Complementary medicine

What is complementary medicine?

Complementary medicine is the umbrella term for treatment methods that supplement scientific, conventional medicine. “Complementary” means supplementary: the methods are not meant to replace the usual treatment but to be used alongside it. In everyday language, people also speak of alternative medicine or naturopathy. Examples include acupuncture, homeopathy, phytotherapy, traditional Chinese medicine (TCM), anthroposophical medicine, osteopathy, shiatsu and kinesiology.

For health insurance, one distinction is decisive: who provides the treatment.

• Complementary medicine provided by physicians: a physician with a specialist title and recognised additional training uses one of five methods. Basic health insurance pays for these services.
• Complementary medicine provided by non-physicians: therapists without a medical degree, such as naturopaths, osteopaths, TCM therapists or homeopaths who have not studied medicine. These services belong in supplementary insurance.

The same method can therefore be paid for by basic health insurance in one case and only by supplementary insurance in another, depending on who uses it. Acupuncture from your GP with a certificate of proficiency is covered by basic health insurance; the same acupuncture from a TCM therapist without a medical degree is not.

Since the popular vote of 17.05.2009, complementary medicine has been part of the Federal Constitution. Art. 118a of the Federal Constitution (Cst.) requires the Confederation and the cantons to take it into account within the scope of their powers. The article does not create a right to reimbursement for every method; which services basic health insurance pays for is set out in the Federal Health Insurance Act (KVG) and its ordinances.

How it works

Five methods in basic health insurance

Basic health insurance covers the costs of the following services provided by physicians:

Method	Requirement for the physician
Acupuncture	SIWF certificate programme Acupuncture – Chinese Pharmacotherapy – TCM (ASA)
TCM pharmacotherapy	SIWF certificate programme Acupuncture – Chinese Pharmacotherapy – TCM (ASA)
Anthroposophical medicine	SIWF certificate programme Anthroposophically Extended Medicine (VAOAS)
Classical homeopathy	SIWF certificate programme Homeopathy (SVHA)
Phytotherapy	SIWF certificate programme Phytotherapy (SMGP)

The SIWF is the Swiss Institute for Postgraduate and Continuing Medical Education. According to the Federal Office of Public Health (FOPH, in German BAG), the physician needs a specialist title in addition to the certificate of proficiency. The services are treated in the same way as other medical services and are subject to the principle of trust: the insurer assumes that the treatment meets the requirements unless a special rule applies. Like every service in basic health insurance, it must be effective, appropriate and cost-effective. You pay your deductible (Franchise) and retention fee (Selbstbehalt), as with any doctor’s bill.

The history in brief

In 1999, the Confederation added five complementary medicine disciplines to basic health insurance on a provisional basis. After an evaluation, the Federal Department of Home Affairs ended the obligation to pay for them in 2005. After the constitutional article was adopted in 2009, today’s five methods were added to basic health insurance again, provisionally from 2012 and permanently from 2017. The criteria that a complementary medicine service must meet for this are set out in Art. 35a of the Health Insurance Ordinance (KVV).

Non-medical therapies through supplementary insurance

Anything offered by non-medical therapists is only paid for by supplementary insurance, usually as part of supplementary outpatient insurance. The insurer sets out in its terms and conditions which methods it recognises, what share it pays, which amounts apply per session or per year and which requirements the therapist must meet. Many insurers require the therapist to be recognised by a register such as ASCA or EMR. Which registers and methods an insurer accepts is not regulated uniformly.

Legal basis

The constitutional basis is Art. 118a Cst., adopted in the popular vote of 17.05.2009. For basic health insurance, Art. 32 para. 1 KVG applies: services must be effective, appropriate and cost-effective. For complementary medicine, Art. 35a KVV specifies the criteria a discipline must meet for its services to be covered, such as a tradition of use and research, scientific evidence and medical experience.

Which methods are paid for today is set out in Art. 4b of the Health Care Benefits Ordinance (KLV). Letters a to e list acupuncture, anthroposophical medicine, TCM pharmacotherapy, classical homeopathy and phytotherapy, each with the certificate programme the physician must hold. As with all services, the co-payment is governed by Art. 64 KVG and Art. 103 KVV.

There is no statutory obligation to pay for complementary medicine provided by non-physicians. Supplementary insurance is a private-law contract under the Insurance Contract Act (ICA); what it pays is governed by the insurer’s terms and conditions. When you take out a policy, the insurer may ask health questions under Art. 4 ICA.

Example: same method, two payers

Nina, 29, has a CHF 300 deductible and no doctor’s bills so far this year. She has eight acupuncture sessions for recurring complaints. The treatment costs of CHF 1,200 are an assumed amount; the deductible and retention fee correspond to the statutory values.

	from a physician with an ASA certificate of proficiency	from a non-medical TCM therapist
Payer	basic health insurance	supplementary insurance only, if she has it
Nina’s share without supplementary insurance	CHF 390	CHF 1,200
Calculation	CHF 300 deductible + 10% of CHF 900	whole bill herself

The calculation shows that supplementary insurance for complementary medicine is mainly worthwhile if you use non-medical therapies regularly. The deductible calculator works out how high your deductible should be; you can compare basic health insurance premiums in the premium calculator.

What this means for you

1. Find out who is treating you. If it is a physician with a certificate of proficiency for the method, basic health insurance pays. If it is a therapist without a medical degree, you need supplementary insurance.
2. Check your supplementary insurance. Which methods are covered, at what percentage, with what annual limit, and which registration must the therapist have? This is set out in your insurer’s terms and conditions.
3. Take out cover early. Supplementary insurance involves health questions. Existing complaints can be excluded.
4. Compare the offers. Benefits for complementary medicine vary considerably between insurers. We are building a benefits comparison under compare supplementary insurance; you will find the insurers’ profiles under health insurers. The needs check helps you decide whether you need such cover at all.
5. Keep your bills. Submit physicians’ bills to basic health insurance, even if they are below your deductible, and therapists’ bills to supplementary insurance.

You will find more about the therapists’ registers under recognised therapists, and on how manual therapies are classified under osteopathy.

Common mistakes

• Believing basic health insurance does not pay for alternative medicine. Five methods are covered if a physician with a certificate of proficiency provides the treatment.
• Believing all acupuncture is covered by basic health insurance. If a non-medical therapist treats you, only supplementary insurance pays.
• Not checking the therapist’s registration. Without a recognised registration, supplementary insurance often pays nothing either.
• Overlooking the limit. Supplementary insurance usually caps benefits per session or per year. A large number of sessions can use up the limit quickly.
• Treating methods as equivalent. Osteopathy, kinesiology and shiatsu are not among the five methods covered by basic health insurance.