Psychiatric and Medico-Psychological Evaluations
Psychiatric and medico-psychological evaluations are covered at 80% and limited to once per year.
Prior authorization of the Medical Adviser is not necessary for the above to be considered for reimbursement, and the Supplementary Plan is applicable.
Psychotherapy
The therapist must be a recognized psychotherapist in the country where they practice, and a prescription from a medical doctor is necessary (unless the therapist is a psychiatrist). In case of online consultation, the therapist must hold a valid license in the country where they practice.
Psychotherapy is reimbursed according to the following criteria:
Inpatient Treatments
Hospital charges are reimbursed in accordance with the reimbursement rules governing hospitalization. In this case, Prior Authorization is necessary, and the Supplementary Plan is applicable.
Treatment by staff of the hospital or by a specialist who is not hospital staff is reimbursed at 90%. The Supplementary Plan is applicable.
Outpatient Treatments or Day Hospital Consultations
Outpatient treatment prescribed and given by a psychiatric doctor or prescribed and provided by an approved psychotherapist (registered with FSP or ASP in Switzerland, for example) is covered as follows:
- Consultations by a psychiatrist (including remote/telehealth care) are reimbursed at 80% up to a maximum of 12 sessions per annum without the need of prior authorization and the application of the Supplementary Plan.
- Psychotherapy is reimbursed at 80% with a monetary limit of CHF 120.- per session and will be limited to an annual maximum of 50 sessions. For insured members below the age of 18, there is no limit on the number of psychotherapy sessions. The Supplementary Plan is not applicable. For secondary dependents, only 35 sessions per year are reimbursable. One session per day is reimbursable.
- Consultations by a psychiatrist beyond 12 visits per year require prior authorization from our Medical Adviser. If it is medically justified and approved in advance by our Medical Adviser, it will be reimbursed at 80% for the number of supplementary sessions approved. The Supplementary Plan is also applicable. In case of refusal or without prior authorization, the reimbursement will be 80% up to a maximum of CHF 120.- per session within the available limit of psychotherapy sessions.
- Therapies to help individuals with autism spectrum disorder (ASD), such as Applied Behavior Analysis (ABA), play therapy, Relationship Development Initiative (RDI), sensory integration and related therapies, and any other clinically proven ASD therapy are covered at 80% and require prior authorization. The Supplementary Plan is applicable. Psychotherapy and psychiatry sessions as well as occupational speech therapy and psychomotricity sessions that are part of ASD treatment are reimbursable based on the corresponding reimbursement rules of these treatments, which you may find above and below.
- Day hospital accommodation charges are not reimbursable.
Sleeping cures
Sleeping cures in an establishment require prior authorization of the Medical Adviser and are reimbursable at 80%. The Supplementary Plan is not applicable.