Privately insured

What is meant by “privately insured”?

In Switzerland, everyone is insured for hospital stays through basic health insurance, but only for the general ward. If you are “privately insured”, you have also taken out supplementary hospital insurance for the private ward. It covers benefits that go beyond the standard of basic health insurance.

The term should not be confused with private health insurance as in Germany. In Switzerland, there is no either-or: basic health insurance is compulsory for everyone, including the privately insured. Private insurance comes on top and supplements it in hospital.

Hospital insurance is usually offered at three levels:

Each health insurer sets out in its insurance conditions exactly what the private ward includes. The law does not define the private ward.

How it works

Who pays what in hospital?

If you receive inpatient treatment in a hospital on the Hospital List of your canton of residence or of the canton where the hospital is located, the costs are split:

1. Basic health insurance and the canton of residence pay for the treatment according to the general ward tariff. The canton bears at least 55 %, the health insurer the rest. This also applies if you are privately insured.
2. The private insurance pays for the additional benefits according to the contract, such as the supplement for the single room and the choice of doctor. For treatment in a hospital that is not on the list of your canton of residence, it also covers, depending on the contract, the difference from the tariff of your canton of residence.
3. You yourself pay the co-payment of basic health insurance, i.e. the deductible, a 10 % retention fee up to a maximum of CHF 700 and the hospital contribution of CHF 15 per day. In addition, there may be retention fees under the supplementary insurance.

Taking out insurance and health questions

Supplementary insurance is a contract under private law. The health insurer does not have to accept you. Before concluding the contract, it asks you health questions, which you must answer completely and truthfully. Depending on your answers, it can refuse you or add reservations, i.e. exclude certain illnesses from cover. If you conceal something, it may terminate the contract under Art. 6 ICA and, in certain circumstances, refuse benefits. If you want private insurance, it is therefore best to take it out while you are young and healthy.

Premiums

Each health insurer sets its own premiums, depending on the product, for example by age, region and chosen level. In the approval procedure, FINMA checks the tariffs of supplementary health insurance to see whether they safeguard the health insurer’s solvency and protect insured persons against abuse. Unlike in basic health insurance, there are no official premium lists for supplementary insurance that can be compared across all health insurers.

Cancellation and switching

In supplementary health insurance, only you can terminate the contract with ordinary notice, at the end of the third year or later with three months’ notice, or in accordance with the periods agreed in the contract. The health insurer does not have this right. If you switch basic health insurance, your current health insurer may not force you to cancel your supplementary insurance as well, and it may not cancel it for that reason. Basic and supplementary insurance can therefore be with different health insurers.

Legal basis

• Art. 25 para. 2 let. e KVG: basic health insurance covers a hospital stay according to the standard of the general ward.
• Art. 41 para. 1bis KVG: free choice among the hospitals on the Hospital List of the canton of residence or the canton where the hospital is located; remuneration at most according to the tariff of a listed hospital in the canton of residence.
• Art. 49a KVG: the canton and the insurer cover the remuneration of inpatient services proportionately; the canton’s share is at least 55 %.
• Art. 64 para. 8 KVG: the co-payment of basic health insurance may not be insured either with a health insurance fund or with a private insurer.
• Art. 104 KVV: contribution to the costs of a hospital stay of CHF 15 per day, excluding the day of discharge.
• Art. 4 ICA: duty of disclosure when concluding the contract.
• Art. 35a ICA: ordinary right of termination at the end of the third year; in supplementary insurance to social health insurance, only the policyholder has this right (para. 4).
• Art. 7 para. 7 and 8 KVG: protection of supplementary insurance when switching basic health insurance.
• Art. 38 ISA: review of tariffs subject to approval by FINMA.

Exactly which benefits the private ward includes is not governed by any law, but by the general and special insurance conditions of your health insurer.

Example: knee operation with five days in hospital

Thomas is 55 years old, has a deductible of CHF 1,000 and has private supplementary insurance. He has a knee operation in a hospital on the Hospital List of his canton of residence and stays five days, the fifth being the day of discharge. He has had no other costs this year. The breakdown shows who pays which part; the amounts for the canton, the health insurer and the supplementary insurance depend on the tariff and the contract.

What this means for you

Private insurance is a comfort and choice product. These questions help you decide:

1. Do you need the additional benefits? A single room and free choice of doctor are not medically necessary to receive good treatment. Basic health insurance covers the necessary treatment in full.
2. Is semi-private or a flexible solution enough? Some health insurers offer products where you only decide in hospital which ward you want, in return for a retention fee.
3. Can you afford the premium in the long term? If you cancel in old age, you may no longer be able to get new supplementary insurance because of the health questions.
4. Are the conditions right? Check which hospitals are included, whether there are retention fees and how benefits abroad are regulated.

You can switch basic health insurance every year without losing your private insurance. You compare basic health insurance premiums in the premium calculator, and you can find the basic data of all health insurers under Health insurers. We are building a comparison of supplementary insurance under Compare supplementary insurance.

Common mistakes

• Cancelling basic health insurance because you are privately insured. Basic health insurance is compulsory; private insurance only supplements it.
• Believing that private insurance covers the deductible and retention fee. This is prohibited by law.
• Answering health questions inaccurately. This can later lead to cancellation and the loss of benefits.
• Cancelling existing private insurance too quickly. Taking out new insurance later can be more difficult because of age and health, or only possible with reservations.
• Believing you have to cancel basic and supplementary insurance together. When you switch basic health insurance, your supplementary insurance remains in place unless you cancel it yourself.

We explain how we handle data and sources under How we calculate.