Speech therapy in Switzerland: prescription, LAMal/KVG cover and insurer reports

In Switzerland, speech and language therapy (logopédie, Logopädie) is covered by compulsory health insurance (LAMal/KVG) only on medical prescription, for disorders of language, speech, voice, fluency or swallowing that have a neurological or phoniatric cause, under articles 10 and 11 of the OPAS/KLV ordinance. Developmental language and literacy disorders in children are in principle a cantonal responsibility, as special needs education.

Logopédiste, orthophoniste, speech therapist

In French-speaking Switzerland, the profession is called logopédiste and the discipline logopédie. The Association romande des logopédistes diplômé·e·s (ARLD) uses these terms and notes that the discipline is called orthophonie "in some French-speaking cantons and in France".

What the OPAS and OAMal actually say

Article 10 OPAS: covered disorders

Our translation of the OPAS (SR 832.112.31), version in force on 1 August 2026; the official French text is linked:

"Speech and language therapists admitted under art. 50 OAMal and organisations of speech and language therapists admitted under art. 52b OAMal treat, on medical prescription, patients suffering from disorders of language, speech, voice, fluency and swallowing that have one of the following causes:

• a. neurological conditions caused by infection, trauma, intoxication, tumour, vascular disorders, hypoxia, degenerative disorders or as a post-operative after-effect;
• b. phoniatric conditions, in particular partial or total malformation of the lips, tongue, palate, jaw or larynx, and impairment of the orofacial muscles or of laryngeal function of infectious, traumatic, tumoural or functional origin or as a post-operative after-effect."

Both conditions apply together: a disorder on the list and a cause under a or b. A language delay or dyslexia with no neurological or phoniatric cause does not fall within the wording of this text.

Article 11 OPAS: number of sessions and reports

• Para. 1 "The insurance covers, on medical prescription, a maximum of twelve sessions of speech and language therapy, the first treatment having to take place within eight weeks of the medical prescription."
• Para. 2 "A new medical prescription is required for a larger number of sessions to be covered."
• Para. 3 "If speech and language therapy is to be continued at the insurer's expense after treatment equivalent to 60 one-hour sessions within one year, the treating doctor refers the matter to the medical adviser and sends a duly reasoned proposal on continuing the therapy. The medical adviser proposes whether or not to continue the therapy at the insurer's expense, stating to what extent."
• Para. 4 "The treating doctor sends the medical adviser a report on the treatment and the indication for therapy at least once a year."
• Para. 5 "Reports sent to the medical adviser under paras. 3 and 4 contain only the information needed to establish whether the insurer will continue to cover the treatment."

According to a footnote in the OPAS, the current wording of para. 1 (eight weeks) has applied since 1 August 2016. We advise checking the date of older documents, which may reflect an earlier version.

Article 50 OAMal: who can bill basic insurance

As art. 10 OPAS states, the therapist must be admitted under art. 50 of the OAMal (SR 832.102) to work at the expense of compulsory health insurance; organisations are admitted under art. 52b. The admission conditions are set out in those articles: we advise reading them in the official text before taking any steps.

Who pays for what: situation by situation

Since the RPT/NFA reform on 1 January 2008, the cantons have taken over "full formal, legal and financial responsibility" for special needs education, speech therapy included, for children and young people from birth to age 20, according to the EDK/CDIP. Health insurance keeps the organic-cause disorders of art. 10 OPAS.

• Child aged 7, dyslexia and dysorthographia with no organic cause: the canton. The request goes through the cantonal service (in Vaud, the PPLS, which also fund contracted independent therapists under the cantonal scheme; in Valais, the CDTEA). Do not expect a LAMal prescription.
• Child aged 4, simple language delay: in principle the canton, as there is no organic cause.
• Child born with a cleft lip and palate: the medical-therapeutic side (voice, nasality, swallowing, intelligibility). Before age 20, disability insurance (AI/IV) covers "all medical measures needed to treat the congenital disorder", according to the AVS/AI glossary, which does not mention speech therapy. For speech therapy in this indication, a 2024 document from the University Children’s Hospital Basel (UKBB) states that its funding was "entirely transferred to health insurers" on 1 January 2008. We advise getting written confirmation of who pays before the first session.
• Adult aged 67, aphasia after a stroke: LAMal, art. 10 let. a (vascular disorders), on prescription.
• Adult with Parkinson's disease, dysarthria or dysphagia: LAMal, let. a (degenerative disorders).
• Adult after head and neck cancer: LAMal, let. a or b (tumour, post-operative after-effect). At CHUV, the service page states that nine individual therapy sessions are prescribed following a request from the ENT surgeon.
• Teacher with functional dysphonia: LAMal cover possible under let. b, which covers impaired laryngeal function of "functional" origin, on prescription.
• Adult who has stuttered since childhood, with no neurological or phoniatric cause: fluency is on the list of disorders, but the text also requires a cause under a or b. LAMal cover is uncertain. We advise getting the insurer's written position before starting.

Step by step, for an adult covered by LAMal

• 1. Check the indication. We advise asking for the medical diagnosis (stroke, Parkinson's disease, laryngeal surgery) to appear on the prescription, as it is what links the disorder to art. 10.
• 2. Receive the prescription. It covers at most twelve sessions. Note its date: the first session must take place within eight weeks.
• 3. Assess and report back. Send the doctor a short assessment report (our assessment report template can serve as a basis).
• 4. Renew in time. Before the twelfth session, ask for a new prescription, with a few lines on progress. Without it, further sessions are not covered (para. 2).
• 5. Count in hours. The para. 3 threshold is treatment "equivalent to 60 one-hour sessions within one year". With 45-minute sessions, the threshold is reached after 80 sessions. Alert the doctor as the threshold approaches.
• 6. Prepare the report for the treating doctor. The doctor uses it for the proposal to the medical adviser (para. 3), then for the annual report (para. 4).

For psychotherapy, a different route applies: see the Swiss insurer report for psychotherapy.

Template: speech therapy report for continued treatment

This template is meant for the treating doctor, who uses it for the proposal to the medical adviser (para. 3) or for the annual report (para. 4). It sticks to what para. 5 requires.

Template to copy

• Header: your name and address as a therapist admitted to bill compulsory insurance, date, addressee (Dr ..., treating doctor), the words "Confidential, for the insurer's medical adviser".
• Subject: Speech therapy report for continued therapy (art. 11 para. 3 OPAS), or Annual report (art. 11 para. 4 OPAS).
• Patient: surname, first name, date of birth, insurer.
• Medical indication: diagnosis made by the doctor, date, doctor who made it; link to art. 10 let. a or let. b OPAS.
• Speech and language disorder: type (aphasia, dysarthria, dysphagia, dysphonia...) and severity at the start of treatment.
• Treatment delivered: start date, number of prescriptions, number and length of sessions, total hours, current frequency.
• Goals and progress: for each goal, the starting point, the current situation, and how you measured it (same test, same conditions).
• Functional impact: what the patient can now do in daily life (meals, conversations with family, phone calls, work) and what they cannot yet do.
• Proposal: continue or not, remaining goals, frequency, duration, number of sessions or hours requested, next review date, discharge criteria.
• Risks if therapy stops: expected functional consequences, stated soberly.
• Signature: name, title, date.

Filled-in fictional example

A fictional case.

• Subject: Speech therapy report for continued therapy (art. 11 para. 3 OPAS).
• Patient: Mr Alain R., born 1959, insured with insurer X.
• Medical indication: left middle cerebral artery ischaemic stroke on 12 January 2026 (diagnosis by Dr B., neurologist). Art. 10 let. a OPAS, vascular disorders.
• Speech and language disorder: non-fluent aphasia with marked word-finding difficulty at the start, comprehension of simple sentences preserved. Mild dysphagia for liquids at the start, resolved in March 2026.
• Treatment delivered: started 2 February 2026, five successive prescriptions, two 60-minute sessions a week. Total at 30 September 2026: 56 sessions, i.e. 56 hours.
• Goals and progress: naming everyday objects, very few correct answers in February, most items correct in September on the same test. Simple subject-verb sentences: absent in February, produced with cues in September. Writing a shopping list: goal achieved.
• Functional impact: Mr R. orders on his own at the café and holds a phone conversation of a few minutes with his daughter. He cannot yet resume his role as treasurer of his association.
• Proposal: continue for six months, one 60-minute session a week (about 24 hours). Goals: sentences with verbs without cues, a phone call with a stranger, reading a simple bank statement. Review at the end of March 2027, discharge if two successive assessments show no further progress.

The treating doctor takes this report, adds an opinion, and sends it to the medical adviser before the 60-hour threshold is crossed.

Common mistakes

• Starting before the prescription, or more than eight weeks after it. Para. 1 ties cover to a first session within eight weeks.
• Counting sessions instead of hours. The threshold of 60 is expressed in one-hour sessions.
• Sending the report to the insurer's claims department. The text refers to the medical adviser, via the treating doctor. We advise sending it securely, addressed by name to the medical adviser.
• Asking for a LAMal prescription for developmental dyslexia. Direct parents to the cantonal service from the start instead.

Quick comparison with France and Belgium

France. According to the French national health insurance (page dated December 2020), speech therapy sessions in private practice are covered at 60% on medical prescription. Our letter to the prescribing doctor template covers this route.

Belgium. According to INAMI/RIZIV, a doctor prescribes an assessment, a specialist then prescribes treatment, and the health fund's medical adviser gives approval, usually for two years and a set number of sessions.

Switzerland. The OPAS does not require prior insurer approval for the first prescriptions; the medical adviser comes in at the 60-hour threshold, via the treating doctor.

Why Delta fits this case

A report to the medical adviser is built on progress session by session. Delta transcribes what is said in the session, or takes your dictation just after, generates the session report and updates the patient record (summary of care, goals tracked). The "Goals and progress" and "Proposal" sections of the template draw on this record. Delta also drafts letters and assessment reports in your own vocabulary and structure, learned from your existing reports (see our clinical document templates and the Delta page for speech therapists).

Data stays in Europe, in France, on infrastructure certified for health data, and the patient's name and identifying details are pseudonymised before the AI (for the Swiss framework, see our article on the Swiss Data Protection Act). Delta does not fill in insurer forms and does not handle billing or tariffs (the speech therapy tariff): those steps stay in your usual software.

Sources

• OPAS, SR 832.112.31, official PDF (French), in force on 1 August 2026 (arts. 10 and 11).
• OAMal, SR 832.102, official PDF (French), in force on 22 October 2026 (arts. 50 and 52b).
• Assurance Maladie (ameli.fr), dyslexia and dysorthographia, medical follow-up and therapy (2020).
• EDK/CDIP, short information on the intercantonal agreement on special needs education (2007).
• AVS/AI information centre, glossary, congenital disorder.
• INAMI, how to claim reimbursement for speech therapy.