Contract hospital

What is a contract hospital?

A contract hospital is a hospital or birth centre that meets the professional requirements for basic health insurance but is not on a canton’s Hospital List. It has no service mandate from the canton, but may conclude a contract with individual health insurers on the remuneration of services under basic health insurance. That is where the name comes from.

For inpatient care, the Federal Health Insurance Act (KVG) divides hospitals into two groups. Listed hospitals are part of cantonal hospital planning, receive a service mandate and are paid jointly by the canton and the insurer. Within the scope of their service mandate, they are required to admit patients (Art. 41a KVG). Contract hospitals lie outside this planning. Basic health insurance only contributes its own share there, and the canton contributes nothing at all.

For people with basic health insurance only and no supplementary insurance, a stay in a contract hospital is therefore expensive: more than half of the bill is not covered. With supplementary insurance, it can be an option, depending on the contract. Contract hospitals should not be confused with listed hospitals outside your canton of residence: these still receive a cantonal share, but limited to the tariff of your canton of residence.

How it works

To be a contract hospital, a hospital must meet the basic requirements for hospitals: adequate medical care, the necessary specialist staff, appropriate medical facilities and pharmaceutical care, and connection to the electronic patient record (EPR). All it lacks is inclusion in cantonal planning and on the Hospital List.

The insurer concludes a tariff agreement with the hospital. The remuneration from basic health insurance may not be higher than the share the insurer would pay in a listed hospital. Because every canton pays at least 55%, that is at most 45% of the remuneration. There is no cantonal share in a contract hospital. You must pay the outstanding part of the bill yourself if no supplementary insurance covers it.

The free choice of hospital under basic health insurance only applies among listed hospitals. If you choose a contract hospital, you do so at your own financial risk.

Legal basis

Art. 49a para. 4 KVG allows insurers to conclude contracts on the remuneration of services under basic health insurance with hospitals or birth centres that are not on the Hospital List under Art. 39 but meet the requirements of Art. 38 and Art. 39 para. 1 let. a–c and f. The second sentence limits the remuneration: it may not be higher than the share of remuneration under para. 2, i.e. the share the insurer pays for a listed hospital.

Art. 39 para. 1 KVG sets out the admission requirements for hospitals: medical care (let. a), specialist staff (let. b), medical facilities and pharmaceutical care (let. c), cantonal planning (let. d), the Hospital List (let. e) and connection to the electronic patient record (let. f). Contract hospitals lack let. d and e. Art. 41 para. 1bis KVG limits the free choice of hospital to listed hospitals. According to the Federal Office of Public Health (FOPH), uniform financing from 2028 changes nothing for contract hospitals: the share paid by basic health insurance remains at 45%, while for listed hospitals it rises to 73.1%.

Example: listed hospital or contract hospital

Petra is 58, lives in the canton of Zurich and has basic health insurance only. She compares two clinics for a planned operation. We assume remuneration of CHF 12,000 for both; the amount is a worked example, while the cantonal share of 55% is the canton of Zurich’s figure for 2026.

What this means for you

1. Check the hospital’s status. Before a planned procedure, find out whether the hospital is on the Hospital List of your canton of residence or of the canton where it is located. The cantons publish their lists; the canton of Zurich, for example, does so on its page on hospital financing.
2. Ask your insurer. Does your insurer have a contract with the contract hospital? Without a contract, basic health insurance pays nothing at all there. You will find contact details in the profiles under health insurers.
3. Check your supplementary insurance. Read the terms and conditions of your supplementary hospital insurance to see whether, and up to what amount, contract hospitals are covered. Ask for a cost approval.
4. Know the alternatives. Among listed hospitals, you have free choice of hospital, including in other cantons, limited to the tariff of your canton of residence.

Compare basic health insurance premiums in the premium calculator. If you have questions about supplementary insurance, you can request advice.

Common mistakes

• Equating a private clinic with a contract hospital. Privately owned clinics can also be on a Hospital List; the KVG requires the cantons to include them appropriately in their planning. What matters is the list, not who owns the hospital.
• Expecting full cover. In a contract hospital, basic health insurance pays at most 45%, and the canton nothing.
• Assuming your insurer has a contract. Not every insurer has a contract with every contract hospital.
• Not asking your supplementary insurance in advance. Without a cost approval, you risk being left with a large part of the bill.

You will find more terms relating to hospitals and tariffs in the glossary.