Key points at a glance
- Basic health insurance covers the hospital stay at the standard of the general ward (Art. 25 para. 2 let. e KVG).
- The Health Insurance Act (KVG) contains no right to choose the treating doctor in hospital.
- Free choice of doctor is a benefit of supplementary hospital insurance for semi-private or private.
- Free choice of doctor and free choice of hospital are two different things: you already have the choice among listed hospitals in basic health insurance.
- Which doctors you can choose and what you pay for it are set out in the general terms and conditions of your supplementary insurance.
What is free choice of doctor in hospital?
Free choice of doctor in hospital means that during an inpatient stay you can decide yourself who treats you: for example the surgeon who has already examined you as an outpatient, a particular specialist or a doctor with admitting privileges who operates in several clinics. The term only concerns the hospital stay. For outpatient treatment, you basically already have free choice of doctor in basic health insurance.
In basic health insurance under the Federal Health Insurance Act (KVG), there is no free choice of doctor in hospital. The KVG covers the hospital stay at the standard of the general ward. Who treats you there is organised by the hospital according to its duty roster and your condition. The statutory benefits of basic health insurance are the same in all wards; supplementary insurance buys you the choice of person and more comfort, not a different compulsory benefit.
Free choice of doctor is a typical benefit of supplementary hospital insurance for the semi-private or private ward. Such insurance is subject to the Insurance Contract Act (ICA). Its scope is not set by law but in the general terms and conditions (AVB) of each product.
Free choice of doctor is often confused with free choice of hospital. Choice of hospital concerns the hospital, choice of doctor the person who treats you. You already have the choice among the listed hospitals of your canton of residence and of the canton where the hospital is located in basic health insurance, but with the tariff of your canton of residence as the upper limit.
How it works
If you have semi-private or private supplementary hospital insurance, a planned hospital stay usually works like this:
- Agree on the doctor and hospital. You agree with the doctor of your choice in which hospital she will treat you.
- Obtain cost approval. The hospital or you ask the supplementary insurance whether it will cover semi-private or private treatment in this hospital.
- Billing in two parts. Basic health insurance and the canton of residence pay the share that would also arise in the general ward. The supplementary insurance pays the extra costs for the room and the choice of doctor, minus any co-payment under the contract.
How far the choice extends is governed by the product. For “Hospital Flex”, for example, Visana describes free choice of doctor in hospital for a stay in the semi-private or private ward as treatment by a head physician, by a specialist or by a doctor with admitting privileges. Other insurers word it differently; the text of your general terms and conditions always applies.
Semi-private and privately insured patients differ mainly in the room category. Whether and to what extent the choice of doctor is included depends on the product: check the clause in your policy.
Legal basis
There is no statutory right to free choice of doctor in hospital. Art. 25 para. 2 let. e KVG provides that basic health insurance covers the hospital stay at the standard of the general ward. Art. 41 para. 1 KVG gives you free choice among licensed service providers for outpatient treatment, and Art. 41 para. 1bis KVG the choice among listed hospitals for inpatient treatment. The KVG does not govern the choice of person in hospital.
Under Art. 2 para. 2 of the Health Insurance Supervision Act (KVAG), health insurers may offer supplementary insurance alongside basic health insurance; it is subject to the ICA. When you take out a policy, you must answer the health questions truthfully (Art. 4 ICA); if you breach this duty of disclosure, the insurer may cancel the contract and can refuse benefits (Art. 6 ICA). Which doctors and hospitals are covered is set out in the general terms and conditions.
Example: an operation with the surgeon of your choice
Nina is 45, has basic health insurance with a CHF 300 deductible and Visana’s “Hospital Flex” supplementary hospital insurance. For a planned operation, she wants to be operated on by the specialist who already treats her as an outpatient. To do so, she chooses the semi-private ward. She stays in hospital for 5 days. The supplementary insurance amounts come from Visana’s product page, those for basic health insurance from the KVG and the Health Insurance Ordinance (KVV).
| Item | Amount | Basis |
|---|---|---|
| Surcharge for semi-private with “Hospital Flex” | CHF 2,000 | Visana, product page |
| Deductible in basic health insurance, at most | CHF 300 | Art. 103 para. 1 KVV |
| Retention fee in basic health insurance, at most | CHF 700 | Art. 103 para. 2 KVV |
| Hospital contribution, 4 days × CHF 15 (day of discharge free) | CHF 60 | Art. 104 KVV |
| Nina pays at most | CHF 3,060 |
The figures are product examples, not a recommendation. Other insurers offer free choice of doctor with different premiums and co-payments.
What this means for you
First ask yourself how important choosing the person who treats you is to you. The compulsory benefits of basic health insurance are fully covered in the general ward. If you want the choice, check:
- Which ward do you need? Choice of doctor is linked to semi-private or private. Flex hospital insurance lets you decide this for each stay.
- Which hospitals and doctors does the product cover? Check in the general terms and conditions whether doctors with admitting privileges and private clinics are included.
- How healthy are you? Supplementary insurance requires health questions. If you have pre-existing conditions, the insurer may impose a reservation or reject the application.
- What does it cost you per year? Compare the premium and co-payment. You can compare the benefits of supplementary insurance in the supplementary insurance comparison.
You can find the insurers and their offers under health insurers, for example in the profile of Visana. Basic health insurance, which you can have with a different insurer from your supplementary insurance, can be compared in the premium calculator.
Common mistakes
- Confusing free choice of doctor with free choice of hospital. You already have the choice among listed hospitals in basic health insurance, but not the choice of doctor in hospital.
- Assuming basic health insurance pays for the doctor of your choice. In the general ward, the hospital organises the treatment.
- Forgetting the cost approval. Before a planned admission, clarify whether the supplementary insurance covers the hospital, the ward and the doctor.
- Cancelling supplementary insurance too early. You can only get new supplementary hospital insurance after a health check.
Frequently asked questions
Can I choose my doctor in the general ward?
You have no right to do so. Basic health insurance covers the stay at the standard of the general ward, and the hospital organises who treats you. You buy free choice of doctor as an extra with supplementary hospital insurance.
Is free choice of doctor the same as free choice of hospital?
No. Choice of hospital is about which hospital you are treated in; you already have it in basic health insurance among the listed hospitals of your canton of residence and of the canton where the hospital is located. Choice of doctor is about who treats you in hospital.
Can I ask for the head physician?
With semi-private or private supplementary hospital insurance, you can choose a particular doctor within the scope of the general terms and conditions. Whether the hospital can meet your choice also depends on availability and specialty; clarify this before admission.
Does free choice of doctor also apply to outpatient treatment?
For outpatient treatment, you already choose freely among licensed service providers in basic health insurance, unless you have a GP, HMO or telemedicine model. The term free choice of doctor in hospital only concerns inpatient stays.
Related terms
- Semi-private wardSemi-private (halbprivat) is a level of supplementary hospital insurance that gives you a two-bed room in hospital and usually the choice of hospital doctor. Basic health insurance only pays for the general ward, in a listed hospital together with the canton, which pays at least 55%. The additional costs of the semi-private ward are covered by supplementary insurance under the Insurance Contract Act (ICA).
- Privately insuredIn Switzerland, being privately insured means that you have supplementary hospital insurance for the private ward. It pays for additional hospital benefits that basic health insurance does not cover, usually a single room and free choice of doctor. Basic health insurance only covers the general ward of a hospital on the Hospital List, under Art. 25 and 41 KVG.
- Supplementary hospital insuranceSupplementary hospital insurance is voluntary insurance under the Insurance Contract Act (ICA) that pays more than basic health insurance when you need inpatient hospital treatment: free choice of hospital anywhere in Switzerland, a two-bed or single room or your choice of doctor. Basic health insurance only covers the general ward of a listed hospital, and you pay CHF 15 per day in hospital.
- Free choice of hospitalFree choice of hospital means that for inpatient treatment you may choose any hospital in Switzerland that is on the hospital list of your canton of residence or of the canton where it is located. However, basic health insurance and your canton pay at most the tariff that applies to this treatment in a listed hospital in your canton of residence; the canton pays at least 55%.
Sources
- Federal Health Insurance Act (KVG), Art. 25Art. 25 para. 2 let. e KVGfedlex.admin.ch
- Federal Health Insurance Act (KVG), Art. 41Art. 41 KVGfedlex.admin.ch
- Health Insurance Supervision Act (KVAG), Art. 2Art. 2 para. 2 KVAGfedlex.admin.ch
- Insurance Contract Act (ICA), Art. 4Art. 4 ICAfedlex.admin.ch
- Health Insurance Ordinance (KVV), Art. 104Art. 104 KVVfedlex.admin.ch
- Visana, Hospital Flex (product page)visana.ch