Whether it’s depression, anxiety or stress many people in Switzerland need help for mental health conditions at some point. But will health insurance pay for the cost of this treatment?
The term “mental illness” encompasses a wide range of disorders, including clinical depression, anxiety, stress, as well as other chronic or temporary conditions.
Like physical illnesses, mental health issues also impact your well-being, which is people should seek treatment and support.
But is such treatment covered by health insurance?
Generally speaking, Switzerland’s obligatory health insurance (KVG / LaMal) doesn’t distinguish between physical and mental illness, in a sense that one is not considered more important than the other in terms of prioritising treatment.
This is especially the case since it has been medically proven that the two are often inter-related — that is, mental distress can negatively impact physical health, and vice versa.
Therefore, the cost of medical treatment for both is covered by all obligatory health plans, though much depends who (what kind of medical professional) is treating you.
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Psychiatrists versus psychologists
Though some people use the terms interchangeably because both professions work in the field of mental health, for the purposes of health insurance, the two are different.
How?
According to Sanitas insurance provider, psychiatrists have a medical degree and are therefore doctors, on a par with other specialised physicians, in a sense that they can diagnose and treat patients, and also prescribe medication.
Psychologists, on the other hand, have a university degree, which is not, however, as comprehensive as a psychiatrist’s.
In other words, psychologists have no medical training and, though they specialise in the workings (and deviations) of a human mind and behaviour, they cannot treat illnesses or prescribe medications.
Typically, psychiatrists treat more complex mental health conditions than psychologists, especially ones that require medication or medical treatments.
However, there is also another type of mental health providers, called psychotherapists.
They are psychologists who completed several years of training in psychotherapy or psychoanalysis on top of their psychology degree. They can offer a more advanced treatment than ‘regular’ psychologists, but can’t prescribe medications.
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Which of these services does the health insurance cover?
According to Sanitas, which follows the same rules devised by the Federal Office of Public Health as all the other insurance providers in Switzerland, the obligatory KVG / LaMal pays for psychiatric treatment on the same basis as for other doctors practising in Switzerland — that is, minus the deductible and co-payment.
It does not cover unreferred treatment provided by psychologists, though some complimentary policies do (read more about this below).
However, if the therapy is prescribed by a medical doctor, insurance will typically cover the costs.
As for psychotherapists, the insurance will pay, but only if they have a cantonal license to practice psychotherapy and are therefore recognised by the insurance company under the KVG / LaMal.
In such a case, basic insurance covers the cost for up to 30 sessions (again, minus the deductible and co-payment).
If the treatment is to continue beyond the 30 sessions, a psychiatrist must assess your medical history and recommend an extension of the therapy.
The final decision, however, lies with the insurance company.
What about the complimentary insurance?
In most cases, they only pay for psychologists who are members of certain professional associations or are licensed to practice in your canton.
The criteria vary from one insurance provider to another.
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Do you need a referral from your GP to see any of these professionals?
That depends on the type of the basic insurance you have.
If it is a standard model, where you have unlimited access to all kinds of specialists, then you don’t need a referral.
If, on the other hand you have opted for a (slightly cheaper) insurance model, which requires you to have a referral to a specialist, then you must see your GP first.
