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.
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. If we cannot agree a solution with a hospital and its staff or with a doctor, then we are forced to stop working with them temporarily. 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.
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 paid under supplementary insurance.
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».
Some private clinics have not entered into a contractual agreement regarding the provision of additional medical services in a semi-private or private ward. For regulatory reasons, CSS is not permitted to assume the medical fees in these cases, or may only assume them to a limited extent. Hospital services (hotel and clinical services) are not affected.
Are you planning to get treatment in a hospital in the cantons of Geneva or Vaud? From February 2025, there may be some restrictions on the coverage of costs for medical services. Contact your hospital and attending doctor in good time so they can request a commitment to provide cover..
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:
Consult with your doctor to choose a hospital where there are no restrictions.
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».
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.
