As a pregnant expectant mother you will be asking yourself many questions about maternity, including those relating to the contractual conditions, the requirements for receiving daily benefits, but also the assumption of the costs borne by the health insurance and the coverage of which you are and will be beneficiary together with your baby.

Contractual conditions

All working mothers (paid, self-employed, unemployed and also women who work in their husband’s company and who receive a salary) are entitled to paid maternity leave.

Female workers – both full-time and part-time – benefit from 98 days (14 weeks) maternity leave from the day it was paid. If a woman returns to work earlier, the right lapses.

Mothers receive 80% of their wages in the form of a daily allowance, up to a maximum of CHF 196 per day. Cantonal provisions, personnel regulations and collective bargaining agreements can provide for more detailed solutions and vary considerably. However, it should be noted that, during the first eight weeks after giving birth, there is a ban on returning to work.

The working day cannot exceed nine hours and, starting from the eighth week before the birth, it is forbidden to work at night. There is also protection against work considered dangerous or burdensome, as well as substances harmful to health.

Prerequisites

To be eligible for daily benefits, the worker must have been insured with AHV within the nine months prior to the birth and have worked for at least five months during her pregnancy. At the time of the birth, she must also still have an employment relationship, an independent occupation or collaborate in her husband’s company and receive a cash salary.

Having benefited from unemployment allowance before childbirth, or if the conditions were in place to qualify for it, the woman will be able to receive maternity allowance.

Similarly, a woman who at the birth of her child is unable to work due to illness, injury or disability, may receive a daily allowance. This, provided that the woman benefits from an allowance from another insurance, the amount of which has been calculated on the basis of a salary previously earned.

If the above conditions are not met, unfortunately no daily allowance can be received.

The leave begins officially on the day of the child’s birth.

Termination of the employment relationship

During her maternity leave the worker cannot be fired. The employment relationship cannot be dissolved during the entire duration of the pregnancy and the first 16 weeks after the baby is born.

Health insurance and maternity

Swiss law means by maternity: pregnancy, childbirth and subsequent convalescence of the mother (including breastfeeding). This is a relatively long period in which you can benefit from the benefits that LaMal and the supplementary health insurance company offer you.

As a rule, you are exempt from paying the deductible of the LaMal compulsory base, the percentage rate (10% for a maximum of 700 francs per year) and also the costs of hospitalization starting from the 13th week of pregnancy.

Any complications that occur between the first and twelfth week of pregnancy are considered to be an illness and as such are subject to the participation of the costs of the deductible.

In addition to the costs associated with traditional hospital births, the costs of a home for pregnant women or home birth are also covered by health insurance.

An important distinction must be made: diseases that may arise during pregnancy and which have no causal relationship with it (for example, laryngitis), are not subject to exemption from the payment of the deductible and / or participation in costs in general.

What are the benefits of health insurance during pregnancy and maternity?

For a pregnant woman, the mandatory health insurance (LaMal) bears the costs of visits and check-ups, childbirth, postpartum checks and breastfeeding counseling.

For an ordinary pregnancy, check-ups are performed by a doctor, a midwife or prescribed by a doctor during and / or after pregnancy. In total 7 examinations and 10 ultrasound checks are usually recognized in the LaMal environment.

Health insurance reimbursed pregnancy checkups include ultrasound scans, but also the first trimester test for high risk of trisomies 21, 18 and 14, as well as the non-invasive prenatal test (NIPT).

In cases of high risk and for women over 35 years of age, amniocentesis and placenta biopsy may also be taken. In addition, the basic health insurance (LaMal) participates in part in the costs of the childbirth preparation course (maximum 150 francs) and breastfeeding advice (max 3 sessions).

Thanks to supplementary outpatient coverage (LCA), performance can also be improved. Do not hesitate to contact me in case you want to have more information about it.

What hospital coverage is provided for the newborn and for the mother?

The costs of hospitalization of the newborn in good health for the period of hospitalization of the mother in the hospital after the birth are covered by the mother’s health insurance, therefore without deductible participation, no percentage rate or hospitalization costs borne by the latter .

In the event of the infant’s illness, hospital care is attributed to the infant’s health insurance coverage, with the application of the participation in costs in the form of a percentage rate (for children: 10% for a maximum of 350 francs per year). No deductible is collected by the health insurer, provided of course the zero deductible variant for the newborn was chosen when taking out the antenatal health insurance cover.

Disability insurance (AI) instead intervenes for costs that are attributable to certain diseases present at birth (congenital diseases).

Why is it advisable to consider supplementary insurance to the health insurance during the period of pregnancy and maternity?

If you are insured with only health insurance basic coverage, you do not necessarily have the free choice of doctor at the time of birth, and for this reason many future mothers choose to have adequate complementary coverage as well.

Among other things, we would like to remind you that basic insurance covers only the expenses in the general ward at a hospital in your canton of residence, which must also appear on the list approved by the health insurance.

To benefit from a semi-private room or private room hospital birth, you must have stipulated this coverage well in advance, in any case at least 12 months before taking advantage of this service.

A pregnant woman who wants to change basic health insurance before giving birth will in any case benefit from the same basic legal benefits from the new insurer. Instead, particular attention must be paid to the migration of complementary (LCA) from one health insurance company to another, as there may be hidden “pitfalls”.