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Pregnancy: what benefits are supported by your insurer disease?

Expecting a baby, becoming parents: a moment in life like no other! This article goes into detail about the benefits covered by health insurance during pregnancy

Preventive examinations during pregnancy

In the course of a pregnancy “normal”, the basic insurance supports seven tests in total, which can be done by a doctor or by a·e a midwife.

The first review, which usually takes place between the 6th and 9th week of pregnancy, is accompanied by a discussion, during which the patient has with his or her doctor. Some laboratory tests, whereby, for example, to measure the rate of beta-hCG, the”pregnancy hormone”, are undertaken.

If bleeding will occur during this first phase of the pregnancy, your gynecologist will be able to do an ultrasound, which will determine if the fertilized egg has been implanted in the correct place in the lining of the uterus (implantation). From the 6th week, the cardiac activity of the embryo is noticeable.

Pregnancy: how many ultrasounds the basic insurance reimburses a-t-Elle?

For a pregnancy without complications, the law provides for two ultrasounds: the first between the 12th and 14th week and the second between the 20th and the 23rd week.

These benefits are reimbursed by compulsory health insurance. It is the physician must decide whether further controls are necessary and if it is a pregnancy that is “at risk” according to the clinical evaluation. The basic insurance is then also responsible for the cost of ultrasounds additional.

Some supplementary insurance, NATURA for example, pays additional scans (90% of the costs).

Pregnancy: screening for trisomies


Your gynecologist will inform you at the beginning of pregnancy of the possibility of performing a prenatal test for the risk of trisomy. Trisomies 21, 18, and 13 are due to chromosomal abnormalities. Chromosomes, found in the nucleus of cells, have the form of rods arranged in X. They are the carriers of information, or heritage, genetic.

Normally, each cell has 23 pairs of chromosomes. In the case of trisomy 21, also known as Down syndrome, chromosome 21, or part thereof, is present in triple and non-dual. For trisomy 18, Edwards ‘ syndrome, it is chromosome 18, which is altered; Patau’s syndrome, or trisomy 13, for chromosome 13.

The analysis of the prenatal risk of trisomy includes:

  • the test of the first quarter;
  • the test for prenatal non-invasive (TPNI); a “non-invasive test is a medical examination that does not require a skin incision.

If following this review, doubt remains about down syndrome, parents should consult with their physician to determine the need to perform diagnostic tests that are invasive, for example, to a sample of the amniotic fluid (amniocentesis) or a puncture of the placenta (chorionic villus sampling procedure).

Basic health insurance covers the costs for the test of the first semester (prenatal test for the risk of trisomy). When the latter reveals an increased risk of trisomy, the basic insurance also pays the costs of the test for prenatal non-invasive (TPNI) and, if necessary, those of amniocentesis or chorionic villus sampling procedure. Invasive tests to determine the presence of genetic diseases are also supported.

Pregnancy and motherhood: how to calculate its contribution to the costs?

Future and young mothers are exempt from cost-sharing for maternity benefits such as:

  • Follow-up examinations during and after pregnancy, including ultrasound
  • Delivery and benefits of obstetrics
  • Preparation for childbirth
  • Breastfeeding counseling

No cost-sharing (no deductible or copay) is not required for these services. In addition, future and young mothers do not participate in the costs of services of general medicine, or treatment of a disease from the 13th week of pregnancy and up to eight weeks after birth, even for diseases unrelated to pregnancy, such as the flu.

Does that support health insurance in the case of a miscarriage?

A miscarriage, also called a spontaneous abortion, leaves traces. This painful event is unfortunately too often a taboo subject. You should know that 15% to 20% of pregnancies end in a miscarriage between the 5th and 10th week.

What is it in these cases of the franchise and the share? If this spontaneous abortion occurs before the 13th week of pregnancy, the patient must pay the cost-sharing for services related to the interruption of gestation. This also applies to a possible uterine curettage, or aspiration, which would be done after the miscarriage.

If the abortion occurs after the 13th week of pregnancy, the patient is exempt from participation in the costs for benefits that are related to it. An interruption of pregnancy at this point, however, is not considered a birth within the meaning of the act. Any subsequent examination or treatment as a result of complications will be counted as a standard benefit and the insured will have to pay its franchise and its share.

After the 23rd week of pregnancy, a miscarriage or a·e child being born dead·e is equivalent to birth within the meaning of the act. The patient is then exempted from participation in the costs, even for the controls, post-partum, or treatment as a result of complications. This is true for the period up to eight weeks after the miscarriage or the birth of a·e stillborn child·e.

Supplementary insurance: think about it early enough

The supplementary insurance companies offer special benefits in case of maternity, and families. Couples planning to start a family should consider the benefits to which they wish to benefit. Good to know: most of the supplementary insurance policies have a waiting period, or waiting time, during which the insured are not eligible to receive certain benefits.

In brief: benefits paid during pregnancy

In accordance with the legal provisions, the basic insurance supports the preventive examinations below, made during the pregnancy:

  • Seven tests of control
  • Two ultrasound examination
  • Test of the first quarter in the context of prenatal testing
  • In the case of increased risk, prenatal testing, non-invasive (TPNI) and other tests, such as a puncture of the amniotic fluid or biopsy, placental

Those speakers do not pay the cost share (or deductible or co-pay) for services related to motherhood:

  • Follow-up examinations during and after pregnancy, including ultrasound
  • Delivery and benefits of obstetrics
  • Preparation for childbirth
  • Breastfeeding counseling

If complications such as bleeding, edema, hypertension, or others appear until the 13th week of pregnancy, they are treated as a disease. Pregnant women should contribute to the cost.

From the 13th week of pregnancy and up to eight weeks after childbirth, future and young mothers should not participate in the costs of medical services and general health care in case of illness, as these will be related to the pregnancy or not.

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