Vater mit Kind bei Ärztin zur Untersuchung

Cost coverage during hospitalisation

CSS is committed to improving transparency and maintaining a reasonable balance between costs and benefits under supplementary insurance. That’s why the full costs are not always covered during a stay in hospital.

Reasons for restricting the free choice of hospital

CSS wants to protect its clients from bills that lack transparency and charge unreasonably high prices. It should always be clear which services are paid for under basic insurance or supplementary insurance. We make this a key point of all our contract negotiations with each and every hospital. If we cannot agree a solution, then we prefer not to collaborate with that particular hospital for the present – this can lead to cost coverage being restricted.

We also choose not to work with hospitals offering treatment that is not covered by mandatory basic insurance. Because, as the name suggests, supplementary insurance provides cover that supplements these benefits.

Check the hospital list to see whether there are any restrictions in place for your hospital.

No cost coverage

The cost of inpatient treatment in the private or semi-private ward of a hospital is covered by the respective hospitalisation insurance. If the hospital is on the hospital list, no benefits are provided under these supplementary insurance products:

  • myFlex Economy, Balance
  • Semi-private Hospitalisation Insurance
  • CSS Standard Plus Insurance (general and semi-private ward)
  • Minima & Optima Hospitalisation Insurance (Sanagate)
  • Hospital 20 (limited to CHF 500)
  • Hospital 30

Restrictions in the general ward

Some hospitals do not feature on the cantonal hospital list and also do not have a contract with CSS. No matter what insurance you have, there is no cost coverage for these hospitals. They are marked on the CSS hospital list as «Hospitals with no recognised or available general ward».

Hospitals with maximum tariff

Hospitalisation insurance covers the accommodation and treatment costs in accordance with the applicable tariff agreement (tariffs for VVG additional services/benefits) between CSS and the hospital in question. If no such agreement exists with a hospital that appears on the hospital list (below), CSS may set a maximum tariff that caps the cost of the stay (non-medical services) covered by CSS under supplementary insurance. Medical fees (treatment costs) are not affected by these restrictions.

The maximum tariff applies to myFlex Premium clients and the following hospitals:

  • Clinique La Prairie (VD)
  • Clinique de Carouge (GE)

Restrictions. What now?

Your hospital contacts CSS before performing surgery to request a commitment to provide cover. CSS provides it with information regarding which costs are included in your insurance cover and which are not. If costs are not covered or only partly covered, you will receive a copy of the commitment to provide cover. This lets you see which costs might not be covered.

If you want to avoid these restrictions, you have the following options:

Alternative hospital

Consult with your doctor to choose a hospital where there are no restrictions.

General ward

Forego supplementary insurance benefits by seeking treatment in the general ward. CSS will cover the costs under basic insurance – provided the hospital is not marked on the list as a «Hospital with no recognised or available general ward».

Pay yourself

Find out from the hospital how high the cost of your treatment in a semi-private or private ward is likely to be. You can always choose to pay any costs that are not covered from your own pocket.