How Does Maternity Coverage Work?

Franchise-exempt from week 13

Under KVG, maternity-related care is exempt from the Franchise and Selbstbehalt starting from week 13 of pregnancy through to 8 weeks after birth. During this period, you pay nothing out of pocket for covered maternity services — your insurer covers 100%.

Before week 13, standard cost-sharing rules apply. Prenatal visits and tests in the first trimester are covered by KVG, but count toward your Franchise and Selbstbehalt like any other medical service.

What is covered

KVG covers a comprehensive range of maternity services:

• Prenatal check-ups — regular visits with your gynaecologist or midwife
• Ultrasounds — a defined number of ultrasounds are covered (typically 2 routine scans, plus additional if medically indicated)
• Blood tests and screening — standard prenatal blood work, glucose testing, etc.
• Birth — hospital delivery, birth centre (Geburtshaus), or home birth
• Postnatal check-ups — follow-up visits for mother after delivery
• Midwife care — home visits by a midwife after birth (Hebammenbesuche)
• Breastfeeding counselling — 3 sessions with a certified lactation consultant

No Selbstbehalt for maternity

This is important to understand: during the franchise-exempt period (week 13 to 8 weeks postpartum), you pay neither Franchise nor Selbstbehalt for maternity-related care. This is unique — for all other KVG services, the 10% Selbstbehalt applies even after the Franchise is met.

However, non-maternity-related medical care during pregnancy still follows standard cost-sharing rules. If you visit a doctor for a cold during pregnancy, that is not maternity care and normal Franchise/Selbstbehalt applies.

Hospital stay

The birth itself and the hospital stay afterward are covered in the general ward (allgemeine Abteilung), just like any other hospital stay. KVG covers the full cost. If you want a private or semi-private room, you need supplementary hospital insurance (Spitalzusatzversicherung).

Caesarean section

A caesarean section (Kaiserschnitt) is fully covered by KVG when medically indicated. The decision is made by your medical team based on medical necessity. An elective caesarean without medical indication may not be fully covered — discuss with your doctor and insurer in advance.

Birthing options

KVG covers all three main birthing options in Switzerland:

• Hospital birth — the most common option, fully covered in the general ward
• Birth centre (Geburtshaus) — a midwife-led facility, fully covered by KVG
• Home birth — attended by a registered midwife, fully covered by KVG

Your choice of birthing location does not affect coverage. All three are equally covered under basic insurance.

Newborn insurance: 3-month deadline

Your newborn must be insured separately under their own KVG policy. You have 3 months from birth to enrol your baby with a KVG insurer. If you enrol within this period, coverage is backdated to the date of birth — meaning all medical costs from birth onward are covered.

The baby's insurance is a separate policy from the parents. You can choose any KVG insurer for your child — it does not need to be the same as yours. The insurer must accept the child without any health checks (Aufnahmepflicht).

What is NOT covered

While maternity coverage is generous, some things are not included in KVG:

• Prenatal classes (Geburtsvorbereitungskurse) — not covered by KVG, though some supplementary insurances reimburse them
• Room upgrades — private or semi-private rooms require VVG supplementary insurance
• Non-medical services — doula services, alternative birth preparation methods, etc.
• Cosmetic procedures — post-pregnancy cosmetic treatments

Supplementary insurance for maternity

If you are planning a pregnancy, consider supplementary insurance (VVG) before becoming pregnant. Most VVG policies have waiting periods of 1-2 years for maternity benefits. Supplementary insurance can cover private/semi-private hospital rooms, additional midwife services, prenatal classes, and alternative medicine during pregnancy.

Once you are already pregnant, it is generally too late to take out supplementary maternity insurance — the waiting period will not have elapsed.