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Notices to customers
Supplementary hospital insurance: Negotiating fair prices
When you pay for private or semi-private supplementary hospital insurance, you are covering the costs of a free choice of doctor, additional comforts and accommodation benefits. In practical terms, that translates to a one or two-bed room plus additional care services. We regularly renegotiate the prices of these benefits with hospitals. We are committed to fair prices and a transparent pricing model, with a view to ensuring that your premiums remain affordable.
If Helsana is unable to reach an agreement with a particular hospital, temporary maximum fees may apply, which means that we only pay up to the predefined maximum amounts. When this happens, you may find that some costs are not covered. In such cases, we will provide detailed advice and work with you to find a solution.
Which hospitals currently charge maximum fees?
|Canton of Basel-Stadt|
In addition, limited services are available at the following hospitals:
|What are maximum fees?|
These represent the maximum amounts that Helsana is prepared to reimburse under supplementary hospital insurance. Patients who go into a hospital with maximum fees must anticipate uncovered costs as the hospitals can charge prices according to their schedule of charges that are higher than Helsana maximum fees. The patient has to pay the uncovered part him/herself.
|What about hospitals without a cantonal service mandate?|
|There is no inpatient agreement with the hospitals without a cantonal service mandate or with cantonal contingents. In these cases we do not cover any benefits under basic or under supplementary hospital insurance outside the cantonal service mandate according to the list of hospitals or outside the cantonal contingent.|
|Is compulsory health insurance (OKP) also affected?|
In part, depending on the type of hospital:
|How do I know in which hospitals uncovered costs can arise?|
|You can find the list of hospitals without recognised tariffs / maximum fees and without a recognised general ward here: Hospitals with limited services (PDF, 152KB)|
|I’m not planning to go into hospital at present. Do the maximum fees still affect my insurance contract?|
No, there is no change to the insurance relationship/contract.