Functional Rehabilitation

Functional Rehabilitation

Functional rehabilitation treatments include physiotherapy, kinesitherapy, chiropractic, osteopathy, etiopathy, occupational therapy (ergotherapy), diathermy, ultrasounds, infrared, hydrotherapy, inhalations and fangotherapy.

Podiatry sessions can also be covered if this is approved in advance by our Medical Adviser.

First and foremost, it is imperative to note that for any claim to be considered for reimbursement, the doctor's prescription must specify the following:

  • Number of sessions
  • Length of suggested treatment
  • Should this period exceed 6 months, the treating physician must reassess the treatment after six months and issue a new prescription

Failure to provide this information will result in the claim not being reimbursed.

Functional rehabilitation treatments are reimbursed at 80% up to a maximum of CHF 70.- per session.

The Supplementary Plan is applied only from the 31st session onwards.

Reasonable and customary charges for the medical practitioner’s home visit are reimbursed at 80% if the insured person is unable or cannot leave the premises due to circumstances.

In addition, the following treatments are reimbursed under the same terms and conditions:

  • Acupuncture and mesotherapeutic treatments for functional rehabilitation only if performed by a medical doctor 
  • Long-term functional rehabilitation treatments

Please note that unless otherwise approved by the Medical Adviser a maximum of one session per day will be considered for reimbursement irrespective of ailments, sessions, time duration or cost in any 24-hour period.
 

Exception

Chiropodist/podiatrist consultations and sessions require prior authorization from the Medical Adviser.

Massage, kinesiology, reflexology, shiatsu, and tui na are not covered, even if prescribed by a medical doctor.

Main Plan & SPP (excl. secondary dependents) Temporary contract (shorter than 3 months) Secondary dependents
Applicability Yes Yes Yes*
Prescription Required Required Required
Prior authorization Not required** Not required** Not required**
Reimbursement rate 80% up to a maximum of CHF 70.- / session*** 80% up to a maximum of CHF 70.- / session*** 80% up to a maximum of CHF 70.- / session***
Supplementary Plan Only from the 31st session onwards N/A N/A
* - - Waiting period for new affiliates: expenses incurred during the first year of coverage shall not be reimbursed
** Except for podiatry sessions Except for podiatry sessions Except for podiatry sessions
*** Charges for the medical practitioner’s home visit are reimbursed at 80% Charges for the medical practitioner’s home visit are reimbursed at 80% Charges for the medical practitioner’s home visit are reimbursed at 80%

Sessions of Lymphatic Drainage

Sessions of lymphatic drainage are covered at 80% upon doctor’s prescription, however the Medical Adviser’s prior authorization is required.

An exception applies when lymphatic drainage is prescribed as part of cancer treatment. In such cases, the requirement for prior authorization may be waived, provided that the medical prescription explicitly states that the treatment is linked to cancer care.
 

Main Plan & SPP (excl. secondary dependents) Temporary contract (shorter than 3 months) Secondary dependents
Applicability Yes Yes Yes*
Prescription Required Required Required
Prior authorization Required** Required** Required**
Reimbursement rate 80% 80% 80%
Supplementary Plan Yes N/A N/A
* - - Waiting period for new affiliates: expenses incurred during the first year of coverage shall not be reimbursed
** Not required if prescribed as part of cancer treatment Not required if prescribed as part of cancer treatment Not required if prescribed as part of cancer treatment