What costs are covered by insurance in Switzerland in the event of an unfulfilled desire to have children?

Introduction

In Switzerland, health insurance companies only cover a small proportion of the costs of having a child – in general, a distinction must be made here between coverage by basic insurance and coverage by supplementary insurance. In addition, in some cases, fertility treatment can be tax deductible.

Basic insurance

The following costs are normally covered by basic insurance:

• The costs for diagnostic clarification of the causes of an unfulfilled desire to have a child; however, after the age of 40, coverage may be refused
• Female hormone treatment (for up to one year, i.e. 6-12 cycles).
• The cost of intrauterine insemination (IUI), but only three insemination attempts per pregnancy and only if no sperm donor is needed (i.e. only so-called homologous insemination), some insurance companies only pay up to the completed 40th year of the woman’s life.

Not covered by basic insurance:

• The treatment costs of artificial insemination by IVF or ICSI – these range from CHF 4,000 to CHF 9,000 per cycle for IVF treatment and even between CHF 8,000 and CHF 10,000 per cycle for IVF treatment due to the additional effort involved.
• The costs of cryopreservation – which in Switzerland range between CHF 200 and CHF 1,000 per year

Supplementary insurance

There is currently (November 2022) only one supplementary insurance in Switzerland that covers the costs of fertility treatment with IVF or ICSI – this is the Kinderwunsch supplementary insurance from Sanitas. However, with this insurance product there is a significant waiting period (24 months) during which no costs of infertility treatment are covered, and only part of the costs are covered up to a maximum (e.g. 75% of the costs up to a maximum of CHF 12,000).

Simple calculation example:

Assuming a woman takes out supplementary child insurance with Sanitas at the age of 25 and cancels it at 35, she will pay premiums of around CHF 3,400 based on the Sanitas insurance tariff over her insurance period.

Assuming that she actually undergoes IVF treatment twice during the insurance period at a cost of CHF 6,000 each time, she still pays 25% of the total treatment costs of CHF 12,000 herself – i.e. CHF 4,000 – and the supplementary insurance covers CHF 8,000.

Thus, in this example, the insurance results in a net saving of CHF 4,600 (= CHF 8,000 – CHF 3,400) compared to the self-paid treatment.

However, as with any insurance product, caution is advised here:

If it is already known that there are problems with fertility or IVF or ICSI treatment is already planned, the insurance application will most likely be rejected – it is in the nature of an insurance product that risks already known at the time of conclusion are not covered.

In addition, as mentioned at the beginning, there is a waiting period of 24 months until the start of treatment, otherwise the costs of the treatment will not be covered – thus it is necessary to take out this insurance product a few years before trying to realize the desire to have a child, in order not to reduce the probability of fulfillment of the desire to have a child by delaying the treatment.

In this respect, this supplementary insurance product is primarily suitable for younger women who want to insure themselves against an unfulfilled desire to have children, but do not yet know whether they will need fertility treatment.

Deduction from tax

In some cantons, the costs of IVF or ICSI treatment as well as the costs of cryopreservation can be deducted from taxes as medical expenses – for example, there are decisions of the cantons of Basel-Land, Basel-Stadt and St. Gallen that the costs of IVF treatment are considered medical expenses for tax purposes and are accordingly deductible from taxable income – in general, there is the opinion that the

Since the deductibility of fertility treatment is not regulated uniformly across the cantons, it makes sense to obtain information on this from the cantonal tax authorities in advance.

Deducting it from income can at least reduce the tax burden in the year of the fertility treatment.

Situation in other European countries

Other European countries are more generous with regard to the assumption of costs for infertility treatment than Switzerland – a brief overview is provided here for those who are interested.

Germany

People with statutory health insurance in Germany have a legal right to have their health insurance company contribute to fertility treatment. All that is required is to submit a treatment plan to the health insurance company prior to the start of treatment, which includes the planned treatment and the costs incurred.

In general, public health insurance covers 50% of the treatment and medication costs for a total of 8 cycles of IUI without prior hormonal stimulation, plus 3 cycles of IUI with hormonal stimulation, plus 3 cycles of IVF/ICSI treatment. However, this only applies to married couples and only if they use their own eggs and sperm, and if both spouses are at least 25 years old, the woman is at most 40 years old and the man is at most 50 years old.

For privately insured persons in Germany, the requirements for cost coverage or cost sharing are very different; in this case, the insurance company should be consulted in any case.

Austria

Inseminations (IUI treatments) are not covered by health insurance in Austria. The so-called IVF fund, however, covers 70% of the costs for four IVF or ICSI treatments per pregnancy under certain conditions. The main requirements for cost coverage are:

• The indication for the reasons of infertility must be secured and one of the following reasons must be present:
  • Either in women: tubal infertility (fallopian tubes blocked, removed or non-functioning on both sides), polycystic ovary syndrome (PCO syndrome) or endometriosis.
  • And/or in the male: limited fertility of the male.
• The woman must not have exceeded 40 years of age and the man must not have exceeded 50 years of age
• Austrian or EU/EEA citizens or Swiss citizens, otherwise unlimited Austrian residence title
• Couple in marriage or cohabitation (notarial deed required)

Other European countries

The following table provides an overview of the average cost coverage for IUI and IVF/ICSI treatments in the DACH region, as well as the most populous countries in Europe. This disregards the exact criteria for cost coverage, which in some cases differ greatly between countries.

Sources: Fertility Europe – European Atlas of Fertility Treatment Policies (2021). , various national sources

It is noticeable that cost coverage is handled very differently – here are 3 main observations:

• France is the most generous country in terms of cost coverage followed by Spain, Italy and Austria form the midfield
• In the UK, coverage varies by region, with up to 3 cycles per pregnancy covered by the NHS in some parts of the country, and only one cycle in others
• Switzerland (apart from the lack of reimbursement for IUI in Austria) is at the bottom of the list of countries considered

Conclusion

Switzerland is one of the European countries where the lowest percentage of infertility treatments is covered by insurance.

The basic insurance usually covers the clarification of the causes of an unfulfilled desire to have a child, hormone treatment for the woman and the costs of intrauterine insemination (IUI), although this should ideally be clarified for the specific case before treatment begins.

In Switzerland, there is currently only one supplementary insurance that covers the costs of IVF or ICSI. However, this should be taken out early, as it is associated with a waiting period of 24 months. However, due to the exclusion of pre-existing conditions, supplementary insurance is rarely relevant for those affected by an unfulfilled desire to have children.

The costs of fertility treatment are tax deductible in Switzerland, but the situation differs between cantons and it is recommended to obtain information from the cantonal tax authorities in advance.

Last update: November 24, 2022