Rehabilitation: when does health insurance pay for rehab?


Getting back to everyday activities – rehabilitation at home or in a clinic. What you need to know so that your health insurer will pay for rehab or spa treatment.

What exactly is rehabilitation?

Rehabilitation comes from the Latin term ‘rehabilitatio’, meaning restoration. It’s often shortened to ‘rehab’. Medical rehabilitation is intended to reduce the impact of various physical, psychological and social consequences of an accident or medical condition by providing a therapy that is targeted to the individual’s needs.

Regaining independence

Following a stroke, a heart operation, an orthopaedic injury, a burnout or some form of addiction, medical rehabilitation helps patients of all ages to regain as much independence as possible in their everyday activities. Spa treatments, such as balneotherapy, are meant to help patients convalesce and recover their strength after a serious illness, even if no special care or treatment is required.

Medical rehabilitation: what will my health insurance pay?

Basic insurance will pay if 4 conditions are met: need for hospitalisation, prescribed by a doctor, health insurer gives a commitment to provide cover, recognised clinic. Discuss these points in advance with your doctor.

When basic insurance pays

In Switzerland, your health insurer’s basic insurance will pay for medical rehab if these conditions are met.

  1. Need for hospitalisation: this means that the necessary diagnostic and therapeutic measures can only be provided in an inpatient setting. In other words, the patient must stay overnight at the clinic. This condition does not apply in the case of outpatient rehabilitation.
  2. Prescribed: the stay at a rehabilitation facility must be prescribed by your doctor.
  3. Commitment to provide cover: the competent medical professional must request a commitment to provide cover from the health insurance company.
  4. Recognised clinic: if the rehabilitation clinic features on the hospital list of the canton in question and is permitted to carry out the measures required, basic insurance will cover the cost of the medical services and the inpatient stay.

Rehab clinics abroad for clients

As a client of CSS, you have an advantage. You can get treatment at selected rehab clinics abroad (in german).

Outpatient or inpatient rehab?

Medical rehabilitation usually takes place in an inpatient setting (with overnight stay/s) in a rehabilitation clinic or healthcare sanatorium, is provided by trained staff and has a clear goal: helping patients to regain their independence. After all, following an illness or accident, you want to be able to enjoy life with the same independence as before.

Medical rehabilitation can also be provided on an outpatient basis, not involving any overnight stays. The doctor in charge of treatment decides which form of rehab is better suited to each particular case. They will also obtain the necessary commitment to provide cover from the health insurer.

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Spa and recovery cures: which supplementary insurance pays what?

If you are prescribed spa treatment involving balneotherapy, basic insurance will cover only part of the cost. Your health insurer’s basic insurance will not pay anything towards the cost of a recovery cure. Supplementary insurance enables you to close the gaps in your basic insurance.

  • Medical costs insurance provides perfect protection following an accident: unlimited cost coverage for 5 years. And it gives you a free choice of doctor, clinic, private or semi-private ward.
  • Hospitalisation insurance lets you plug the gaps in your basic insurance: free choice in recognised hospitals with the Balance option. 90% of the costs are covered for a period of 90 days. The Premium option covers 90% of the costs for an unlimited period.
  • Protected with spa and nursing care insurance: a maximum of CHF 80 per day for spa treatments, home care, home help and recovery cures following a stay in hospital. Depending on which option you choose, that’s between CHF 800 and CHF 2,400 a year.

At CSS, we're here for you

A stay in hospital for an operation or follow-up treatment raises questions and uncertainties. We’re here for you and will accompany you every step of the way, from the initial consultations, to a second opinion, right through to discharge – and beyond.

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