General, semi-private, private: these words appear on every hospital insurance offer. They do not describe the quality of care, but the setting of the stay and the choice of doctor. Knowing what basic insurance already guarantees lets you judge what a complementary policy really adds.
What basic insurance guarantees in hospital
Basic insurance covers necessary inpatient treatment, and a hospital stay at the standard of the general ward. The medical care is the same: necessary treatment is owed whatever the ward, and it is the hospital that decides on the medical care.
The insured person chooses freely among the hospitals that are able to treat their illness and that are on the list of their canton of residence or on that of the canton where the hospital is located. If that hospital is in another canton, the insurer and the canton of residence pay up to the tariff that applies in a listed hospital in the canton of residence: any difference is paid by the insured person, or by a complementary insurance policy.
The Federal Office of Public Health lists the situations that cause no extra cost: treatment in a listed hospital of one's canton of residence that is able to treat the illness; treatment outside one's canton's list for medical reasons, when no listed hospital in the canton can provide the necessary care, with the canton's prior cost guarantee; and emergency treatment in a hospital outside that list. Outside these situations, choosing another hospital can leave costs to the insured person or their complementary insurance. In hospital, cost-sharing consists of the deductible, the co-payment and a daily contribution to the cost of the stay.
What the semi-private and private wards add
The Federal Office of Public Health sums up the role of complementary insurance: it is optional and offers extra comfort, such as a stay in the semi-private or private ward of a hospital. In practice, the semi-private ward generally means a two-bed room, and the private ward a single room; what mainly changes is the free choice of doctor and the hotel-style comfort.
The exact content depends on the contract, which falls under the Insurance Contract Act (VVG/LCA) and not the LAMal: free choice of the chief physician or not, hospitals covered in Switzerland and abroad, cost-sharing depending on the ward chosen, a waiting period for maternity. Two contracts with the same ward name may therefore cover different things.
What FINMA requires of insurers
During a stay in the semi-private or private ward, the bill is split. Basic insurance and the canton pay the flat rate per case set for the treatment, as in the general ward; only the additional services, which fall within the scope of the complementary insurance and go beyond that flat rate, are billed to the complementary insurer.
The Swiss Financial Market Supervisory Authority has examined the billing of hospital complementary insurance. It expects insurers to pay only for additional services, not included in compulsory insurance, and at a price that is appropriate to the services actually provided.
In January 2025, it stated that it would continue not to approve new hospital complementary insurance products unless it is guaranteed that its requirements can be met over the long term. For the insured person, this means that a hospital complementary premium must pay for something genuinely additional, not for what basic insurance already pays.
Flexible options
Some insurers let you choose the ward at the time of hospitalisation rather than when the contract is taken out, in return for a contribution per day in the semi-private or private ward. These options reduce the premium in exchange for a contribution when the day comes; whether they are worthwhile depends on the amount of that contribution and its annual cap, which are set out in the contract terms.
The questions to ask before signing
- Is free choice of doctor included, or only the room?
- Which hospitals are covered, in Switzerland and abroad, and on what conditions?
- Is there cost-sharing depending on the ward, and with what annual cap?
- What is the waiting period for maternity, if a pregnancy is being considered?
- Up to what age can you join, and what happens if you want to change level later?
Like any complementary policy, hospital insurance may be refused or come with a reservation on the basis of the health questionnaire. Cancelling existing cover before you have obtained new cover in writing therefore remains a risk.