Complementary medicine: Who pays for acupuncture, TCM and the like?
Acupuncture for back pain, herbal medicine for a cold, or homeopathy as support: complementary medicine is widely used in Switzerland. According to the Swiss Association for Complementary Medicinal Products, around two thirds of the Swiss population have used such treatments at least once. Especially in the colder months and for chronic complaints, many people look for an addition to conventional medicine. Whether your health insurer pays, however, depends less on the method than on the practitioner. This is exactly where unexpected costs can arise for insured persons.
Same treatment, different billing
A simple example makes the difference clear: if someone is treated by a doctor with additional training in acupuncture, basic insurance pays for the session, minus the deductible and co-payment. If the same treatment is provided by a non-physician acupuncturist, basic insurance pays nothing. In that case, it depends on whether you have taken out suitable supplementary insurance.
The background: since 2012, basic insurance has covered five disciplines: acupuncture, anthroposophic medicine, drug therapy in Traditional Chinese Medicine (TCM), classical homeopathy and herbal medicine. They may only bill through basic insurance if they are doctors who, in addition to their specialist title, can provide proof of recognised complementary-medicine training—usually a certificate of competence in the respective method. The easiest way to check this is to ask the practice directly before your first session.
Shiatsu, kinesiology and the like: a case for supplementary insurance
Many complementary treatments do not take place in a doctor’s practice, but with naturopaths, acupuncturists or complementary therapists. Their services are not part of basic insurance, even if it is one of the five recognised methods. Other popular methods such as shiatsu, kinesiology, craniosacral therapy or foot reflexology are not among the five disciplines anyway and are therefore never covered by basic insurance.
Without suitable supplementary insurance, insured persons can quickly face high costs here. An hour of acupuncture with a therapist costs CHF 150 or more, depending on training, region and practice. In addition, complementary medicine rarely works with just one session. With a series of ten sessions, you can quickly end up paying over CHF 1,000.
This is where outpatient supplementary insurance comes in. Depending on the provider and plan, it contributes to treatments by non-physician professionals—typically as a percentage of the costs and with an annual maximum. For example, it might cover 75% of costs up to CHF 2,000 per calendar year. Prescribed herbal and homeopathic medicines may also be insured, depending on the product, with a separate contribution.
For supplementary insurance, both must be recognised too: the method and the practitioner
Supplementary insurance does not pay for every treatment with every practitioner. Insurers keep their own lists of therapy methods they contribute to. These lists vary from provider to provider and can be updated. Likewise, the therapist must be recognised—specifically for the exact method being used.
Depending on the insurer, additional rules may apply. Some products require a doctor’s prescription. The insurer may also set maximum rates per treatment time: if the practice charges more, you pay the difference yourself. For longer-term treatments, some insurers check whether the therapy is still medically necessary. The terms of your policy are what count.
Six questions to ask before your first appointment
To avoid surprises on the bill, the following questions can help before your first treatment:
- Am I being treated by a doctor with a certificate of competence for one of the five recognised methods covered by basic insurance, or by a non-physician professional?
- Is complementary medicine included in my supplementary insurance—at what percentage and up to what annual maximum?
- How much of that have I already used this year?
- Is the planned method on my insurer’s list of methods, and is the practitioner recognised for exactly this method? Some insurers offer their own therapist search for this.
- Does my insurer require a doctor’s prescription?
- What is the hourly rate, and is it above the amount my insurer reimburses at most?
The earlier you take it out, the easier it is
If you only think about supplementary insurance when you have acute complaints, it is often too late. Unlike basic insurance, supplementary insurance is governed by the Insurance Contract Act. There is no obligation to accept applicants: before concluding the contract, the insurer checks your health status and may accept an application with exclusions or reject it. If you are already being treated for chronic complaints, you should therefore expect that those very complaints may be excluded from cover. Depending on the product, a waiting period may also apply.
The easiest way to clarify whether your existing insurance cover includes complementary medicine and fits your needs is a short conversation. The advisors at simply will take the time—free of charge and with no obligation—either in person in Gümligen or conveniently via video consultation.
Fact sheet on outpatient supplementary insurance 