basic insurance — for pregnancy, birth and the postpartum period alike.
The exemption from franchise and deductible applies to all maternity benefits (check-ups, midwife etc.) throughout the entire pregnancy. For general illness benefits, the exemption applies from week 13 of pregnancy until 8 weeks after the birth. After that — that is, from week 9 after the birth — the normal rules with franchise and deductible apply again.
Congenital disorders are congenital illnesses or malformations recorded on a federal list (EDI) — more than 200 diagnoses, including congenital heart defects, trisomy 21 and cleft lip, jaw and palate. Disability insurance (IV) covers all treatment costs up to the age of 20, with no deductible for the family. If the baby was registered before birth without a health check, the supplementary insurance also applies without exclusions.
In principle, switching basic insurance is also possible during a pregnancy (deadline: end of November, effective 1 January). For supplementary insurance the following applies: maternity benefits usually have waiting periods of 270 days. Switching shortly before the birth therefore no longer brings any advantage in the supplementary insurance for the upcoming hospital stay.
Basic insurance does not cover postnatal recovery courses directly as a mandatory benefit. Many supplementary insurance policies do contribute, however — often 50–90% of the course costs or an annual amount of CHF 200–900, depending on the insurer and the product chosen. Postnatal recovery always goes through the mother's insurance, not the baby's.
alletta shows you which insurer offers the best conditions for your baby — before birth, without a health check and with cashback of up to CHF 300.
The mother's health insurance 
