Maternity

You can find below the most frequent questions and answers relating to refunds of your medical invoices.
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Maternity

I am pregnant. I have just received a refund statement and have noticed that you have withheld the deductible and 10% co-insurance. Shouldn’t maternity benefits be refunded entirely?

Yes, but only the specific maternity benefits listed in Chapter 4 of the Ordinance on Health Insurance Benefits (OPAS/KLV). These mainly include check-ups examinations.

However, between the 13th week of pregnancy and the eighth week after birth, women are no longer required to contribute financially to the costs of general medical benefits, nor to those for the treatment of illnesses unrelated to pregnancy. More specifically, the Insurer cannot require any statutory co-payments when benefits are related to illness, as listed in Articles 25 and 25(a) of the Federal Law on Health Insurance (LAMal/KVG) and Art. 29, para. 2 of LAMal/KVG (maternity benefits).

Nevertheless, co-insurance statutory amounts still apply in the following cases:

prevention measures, unless the Swiss Confederation has expressly cancelled the contribution to costs;
accidents;
non-punishable abortions;
dental care.

This amendment entered into force on 1 March 2014.

Are electronic breast pumps covered by the basic health insurance?

If you hold basic health insurance with Groupe Mutuel, we refund up to CHF 175 for a Philips Avent single electronic breast pump and up to CHF 340 for a Philips Avent double electronic breast pump. If you hold supplemental health insurance with Groupe Mutuel, you may be entitled to a higher amount depending on your insurance plan. Find out more about the Philips Avent offer