Maternity benefits — what does health insurance cover?
- Specific maternity benefits covered by compulsory health insurance (OKP) are exempt from the deductible and co-payment throughout pregnancy — including check-ups before week 13.
- General medical and nursing care for illness is additionally exempt from cost-sharing from the beginning of week 13 until eight weeks after the birth. Before then, the usual deductible and co-payment rules apply to these illness-related services.
Specific maternity benefits include the statutory pregnancy check-ups, the birth, and contributions towards antenatal preparation, breastfeeding advice and midwifery care. Not every service provided during pregnancy is automatically covered by the OKP; the statutory criteria for the individual service must be met. If you are unsure, we will clarify the indication and possible costs with you in advance.
- Contribution towards antenatal preparation courses: up to CHF 150
- Breastfeeding advice: up to 3 sessions (depending on the situation)
- Midwifery care at home: number depending on the situation
Care plan
- A medical assessment is indicated during the first trimester. It includes history-taking, a clinical and gynaecological examination, counselling and the necessary laboratory tests.
- The first standard ultrasound at 12–14 weeks assesses development appropriate to gestational age, among other points; the second at 20–23 weeks assesses fetal anatomy.
- Other time-specific examinations, such as the glucose tolerance test, are discussed as part of the individual care plan.
Risk or indication pathway
Additional check-ups, an early ultrasound, growth scans, Doppler/flow studies or CTG are not routine for everyone; they are used when clinically indicated — for example because of symptoms, abnormal findings, pre-existing conditions or a high-risk pregnancy. An ultrasound at 6–8 weeks is not automatically one of the two standard covered ultrasound benefits; we clarify the indication and any possible costs in advance.
What happens at the check-ups?
The first check-up includes history-taking, counselling, a clinical and gynaecological examination, assessment for varicose veins and leg oedema, and the necessary laboratory tests. Later check-ups assess weight, blood pressure, fundal height, urine status and the fetal heartbeat; necessary laboratory tests are added according to the stage of pregnancy and findings. Routine CTG is not automatically part of every late check-up in an uncomplicated pregnancy.
NIPT (non-invasive prenatal test)
A blood test of the mother (cell-free DNA, mostly of placental origin, in the maternal blood), which can be carried out from around week 11/12. It provides a risk assessment for trisomy 21, 18 and 13. An abnormal result is not a diagnosis but an indication — diagnostic confirmation (e.g. amniocentesis) is required.
Cover by basic insurance: From week 12, the OKP covers NIPT for trisomy 21, 18 or 13 where the estimated risk is 1:1000 or higher. When this criterion is met, it is a covered specific maternity benefit and neither the deductible nor co-payment is charged. If the OKP criteria are not met, the test is self-paid.
First-trimester test (FTT)
A combination of ultrasound (including nuchal translucency) and the mother's blood values (PAPP-A, β-hCG) between weeks 11+0 and 13+6. The first-trimester test calculates the individual risk of trisomies 21, 18 and 13. The OKP reimburses the statutory first-trimester test as a specific maternity benefit; neither the deductible nor co-payment is charged.
Anomaly scan (weeks 20–23)
A detailed examination of the fetal anatomy: heart, brain, spine, abdominal organs and limbs. This second standard ultrasound is part of maternity care.
Invasive diagnostics — chorionic villus sampling & amniocentesis
Chorionic villus sampling (placental tissue, CVS), amniocentesis and cordocentesis are diagnostic examinations — they can confirm or rule out a suspicion and carry a small procedural risk. The OKP covers them where the statutory criteria are met: in particular where NIPT produces a strong suspicion, where the first-trimester test shows a risk of 1:380 or higher, where ultrasound, family history or another factor indicates a corresponding risk, or where the fetus is at risk because of a pregnancy complication or illness. When a criterion is met, neither the deductible nor co-payment is charged.
In Switzerland, prenatal genetic tests are carried out within the legal framework (Human Genetic Testing Act, GUMG) — with medical counselling, sufficient time for questions and (depending on the test) written consent.
Help with deciding
Whether and which prenatal diagnostics make sense depends not only on figures, but also on your situation, your values and what you would want to do with a result. We advise you in an open-ended way — you decide.
- Reassurance if the result is normal
- Early information and better planning — medically, practically and emotionally
- In the event of abnormalities: targeted assessment and ongoing care
Limits of the tests:
- NIPT and the first-trimester test do not detect all malformations or genetic conditions.
- A normal test does not mean the baby is certain to be healthy.
- An abnormal screening test is not a diagnosis.
Gestational diabetes test
An oGTT (oral glucose tolerance test) between weeks 24–28. This is a routine examination — an early diagnosis allows timely measures and can reduce the risk of complications for mother and baby.
Postnatal period & aftercare
A follow-up check is usually scheduled between the 6th and 10th week after the birth. It covers physical recovery, the pelvic floor, contraception while breastfeeding and your personal wellbeing. Breastfeeding advice can be arranged separately if needed.
Source: FOPH — maternity benefits (German) · Last updated: July 2026 · These notes do not replace individual medical advice.