For Patients
IV, health insurance and congenital conditions – orientation, without guarantee.
Whether and to what extent costs are covered depends on many factors in Switzerland and cannot be answered in general terms. Roughly: for recognised congenital conditions, the disability insurance (IV) generally covers medical measures up to the 20th birthday, after which mandatory health insurance (KVG) generally applies. This information is non-binding and for orientation only – the case-by-case assessment by the responsible insurer is always decisive.
This page offers only general orientation and is not legal or insurance advice. It does not replace the binding information from your IV office or your health insurer. Always clarify cost questions in advance and individually with the responsible bodies.
Cleft lip and palate and certain other conditions are recognised as congenital conditions in Switzerland. For recognised congenital conditions, the IV generally covers the medically necessary measures up to the 20th birthday. Scope and requirements are to be clarified with the IV in each case.
Clarifying early – ideally before planned measures and before the 20th birthday – helps to settle responsibility in good time.
After the 20th birthday, mandatory health insurance (KVG) generally applies to medically indicated treatments. Whether a specific measure is covered depends on the legal requirements and the case-by-case assessment; prior confirmation of coverage can be sensible.
Purely aesthetic procedures are usually not covered. Whether a measure is considered medically indicated is decided by the insurer case by case.
That recognised congenital conditions generally run via the IV up to 20 and via the KVG afterwards is the usual framework.
Whether a specific measure is covered is a case-by-case decision by the responsible body and can vary.
Legal bases and practice can change; the current information from the insurers is always binding.
We give general orientation – binding information is provided by the responsible insurers.
Get in touchIt depends on the individual case. Roughly: for recognised congenital conditions generally the IV up to the 20th birthday, afterwards generally health insurance (KVG). The information from the responsible body is binding.
Not automatically. Whether a specific measure is covered is decided by the responsible insurer case by case. Purely aesthetic procedures are usually not covered.
A prior commitment by the insurer to cover the costs of a planned measure. Before major procedures it is sensible to obtain one.
No. It serves only as general orientation and is not legal or insurance advice. The assessment by your IV office or health insurer is decisive.