Hospital Insurance Coverage

The three-layer cost structure

A hospital bill in Switzerland is calculated in three layers:

1. Franchise (deductible): You first pay your chosen annual franchise (CHF 300–2,500). If you have not yet met it for the year, the hospital costs count toward it. Once the franchise is used up, your insurer takes over.
2. Selbstbehalt (co-insurance): After the franchise, you pay 10% of remaining costs, capped at CHF 700 per year (CHF 350 for children). For hospital stays, an additional flat fee of CHF 15 per day applies (the Spitalbeitrag) — this is not capped. Hospital days are typically calculated per calendar day, so a one-night stay counts as two days.
3. KVG pays the rest: After your franchise and co-insurance are covered, KVG pays the full cost of medically necessary treatment in the general ward of any canton-listed hospital.

What KVG covers in hospital

KVG covers all medically necessary inpatient treatment in the general ward, including:

• Surgery, anaesthesia, and post-operative care
• Diagnostics (laboratory, imaging, ECG, etc.)
• Medications administered during the stay
• Physiotherapy and rehabilitation prescribed as part of the stay
• Nursing care, meals, and standard accommodation in the general ward
• Outpatient follow-up directly related to the hospitalisation

What KVG does not cover

• Room upgrades to semi-private or private wards
• The right to choose your treating physician (Chefarztwahl)
• Companion room for a family member
• Elective treatment that is not medically necessary (cosmetic surgery, fertility treatments not covered under KVG)
• Treatment in hospitals not on the cantonal Spitalliste
• Out-of-canton care that was not medically necessary

The CHF 15 per day hospital contribution

The Spitalbeitrag (contribution journalière / contributo giornaliero) is a flat CHF 15 per day that you pay directly toward your hospital stay, regardless of your franchise status or whether you have met your Selbstbehalt cap. It is meant to represent a portion of the accommodation cost and applies to all adult patients (not children under 18).

This CHF 15/day is separate from and additional to your 10% Selbstbehalt. For a 10-day hospital stay, this amounts to CHF 150 on top of your other cost-sharing.

Additional insurance and hospital stays

Hospital supplementary insurance (Spitalzusatzversicherung) typically covers:

• Upgrade to a semi-private or private room
• Free choice of doctor (Chefarztwahl)
• Nationwide hospital coverage (not just the home canton's hospitals)
• Some plans cover the CHF 15/day Spitalbeitrag
• Higher-end plans include recovery clinic (Kuraufenthalt) and international emergency coverage

If you want additional hospital coverage, it must typically be purchased before any illness arises — insurers can apply waiting periods or exclusions for pre-existing conditions under VVG (supplementary insurance law). Do not wait until you are diagnosed with a condition that requires planned surgery.

Ambulance costs

Ambulance transport (Rettungsdienst) to the hospital is covered by KVG but is subject to a patient contribution of CHF 500 per transport. This means that for each ambulance ride, you personally pay the first CHF 500 (if you have not met your Selbstbehalt cap) — the remainder is covered by KVG. The CHF 500 patient contribution also counts toward your annual Selbstbehalt maximum.

Some supplementary insurance policies cover this CHF 500 contribution. REGA (Swiss air rescue) membership (approximately CHF 30/year per person) covers helicopter rescue transport costs — worth considering if you are active in the mountains.