Hospital contribution

What is the hospital contribution?

The hospital contribution is a daily amount that you pay yourself when you are in hospital as an inpatient. It is part of the statutory co-payment in basic health insurance, but stands alongside the deductible and retention fee as a third, separate element. In the law it is called a “contribution towards the costs of a hospital stay”.

The idea behind it: if you are in hospital, you save on food and household expenses at home. You are expected to contribute part of these savings towards the hospital costs. That is why the contribution applies per day rather than as a percentage of the bill.

The hospital contribution only applies to inpatient treatment. A stay counts as inpatient if it lasts at least 24 hours, or if it is shorter but you occupy a bed overnight (Art. 3 VKL). If you go home on the same day, for example after outpatient surgery, you pay no hospital contribution, only the deductible and retention fee on the bill.

The hospital contribution is a rule of basic health insurance under the Federal Health Insurance Act (KVG). It has nothing to do with supplementary insurance for the semi-private or private ward: even if you have semi-private cover, you pay it, because the basic insurance part of the stay remains the same.

How it works

The health insurer calculates the hospital contribution after your stay and invoices it to you together with the deductible and retention fee. You will see it as a separate item on your statement of benefits.

The rules are the same at all insurers:

• Amount: CHF 15 per day.
• Day of discharge: no contribution is charged for the day you leave the hospital.
• Days of leave: days on which you are allowed to go home during a longer stay do not count. How days of leave are calculated depends on the tariff structure for hospitals.
• No annual cap: unlike the retention fee, the ordinance sets no annual maximum for the hospital contribution. It also does not count towards the CHF 700 cap on the retention fee.

Three groups are exempt: children, young adults in education, and women who are exempt from the co-payment because of maternity. Under the KVG, these are insured persons who are under 19 on 31 December of the year (children) and those who are then aged 19 to 25 (young adults; Art. 16 para. 5 and Art. 16a para. 1 KVG).

Legal basis

The KVG requires the hospital contribution in Art. 64 para. 5: in addition to the deductible and retention fee, insured persons pay a contribution towards the costs of a hospital stay, graduated according to the family’s financial burden. The Federal Council sets the amount.

It has done so in Art. 104 of the Health Insurance Ordinance (KVV). Para. 1 sets the daily contribution at 15 francs. Para. 1bis excludes the day of discharge and days of leave. Para. 2 exempts children and young adults in education under Art. 61 para. 3 KVG, as well as women who are exempt from the co-payment under Art. 64 para. 7 KVG.

Art. 64 para. 7 let. b KVG governs maternity: for benefits from the 13th week of pregnancy, during delivery and until eight weeks afterwards, the insurer may not charge any co-payment. Under Art. 105 para. 3 KVV, this period ends at midnight on the 56th day after the birth. What counts as an inpatient stay is defined in Art. 3 of the Ordinance on Cost Calculation and Service Recording in Health Insurance (VKL).

Example: five days in hospital

Marco is 47, has the standard deductible of CHF 300 and has had no medical costs so far this year. He is admitted to hospital on Monday and discharged on Friday. Assume that the health insurer’s share of the hospital bill is CHF 8,000 (in a listed hospital, the canton pays its own share directly to the hospital and does not charge you).

The example shows: for short stays, the hospital contribution is small compared with the deductible and retention fee. For long stays, for example in rehabilitation, it keeps growing with every day, because there is no cap. For 30 days in hospital it comes to CHF 435, because the day of discharge is excluded (29 × CHF 15).

What this means for you

If you have a planned hospital stay, budget for all three parts of the co-payment: the deductible, the retention fee and the hospital contribution. Which deductible suits you depends on whether you expect an operation next year. You must notify your insurer of a lower deductible by 30 November; all dates are listed under deadlines.

Check the statement of benefits after your stay:

1. Is the number of days correct? The day of discharge may not be charged, nor may days of leave.
2. Do you belong to an exempt group? If you are between 19 and 25 and in education, send your insurer proof of education if it still charges the contribution.
3. Was it a birth? In the case of maternity, the insurer may not charge a deductible, a retention fee or a hospital contribution.

If you receive supplementary benefits, the canton may cover the co-payment (Art. 14 ELG). If your income is low, it is also worth looking at your canton’s premium subsidy.

The hospital contribution is the same at all insurers. The differences between insurers lie in the premium. The premium calculator shows how much you pay with your insurer in comparison, using the official FOPH premiums. You can find information on individual insurers in the health insurers overview.

Common mistakes

• Confusing the hospital contribution with the retention fee. The retention fee is capped at CHF 700 per year, the hospital contribution is not. Even if you have used up the retention fee, you pay CHF 15 per day in hospital.
• Classifying outpatient procedures wrongly. If you go home on the same day, no hospital contribution applies. It only applies to inpatient stays.
• Not using the exemption for education. Young adults in education are exempt. If your insurer does not know your education status, it may still charge the contribution.
• Hoping for supplementary insurance. No supplementary hospital insurance may cover the hospital contribution. Art. 64 para. 8 KVG prohibits it.

We explain how we build examples and calculators under How we calculate.