General ward

What is the general ward?

The general ward is the hospital insurance class that basic health insurance covers. If you only have basic health insurance, you count as “insured for the general ward” in hospital. The Federal Health Insurance Act (KVG) describes the benefit as follows: basic health insurance covers a hospital stay “in line with the standard of the general ward”.

The law does not say exactly what this standard means. It includes all medically necessary examinations, operations, medicines, nursing care and therapies, as well as accommodation and meals. In practice, this usually means a room with several beds and treatment by the medical team responsible for the ward. You cannot freely choose the doctor who treats you.

The general ward is distinguished from two other classes covered by supplementary hospital insurance under the Insurance Contract Act (ICA):

• Semi-private: as a rule a two-bed room and a free choice of doctor in the hospital. You can find out more under semi-private ward.
• Private: as a rule a single room, a free choice of doctor and additional comfort services. You can find out more under private ward.

Each insurer sets out the exact benefits of these classes in its insurance conditions. Medically, the general ward has the same entitlement: a necessary operation must not depend on whether you have supplementary insurance.

How it works

If you are admitted to hospital as an inpatient, the hospital bills your stay using a flat rate per case. This flat rate covers treatment, care and your stay in the general ward. The hospital may not charge anything beyond this for benefits of basic health insurance.

The flat rate is shared between two payers. Your canton of residence pays at least 55%, your health insurer the rest. Each canton sets its share every year. You pay your share through the co-payment: the deductible and a 10% retention fee up to the annual maximum of CHF 700. On top of this comes the hospital contribution of CHF 15 a day. Children, young adults in education and women for whom no co-payment is charged because of pregnancy or maternity do not pay a hospital contribution. You do not pay for the day of discharge.

You can choose among the hospitals on the Hospital List of your canton of residence or of the canton where the hospital is located. If the hospital is outside your canton, the insurer and the canton pay at most the tariff that applies to this treatment in a listed hospital in your canton of residence. If the hospital is more expensive, you pay the difference, unless there are medical reasons: an emergency or a treatment that no listed hospital in your canton offers. Except in an emergency, this requires approval from your canton of residence. A free choice of hospital throughout Switzerland without this risk is a typical benefit of supplementary hospital insurance.

Legal basis

Art. 25 para. 2 let. e KVG provides that basic health insurance covers a hospital stay in line with the standard of the general ward. Art. 49 para. 1 KVG requires flat rates for inpatient treatment, as a rule flat rates per case; under Art. 49 para. 5 KVG, these settle all of the hospital’s claims for services under the KVG. Art. 49a para. 2ter KVG obliges the cantons to cover at least 55%.

The choice of hospital is governed by Art. 41 para. 1bis KVG: free choice among the listed hospitals of the canton of residence and the canton where the hospital is located, with payment at most according to the tariff of the canton of residence. Art. 41 paras. 3 and 3bis KVG govern the exceptions for medical reasons. The hospital contribution is laid down in Art. 64 para. 5 KVG and Art. 104 of the Health Insurance Ordinance (KVV): CHF 15 a day, not for the day of discharge and not for children, young adults in education or women who are exempt from co-payment because of maternity. Services above the standard of the general ward are not compulsory benefits; they are paid for through supplementary insurance under the ICA or privately.

Example: five days insured for the general ward

Marco is 52 years old, insured for the general ward and has a CHF 1,500 deductible. He spends five days in a listed hospital in his canton of residence for an operation. He has had no costs so far this year. The flat rate per case of CHF 12,000 is chosen for illustration; the cantonal share of 55% and the hospital contribution are statutory values.

Payer	Share	Amount
Canton of residence	55% of the flat rate (statutory minimum)	CHF 6,600
Health insurer	45% of the flat rate, minus Marco’s co-payment	up to CHF 5,400
Marco: deductible and retention fee	Deductible plus 10%, at most CHF 700	at most CHF 2,200
Marco: hospital contribution	4 days × CHF 15, not including the day of discharge	CHF 60

What this means for you

For medical care, the general ward is sufficient. Whether supplementary hospital insurance makes sense depends on your wishes and your budget:

1. Is a room with fewer beds important to you? Then look at semi-private or private cover.
2. Do you want to choose your doctor in hospital yourself? Only supplementary insurance covers this.
3. Do you want to go to a hospital outside your canton without the risk of a tariff difference? Supplementary insurance for the general ward throughout Switzerland can cover this.

Bear in mind: supplementary insurance asks health questions and can turn you down. With pre-existing conditions, taking out a policy can be difficult or only possible with a reservation. You can compare supplementary insurance benefits in the comparison of supplementary insurance. You will find the premiums for basic health insurance, which provides the same benefits for the general ward at all insurers, in the premium calculator, and the insurer profiles under health insurers. The page on hospitalisation helps you with everything around a hospital stay.

Common mistakes

• Thinking that general ward cover means worse medicine. The medically necessary treatment is the same.
• Overlooking the hospital contribution. CHF 15 a day is payable in addition to the deductible and retention fee.
• Choosing a hospital in another canton without checking first. Without a medical reason, a tariff difference can arise.
• Agreeing to a room upgrade without a price. Ask what it costs before you are admitted and get it in writing.
• Cancelling supplementary insurance without a replacement. If you later want semi-private cover again, you will have to answer health questions and can be turned down.

We explain how we build our examples under how we calculate.