Supplementary health insurance and hospitalization: changes that apply as of 1st January 2025

Supplementary health insurance and hospitalization: changes that apply as of 1st January 2025

Supplementary health insurance and hospitalization: changes that apply as of 1st January 2025

Since 1st January 2025, there have been significant changes in the rules for reimbursement under supplementary health insurance policies in Switzerland, in particular for semi-private and private hospitalisation. This reform, initiated by FINMA (the Federal Financial Market Supervisory Authority) and implemented with the support of the Swiss Insurance Association (SIA), aims to boost the transparency of supplementary services, but it is also the source of tension locally, especially in French-speaking Switzerland.

Regulatory background: towards greater transparency

The movement for reform began in 2020, when FINMA found irregularities in invoices for supplementary services. Some seemed difficult to understand, and even excessive, and they lacked transparency. In response, the SIA has drawn up an industry framework entitled Additional benefits under the Insurance Policy Law (LCA), with the aim of establishing clear rules for presentation and invoicing. These new requirements, applicable from 2022, were subject to a transition period ending in 2024.Since 1st January 2025, only services covered by pricing agreements that comply with these requirements may be reimbursed. This reform has helped stabilise premiums in many instances, thanks in particular to the review of prices that were initially disproportionate.The new regulations relate exclusively to supplementary insurance policies governed by the LCA (Swiss Federal Law on Insurance Policies), particularly with regard to semi-private or private hospitalisation. It does not affect insurance policies that are compulsory under the Federal Law on Accident Insurance (LAA) and has a lesser impact on LAA supplementary insurances, known by the acronym LAAC.

Pricing tensions in French-speaking Switzerland

The harmonisation of prices did not, however, go smoothly without disputes. In Geneva and the canton of Vaud, there is still no agreement between certain supplementary insurance companies and the providers of services. This disagreement on prices is currently preventing full coverage of certain hospital services, particularly semi-private hospitalisation. The main bone of contention is that local medical practitioners - in particular the Association of Genevan Doctors (AMGe) - want to impose their own pricing models, which insurers do not consider to be compliant with FINMA criteria.
Agreements were reached in the rest of the country thanks to a more fragmented approach taken to negotiations. Nonetheless, some doctors do not meet the new requirements, and their services are not reimbursed.
In French-speaking Switzerland, negotiations are more complex due to the centralized role of canton associations. This situation has led to a temporary standstill, with actual impact on policyholders, in particular the risk of having to cover part of the cost of a hospital stay themselves.

The issues at stake for companies and policyholders

Legitimate issues are raised under these circumstances, both for policyholders and for companies that have taken out semi-private cover for their employees. It is important to remember that policyholders remain fully covered: contractual cover remains valid, even in the event of a temporary contractual void with certain service providers.
If the institution or the doctor of the insured is not covered by an agreement - and as a result, the cost of care is not reimbursed, insurance companies systematically offer alternatives. They refer policyholders to other partner hospitals or doctors, to ensure that treatment continues to be covered as provided in the policy.
Policyholders are strongly advised to check beforehand that their chosen healthcare establishment or provider is recognised, and, if necessary, to ask for written confirmation of coverage. This will avoid any misunderstandings at the time of hospitalisation.
The Qualibroker Swiss Risk & Care group is also there to advise companies and their employees.

Since 1st January 2025, only services covered by pricing agreements that comply with these requirements may be reimbursed.

Hospitalization: how to avoid unpleasant surprises

Since January 2025, certain semi-private and private services are temporarily no longer covered in certain establishments. To ensure that your supplementary insurance policy duly reimburses you:

  • Contact your insurer or broker in advance: Check whether the establishment and/or doctor are recognized and under what conditions. The clinic may have signed an agreement with insurance companies but this does not mean that all care providers are covered by this agreement.
  • Ask for a written confirmation of cover: This confirms that medical services and fees will indeed be reimbursed.
  • Find out about alternatives: If coverage is not guaranteed, your broker or insurer will refer you to a similar establishment that is fully covered.
  • Consult the latest listings: Some hospitals may be on negative lists. Check regularly for updates published by insurance companies (websites).
  • Clarify which services are included: Make sure that the services offered do not lead to unforeseen costs that are not covered by the policy.
  • Keep all supporting documents: Invoices and communications can be useful in the event of a dispute.

Any doubts? It’s better to plan ahead than to end up having to pay yourself. Get in touch with us!

How does Biings change the way we deal with absenteeism?

The biggest difference is that Biings doesn’t just record absences like most software products do. It helps users understand them. The tool uses real-time monitoring to highlight short and repeated absences, which are often the most revealing symptoms of unhappiness or dysfunction. This gives HR an objective vision of absenteeism so it can quickly identify situations of concern. This changes everything: instead of taking action after the problem has become chronic, Biings allows managers to intervene earlier, protect employees and reduce costs related to medical leave, all at the same time.

Is Biings intuitive or do users require training?

While the tool was designed to be accessible, training helps users appreciate its true potential. Training is needed to understand how to create filters, correctly interpret alerts and segment data. It helps users become more efficient and take full advantage of Biings’s features. Training is an investment that pays off quickly, since trained HR staff know how to turn figures into concrete actions, for a real impact on prevention and performance.

Can teams reduce absenteeism just by installing Biings?

No, absolutely not. Biings is a great decision support tool, but it will never replace people. Managers, for example, are on the front line. At a residence for persons with disabilities, the manager was able to reduce the frequency of absences by a factor of three just by seeing his employees every day. This is a concrete example of how important direct contact is. Biings provides visibility, but dialogue, listening and continuous training for managers and HR can transform this visibility into sustainable results.

This article was published in Insurance Inside n°38 - June 2025.

Cyrielle Suzat, Healthcare BU Director

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