Pregnancy is a time that often involves a variety of medical check-ups, tests, and supportive care to ensure the well-being of both the expectant mother and the baby. During pregnancy, the following tests and examinations are reimbursed at an 80% rate:

• Gynecological examinations
• Ultrasounds
• Obstetrician fees

In some cases, additional tests such as genetic analyses may be required. These are considered for reimbursement only if medically justified and authorized in advance by the Medical Adviser.
For further details about the reimbursement of genetic tests, please see benefit 26 – Genetic tests in our Rules.

Beyond medical examinations, UNSMIS also provides coverage for supportive services that play an important role in preparing for childbirth and ensuring proper care during and after pregnancy. With a valid medical prescription, the following services are also reimbursable:

• Preparation for birth/delivery classes
  • Classes must be given by a recognized nurse or midwife in the relevant jurisdiction.
  • Costs are reimbursed up to a total of CHF 200.-.
• Midwifery visits
• Nursing care

Since midwives are recognized medical professionals, their fees, including those for home visits, are reimbursable with a valid prescription. However, doula services are only eligible for reimbursement if the doula is a registered nurse.

In case you have complementary insurance with GPAFI, you may also wish to review their website about the details of prenatal insurance.

UNSMIS provides reimbursement for delivery-related costs, whether the birth takes place in a medical facility or at home. The level of reimbursement depends on the setting and the type of medical professional involved.

When delivery occurs in a hospital or clinic setting—whether vaginal or caesarean—the costs are reimbursed at a 90% rate with the application of the Supplementary Plan. This coverage also extends to the professional fees of the  obstetrician, anaesthetist, and midwife during the hospital stay. These fees are likewise reimbursed at the same rate of 90%.

Any stay in a clinic or a hospital follows the same reimbursement methodology, requirements and limitations described in the 'Hospitalization' page.

Home deliveries are also recognized under UNSMIS coverage. When attended by a midwife, nurse, or physician, costs related to a home delivery are reimbursed at 80%.

Following childbirth, UNSMIS provides coverage for a range of postnatal care services to support the health and well-being of both the mother and the newborn.

Midwife or Nurse Visits

A maximum of six postnatal sessions or home visits by a midwife or nurse are reimbursed at 80%, provided that the stay in the medical establishment does not exceed six days. To be eligible, the midwife must be a recognized healthcare professional in the concerned jurisdiction. These visits can be particularly beneficial for follow-up examinations, breastfeeding support, and general maternal and infant care.

A valid medical prescription is required.

Breast Pump Purchase

The cost of purchasing a breast pump is reimbursed at 80%, upon presentation of a valid medical prescription.

By covering these essential services, UNSMIS seeks to ease the transition to parenthood and promote the recovery and health of mothers and infants during the crucial postnatal period.

Sterilization procedures are reimbursed at 80% only when they are medically necessary and prescribed due to an underlying medical condition. In such cases, a valid medical justification must be provided to support the request for reimbursement.

Voluntary sterilization, carried out as a personal choice without medical justification, is not covered. Likewise, the reversal of sterilization, when performed voluntarily, is also excluded from coverage.

Infertility can be a deeply challenging experience, both emotionally and physically. UNSMIS recognizes the importance of providing access to safe and effective infertility treatments to support members who wish to build a family. To ensure fairness and consistency, reimbursement is subject to specific rules and requires the prior approval of the Medical Adviser.

The term of infertility treatment refers to any medical procedure (invasive or non-invasive) aiming to induce pregnancy by means of standard reproductive medicine and carried out in a recognized specialized center.

For the purpose of reimbursement, infertility is defined as the failure to become pregnant:

• The inability of opposite-sex partners to achieve conception after at least one year of unprotected intercourse.
• The inability of a woman, with or without an opposite-sex partner, to achieve conception after at least 3 trials of medically supervised artificial insemination over a one-year period.
• For a male without a female partner after at least 2 abnormal semen analyses obtained at least 2 weeks apart.
• For an individual or their partner who has been clinically diagnosed with gender dysphoria.

With the prior approval of the Medical Adviser, infertility treatments are reimbursed at 80% up to a maximum of CHF 20,000.- per insured member in the lifespan.

To request prior authorization, please kindly send us a medical report which includes the information below:

• exams done and results
• treatment undertaken already
• treatment proposed
• cost estimate

The costs covered by the total credit include all care relating to infertility treatment, such as:

• medical procedures, consultations and examinations and egg retrieval and embryo transfer
• laboratory tests and fees including fees for sperm preparation, hatching, micro-injection, embryo transfer, ICSI, embryo freezing and cryopreservation (only in case of illness)
• costs related to any type of donor or reproductive cells storage to postpone pregnancy are not covered
• biologist’s fees
• scans
• nursing care and services
• operating fees, theatre charges
• post-op, outpatient day care
• materials and anesthesia
• medicaments
• other expenses normally associated with such treatment

Important rules and limitations 

• The Medical Adviser’s approval must be submitted with each reimbursement claim related to infertility treatment.
• Surrogacy is not covered, unless the surrogate mother herself is insured under UNSMIS, in which case it is treated as a regular pregnancy under the principle of insurable interest.
• Only costs strictly related to the insured member are eligible for reimbursement.
• Patients must be under 45 years of age at the start of the planned treatment.