Mehr Transparenz in der Spitalzusatzversicherung

FINMA, also acting as the supervisory authority for supplementary health insurance under the Federal Insurance Contract Act (ICA), formulated its ideas on the transparency and traceability of services in the area of supplementary hospital insurance at the end of 2020. The health insurance industry, which has been dealing with this issue for several years, confirms that action is needed. In January 2021, the SIA launched the industry project ‘ICA additional services’ to address the requirements for the supplementary hospital insurance of the future. The aim of the industry is to provide competitive supplementary insurance that takes into particular consideration the needs of policyholders who want to invest in their health beyond the compulsory basic insurance and cover additional services. 

Detailed description of the additional services 

In order to allow patients with supplementary insurance to be billed transparently and comprehensibly for additional services, supplementary health insurers conclude additional service contracts with hospitals and attending physicians. Additional service contracts are characterised by a detailed description of the additional service. Hospitals must state exactly which services are covered by basic insurance and which are covered by supplementary insurance. 

Supplementary health insurers have developed 11 principles for defining, evaluating and billing additional services, which constitute the minimum standard for contracts. These principles form the basis for increasing transparency and traceability. All health insurers renegotiated their contracts with the individual public hospitals and private clinics based on this. Due to the large number of new contracts to be concluded, this process lasted until the end of 2025. 

In addition to the industry framework with its 11 binding rules, an additional document has been drafted with specific requirements for additional medical services and the tariff models required for billing. Representatives from private hospitals and affiliate doctor organisations worked on this. These are services provided by attending physicians who are not employed by the hospital but use the hospital as a ‘workshop’. 

Ratio of compliant contracts constantly increasing 

In March 2025, an assessment was carried out that represented 96 per cent of the market. The survey showed that 73 per cent of the contracts are industry-compliant and that great efforts are being made to bring the remaining 27 per cent into line. 2025 saw intensive efforts continue to achieve ambitious goals in terms of traceability and transparency. The final assessment is scheduled for spring 2026. 

Target-oriented collaboration as a prerequisite 

All players in the healthcare system need to be involved in order for the changes described to take effect. Targeted collaboration between service providers and insurers is a basic prerequisite here. The challenge lies in mapping the additional services in the insurance and hospital systems. Linked to this is implementation of completely new billing and invoicing processes. 

In a functioning market, competition plays a key role – and people with supplementary insurance can choose the best product for them from a wide range of products. Supplementary insurers are committed to further product development, ensuring that medical innovations and added value are insurable, whether inpatient or outpatient related. This is ensured by the consistent application of the principles formulated by the supplementary health insurers, which guarantee a transparent and comprehensible definition of the additional services insured.