Hospital Supplementary Insurance: Semi-Private, Private, or Flex – The Differences Explained
As a rule, the cancellation of your supplementary insurance policies must reach the insurer by September 30. September is therefore the month when it pays to take a conscious look at your coverage. Especially with hospital supplementary insurance, it’s worth taking a close look at the choice of model: Am I paying for something I might never need? We show you what distinguishes Semi-Private, Private, and flexible models and which option suits which situation.
What basic insurance covers and doesn't cover in hospital
First, let’s clarify what the situation looks like without supplementary insurance. Basic insurance covers inpatient stays in the general ward. You are generally free to choose from all listed hospitals, meaning free choice of hospital already applies nationwide under mandatory insurance. The catch lies in the costs: the canton and health insurer will reimburse at most the reference tariff of your canton of residence. If the chosen hospital is more expensive, you pay the difference yourself.
In addition, there are two other points that are often underestimated. In the general ward, you are usually treated by the doctor on duty. You do not have a free choice here. Furthermore, you usually share a room with several other patients. This is precisely where hospital supplementary insurance comes into play.
How the levels of hospital supplementary insurance differ
Hospital supplementary insurance policies differ primarily in comfort, freedom of choice of treating physician, and cost coverage. The classic Semi-Private and Private models offer a fixed scope of benefits, while flexible models allow more leeway in choosing services.
Semi-Private or Private?
The most important difference between the two classic models lies in the room and the choice of treating physician. Semi-Private generally means a two-bed room and additional treatment options. Private offers a single-bed room and the most comprehensive freedom of choice, especially regarding the doctor.
Both models also cover additional costs for out-of-canton hospital stays compared to the reference tariff, and depending on the insurance, other benefits. These include, for example, easier access to specialists, a second medical opinion, or contributions to household help and home care.
Flexible Models
Flexible models take a different approach: you only decide at the time of hospital admission which scope of services you actually want to use, and you pay a corresponding surcharge for it. For a planned operation, for example, a single room or the choice of treating person might be interesting, while for a short hospital stay, the general ward is sufficient.
The advantage: you don’t permanently pay for the highest coverage, but can still claim additional services if needed. Depending on the product, stays in rehabilitation and psychiatry are also included.
Out-of-country coverage also differs
There are also significant differences in out-of-country coverage depending on the model. It ranges from a limited contribution to hospital stays to worldwide coverage with comprehensive cost absorption. Some hospital supplementary insurance policies also include travel insurance.
Cost sharing and reimbursement: potential levers for premiums
Many perceive the premium for hospital supplementary insurance as fixed. However, it doesn’t necessarily have to be. Two adjustment screws can noticeably reduce costs, depending on the model and insurance. The premium structure for hospital supplementary insurance is not the same for every provider. Depending on the insurer and product, cost sharing or a reimbursement for claim-free periods can influence the premium.
With some models, you can choose cost sharing and thus receive a lower premium. In return, you cover an agreed portion of the costs yourself in the event of a claim. The amount of this cost sharing and how it is applied varies depending on the insurance product.
A reimbursement may also be provided for individual products. In this case, insured persons receive back a portion of the paid premiums if no claims are made. Whether such a reimbursement is offered and how high it is also depends on the respective insurer and model.
Therefore, when comparing different hospital supplementary insurance policies, one should not only pay attention to the monthly premium, but also consider cost sharing, possible reimbursements, and the actual scope of benefits.
Which hospital supplementary insurance option suits which life situation?
There is no blanket answer, but a few reliable pointers.
Those who are young and healthy and rarely need to go to the hospital often fare best with a flexible solution. Families benefit from the ability to freely choose a room and doctor for a child’s procedure. From about age 50, the question of appropriate coverage gains importance, as planned procedures become more frequent and switching to a higher level can become more difficult with age. And those who travel a lot abroad should make international coverage their main criterion.
Health check and deadlines: plan ahead
Supplementary insurance policies are subject to the Insurance Contract Act. Therefore, there is no obligation to accept: the insurer checks your health status and can accept or reject an application with reservations. Anyone who wants to change or upgrade should therefore never cancel before the new coverage is confirmed in writing.
For many supplementary insurance policies, the cancellation period is three months to the end of the year, meaning the letter must arrive by September 30. Different rules may apply for multi-year contracts or after a premium increase; it’s worth checking your policy.
The best way to clarify which level suits your everyday life, your budget, and your health is through a conversation. simply advises you without obligation, personally in Gümligen or conveniently via video consultation.
Fact sheet on outpatient supplementary insurance 