Semi-private or private ward: is it still worth it?

What semi-private and private change in hospital

Basic health insurance pays for every medically necessary hospital stay, namely “in line with the standard of the general ward” (Art. 25 para. 2 let. e of the Federal Health Insurance Act, KVG). You choose freely among the listed hospitals of your canton of residence or of the canton where the hospital is located; for a hospital in another canton, it pays at most the tariff of your canton of residence (Art. 41 para. 1bis KVG). The medical treatment you receive does not depend on the ward: basic health insurance pays for all services that are effective, appropriate and cost-effective (Art. 32 KVG).

Supplementary hospital insurance pays for what goes beyond this. The usual levels:

The biggest difference is the free choice of doctor in hospital: the KVG gives you no right to pick the treating doctor. With semi-private or private cover, you can, for example, ask for a particular surgeon. The room is the more visible difference, the choice of doctor the one with greater consequences.

Who pays what in hospital

Even if you stay in a semi-private or private ward, the canton and basic health insurance pay their share as for any other patient. In a listed hospital, the treatment is billed as a case-based flat rate; the canton of residence pays at least 55 %, the insurer the rest (Art. 49a para. 2ter KVG). Supplementary insurance only pays the invoice for the additional benefits: the room, the fee of the senior doctor you chose, comfort services.

What stays with you, whatever the ward:

• Deductible: at least CHF 300 a year (Art. 103 para. 1 of the Health Insurance Ordinance, KVV), with an optional deductible up to CHF 2,500 (Art. 93 KVV).
• Retention fee: 10 % above the deductible, at most CHF 700 a year for adults (Art. 103 para. 2 KVV).
• Hospital contribution: CHF 15 per day, not for the day of discharge (Art. 104 KVV).

No supplementary insurance may cover this co-payment (Art. 64 para. 8 KVG). Semi-private insurance therefore makes a hospital stay more comfortable, but not cheaper.

Step by step: reviewing semi-private or private cover

1. Get out your policy and general terms and conditions. Which level do you have, which hospitals are covered, is there a hospital deductible or a retention fee in the supplementary insurance? How has the premium developed in recent years?
2. Work out what matters to you. Is it a quieter room, a particular doctor or a hospital outside your canton? For a free choice of hospital throughout Switzerland, the level “general ward throughout Switzerland” is often enough.
3. Calculate the premium over several years. Multiply the annual premium by the number of years you are planning for. The sample calculation below shows how this compares with a hospital stay.
4. Ask yourself: “Would I still be insurable later?” If you cancel or reduce your cover today, an insurer may ask health questions on a new application and refuse you (Art. 4 of the Insurance Contract Act, ICA). If you have a pre-existing illness, you may not get that level again later.
5. Ask about alternatives. A lower level, a flex product, a higher hospital deductible in the supplementary insurance: have your insurer confirm in writing what a change means and whether you can go back.
6. Keep to the deadlines. You can cancel ordinarily at the end of the third year of the contract at the earliest, with 3 months’ notice, unless the general terms and conditions provide for something shorter (Art. 35a para. 1 ICA). The insurer itself cannot cancel ordinarily (Art. 35a para. 4 ICA). The exact deadline is in the general terms and conditions.

Is it still worth it? Three developments

FINMA criticised the invoices

In December 2020, FINMA found that invoices in supplementary health insurance were often lacking in transparency and in some cases unjustifiably high: many invoices did not show which additional benefit was being billed on top of the case-based flat rate of basic health insurance. On 16.01.2025, it took stock. Prices for inpatient stays in semi-private and private wards have for the most part stagnated since 2020, and premiums for supplementary hospital insurance stagnated or fell “in many areas”. At the same time, according to FINMA, numerous contracts with hospitals and doctors still do not meet the requirements. FINMA only approves new supplementary hospital products if these requirements are met permanently.

For you, this means: the additional benefits must be genuine benefits outside basic health insurance. Check your hospital invoice for services that appear twice.

Situations without a contract

If an insurer and a hospital or doctors cannot agree on the prices for additional benefits, a situation without a contract arises. FINMA regards this, in the interest of insured persons, as a possible alternative to excessive prices. For you, it can mean that the supplementary insurance does not pay part of the additional benefits. Before a planned operation, ask your insurer whether there is a contract with the hospital and the doctor, and get a cost approval. What you can do in a dispute is explained in the article Situation without a contract.

More operations on an outpatient basis

Basic health insurance now only pays for certain planned operations on an outpatient basis, unless special circumstances speak against it (Art. 3c of the Health Care Benefits Ordinance, KLV). Since 01.01.2023, the list in Annex 1a KLV has covered 18 groups of operations throughout Switzerland. An outpatient operation involves no hospital room, and pure supplementary hospital insurance pays little or nothing, depending on its terms. How far your product covers outpatient operations is set out in the general terms and conditions.

Sample calculation: 10 years of premiums against one hospital stay

There is no public premium data for supplementary hospital insurance. The figures below are assumed and do not come from any particular contract; they only show the method.

Example with fictitious people. Daniel, 52, has semi-private cover. Assumed premium: CHF 120 per month. His sister Sandra, 49, has flexible hospital insurance with an assumed premium of CHF 60 per month and a co-payment of 20 %, at most CHF 2,000, if she chooses semi-private. Both assume a planned hospital stay of 5 days, semi-private, with an assumed invoice for additional benefits of CHF 6,000.

Over 10 years with one stay, Daniel pays CHF 14,400 in premiums for CHF 6,000 of additional benefits, Sandra CHF 8,400 in total. With two or three stays the calculation looks different; without a stay, the premium is purely the price of the certainty of being able to choose in hospital. None of these options is right or wrong; the calculation does not replace the question of what comfort and choice of doctor are worth to you. It is not a recommendation for your situation.

Special cases

From 50 and in retirement

For many products, the premium depends on age, and some insurers only accept new customers into supplementary hospital insurance up to a maximum age. If you cancel at 60 or 70, you will usually not get the cover back later. On the other hand, the risk of a hospital stay is higher in old age. Before you cancel, ask for alternatives such as a lower level or a hospital deductible. More on this in the article Supplementary insurance from 60.

Flexible hospital insurance

Flexible hospital insurance is a middle way: before each admission, you decide whether you want to stay in the general, semi-private or private ward, and you pay a co-payment for the higher level. How high it is and whether there is an annual maximum is set out in the general terms and conditions. Details in the article Flexible hospital insurance.

Taking out new cover

If you want to take out semi-private or private cover today, you answer health questions. The insurer may refuse you or add a reservation (Art. 4 ICA). If you answer a question incorrectly, it may terminate the contract within 4 weeks of finding out (Art. 6 ICA). After applying, you have 14 days to revoke your application (Art. 2a ICA). How to answer the questions correctly is shown in Health questions in the application.

Changing your basic health insurer

You can keep your supplementary hospital insurance when you change your basic health insurer; the insurer may not cancel it for that reason. You can compare basic health insurance premiums in the premium calculator; the process is shown in Switching health insurer.

Common mistakes

• Confusing semi-private with better medicine. Basic health insurance pays for the necessary treatment in every ward. Supplementary insurance pays for the room, the choice of doctor and the choice of hospital.
• Cancelling straight away out of annoyance at the premium. After cancelling, an insurer will check your health again. First ask about a lower level or a flex product.
• Not asking before a planned operation. In a situation without a contract or at a hospital outside the general terms and conditions, you pay part of the cost yourself. Get a cost approval.
• Not checking the hospital invoice. Additional benefits must be genuine benefits outside basic health insurance. Report duplicate items to your insurer.
• Forgetting the co-payment. The deductible, the retention fee and the CHF 15 hospital contribution per day stay with you even with semi-private cover.

How to decide next

Which supplementary insurance suits you in the first place is shown in Which supplementary insurance do I really need?. The supplementary insurance comparison is preparing a comparison of the benefits of supplementary hospital insurance. If you would like a personal assessment, you can get in touch via the enquiry form; this is voluntary. What counts are the general terms and conditions and the information from your insurer. You will find all articles on this topic in the section Supplementary insurance.