Health insurance: maternity and pregnancy
Various benefits are paid by the health insurance during maternity. This includes benefits during pregnancy and the postnatal period and for childbirth. Find out what CONCORDIA contributes towards and how the issues of deductible and retention fee are organised during this special period.
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Short and simple
The health insurance pays many costs during pregnancy and childbirth.
It also pays for some things after the birth.
For example, examinations with a doctor or a midwife.
It also pays a certain amount towards antenatal classes and breastfeeding consultations.
CONCORDIA pays even more for people who have supplementary policies.
«Special maternity benefits» – what does this mean?
The term «maternity» refers to the pregnancy, childbirth and the subsequent recovery period. During this period, the basic insurance pays not only the costs of medical treatment but also what are known as «special maternity benefits». CONCORDIA complements the catalogue of benefits by the basic insurance, through supplemental insurance for pregnancy and maternity.
The following list shows which tests and treatments are included in «special maternity benefits»:
1. Check-ups during pregnancy
| Normal pregnancy | High-risk pregnancy | Who is permitted to perform the check-up/scan? | ||||
|---|---|---|---|---|---|---|
| Check-ups | 7 | As many as are medically necessary | Gynaecological specialist or midwife | |||
| Ultrasound scans | Two in total:
|
As many as are medically necessary | Only doctors with the appropriate qualification |
2. Prenatal diagnostics
The following prenatal tests are covered by the basic insurance:
- First trimester test (combination of ultrasound scan and blood test)
- Non-invasive prenatal testing (blood test) if there is an elevated risk of chromosomal disorder (trisomy)
- Invasive tests such as amniocentesis, chorionic villus sampling, percutaneous umbilical cord sampling (cordocentesis) in the event of elevated risk
- Recording of the unborn baby’s heartbeat (cardiotocography, CTG) when indicated during a high-risk pregnancy
All tests are performed by doctors. CTG is the only procedure that may also be performed by midwives.
3. Check-up after the birth
4. Check-up after a miscarriage
5. Antenatal classes
Have you taken out NATURA or NATURAplus supplementary insurance with CONCORDIA?
If your course costs more than CHF 150 or you do not wish to take the antenatal course with a midwife, the NATURA and NATURAplus supplementary policies pay 50% of the costs up to a maximum of CHF 200 per year.
Please note: if you request contributions towards more than one of the following benefit areas, you are entitled to a maximum of CHF 500 per year:
- Antenatal classes
- Breastfeeding consultations
- Antenatal exercise classes
- Pelvic floor exercise classes
- Uterus involution exercise classes
- Baby swimming classes (only with NATURAplus)
6. Breastfeeding consultations
Have you taken out NATURA or NATURAplus supplementary insurance with CONCORDIA?
If you require more than three breastfeeding consultations, the NATURA and NATURAplus supplementary insurance policies pay 50% of the costs of all further consultations up to a maximum of CHF 200 per year.
Please note: if you request contributions towards more than one of the following benefit areas, you are entitled to a maximum of CHF 500 per year:
- Antenatal classes
- Breastfeeding consultations
- Antenatal exercise classes
- Pelvic floor exercise classes
- Uterus involution exercise classes
- Baby swimming classes (only with NATURAplus)
7. Midwife’s services
In addition to the benefits listed above, home visits from midwives are also covered by the basic insurance:
- Postnatal care: After a pre-term birth, a multiple birth, a Caesarean section and for first-time mothers, the basic insurance pays for up to 16 home visits by a midwife in the first 56 days after the birth. In all other cases, 10 home visits are covered. Additional home visits are possible if prescribed by a doctor.
- Miscarriage: In the event of miscarriage between the 13th and 23rd week of pregnancy, the basic insurance pays for up to 10 home visits. Additional home visits are also covered on prescription by a doctor.
The birth – which benefits does the health insurance pay?
Birth in hospital or at a birth centre
ANCHOR_ID= EA18A407061409C1ED4BFF31A2F2A097F00779F4ABCB86721240B0F746BA312CThe costs of inpatient birth on a general ward at a hospital or birth centre are paid in full by the basic insurance, provided that the hospital or birth centre is on the hospital list of the insured person’s canton of residence.
Do you have supplementary hospital insurance from CONCORDIA and want to go to a hospital that is not on the hospital list in your canton of residence? Or would you like to spend your inpatient stay on a semi-private or private ward? Then please apply for a cost guarantee via the doctor treating you.
Family rooms for the birth
The basic insurance does not provide any benefits for family rooms.
The DIVERSAcare and DIVERSApremium supplementary insurance policies from CONCORDIA pay the following contributions towards charged overnight stays in a family room:
| DIVERSAcare | DIVERSApremium | |
|---|---|---|
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Do you have PRIVATE supplementary hospital insurance from CONCORDIA?
Do you have PRIVATE supplementary hospital insurance from CONCORDIA?Outpatient and home births
| Insurance | Flat amount | |
|---|---|---|
| PRIVATE hospital insurance | CHF 1'500 | |
| SEMI-PRIVATE hospital insurance | CHF 1'000 | |
|
GENERAL hospital insurance LIBERO hospital insurance |
CHF 300 |
Am I entitled to a home help?
Have you taken out supplementary hospital insurance or DIVERSA supplementary insurance from CONCORDIA?
| Insurance | Contribution |
|---|---|
| DIVERSApremium | CHF 50 per day, max. 30 days per year |
| DIVERSAplus | CHF 50 per day, max. 30 days per year |
| DIVERSAcare | CHF 30 per day, max. 30 days per year |
| DIVERSA | CHF 30 per day, max. 30 days per year |
| PRIVATE hospital insurance | CHF 70 per day, max. 30 days per year |
| SEMI-PRIVATE hospital insurance | CHF 50 per day, max. 30 days per year |
| LIBERO hospital insurance | CHF 30 per day, max. 30 days, within 365 days |
| GENERAL hospital insurance | CHF 30 per day, max. 30 days per year |
The home help must be provided by an organisation or private individual working for their own account. If you have multiple insurance products from CONCORDIA, the contributions are accumulated.
Uterus involution
Have you taken out NATURA or NATURAplus supplementary insurance with CONCORDIA?
- Antenatal classes
- Breastfeeding consultations
- Antenatal exercise classes
- Pelvic floor exercise classes
- Uterus involution exercise classes
- Baby swimming classes (only with NATURAplus)
Rooming-in
The basic insurance does not cover any costs for rooming-in.
DIVERSAcare and DIVERSApremium supplementary policies from CONCORDIA and CONCORDIA hospital insurance policies do pay contributions towards the costs of rooming-in. Insured persons are entitled to the following within a calendar year:
| DIVERSAcare | DIVERSApremium | Hospital insurance | |
|---|---|---|---|
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Waiting period for pregnancy and childbirth
Waiting period for pregnancy and childbirthCost sharing during maternity
Normally, insured persons have to contribute towards the costs of services they receive via the deductible, the retention fee and flat fees for hospital stays – this is stipulated by the Federal Office of Public Health. In the case of maternity, this principle is adjusted:
- No cost contribution is charged for «special maternity benefits».
- In addition, the cost contribution for all other medical benefits does not apply between the 13th week of pregnancy and 56 days after the birth. It does not matter whether the medical benefits are connected to the maternity or not.
What happens in the case of miscarriage or still birth?
If miscarriage occurs before the 13th week of pregnancy, the affected individuals must contribute towards the treatment costs (deductible and retention fee). This also applies if it is necessary to scrape out the lining of the uterus (curettage) after the miscarriage.
If miscarriage occurs between the 13th and 23rd week of pregnancy, the associated benefits and one follow-up check are exempt from the cost contribution. The affected individuals do not have to pay either the deductible or the retention fee. However, the miscarriage is not regarded as a birth.
After the 23rd week of pregnancy, miscarriage or still birth is treated as a birth. In this case, the affected individual does not have to pay any cost contribution, including for follow-up checks and treatment of complications. This applies for a period lasting up to eight weeks after the miscarriage or still birth.
