Particulier
Hospital and LAMal: who pays what in 2026, in plain terms
Hospital stay: what LAMal reimburses, what you pay (deductible, co-payment, CHF 15 per day) and the particular cases in Geneva.
Julie Favre
23 October 2026
6 minutes read
Blog
Hospital and LAMal: who pays what in 2026, in plain terms
Hospital stay: what LAMal reimburses, what you pay (deductible, co-payment, CHF 15 per day) and the particular cases in Geneva.
By Julie Favre · Published on
Particulier
Who pays if I am admitted to the HUG tomorrow?
You are admitted to the HUG (Geneva University Hospitals) for an operation. You then receive an invoice from the hospital, but you do not pay all of it yourself. The cost of the stay is split between two payers.
For a stay in the general ward of a hospital on the cantonal list, your canton of residence covers at least 55% of the tariff. The LAMal insurer pays at most 45% (art. 49a LAMal). The canton pays its share directly to the hospital. You have nothing to advance on that side.
This split applies to inpatient hospital care, that is, care involving an overnight stay. For outpatient care (no night in hospital), the insurer pays alone, after deduction of your deductible and your co-payment.
Under art. 49a LAMal, the canton of residence funds at least 55% of an inpatient hospital stay in the general ward, and the health insurer at most 45%, for a hospital listed on the cantonal list.
What you pay yourself comes on top, via cost-sharing (deductible, co-payment, daily charge). It applies to the insurer's share, not to the canton's. This is the subject of the next section.
What to do: before a planned hospital stay, ask your insurer for a summary of the deductible you have already used during the year.
Canton of residence (paid directly to the hospital)
AmountAt least 55% of the tariff
Share≥ 55%
LAMal insurer (share to which your cost-sharing relates)
AmountAt most 45% of the tariff
Share≤ 45%
Total
Amount100% of the inpatient stay tariff (general ward, hospital on the cantonal list)
Share100%
Key takeaway
For an inpatient stay in the general ward, the canton of residence funds at least 55% of the tariff and the LAMal insurer at most 45%; your cost-sharing (deductible, co-payment, daily charge) comes on top and relates only to the insurer's share.
Source: Art. 49a LAMal — fedlex.admin.ch
Deductible, co-payment and daily charge: what you really pay
How much comes out of your own pocket for 5 days in hospital? Three elements come into play (art. 64 LAMal and OAMal (Ordinance on Health Insurance)). The amounts below are those in force at the time of writing (October 2026): check them on bag.admin.ch before deciding.
The deductible: from CHF 300 (the legal minimum for an adult) up to CHF 2,500 per year. You pay it first, before the insurance reimburses anything.
The co-payment: 10% of the costs exceeding the deductible, capped at CHF 700 per year for an adult (CHF 350 per child).
The daily charge: CHF 15 per day of hospitalisation for adults. It does not apply to children or to young adults in training, nor in the case of maternity.
Example: 5-day stay, insurer's share invoiced at CHF 8,000, deductible untouched.
- CHF 300 deductible: you pay CHF 300. On the remaining CHF 7,700, 10% is CHF 770, capped at CHF 700. Daily charge: 5 x 15 = CHF 75. Total: 300 + 700 + 75 = CHF 1,075.
- CHF 2,500 deductible: you pay CHF 2,500. On the remaining CHF 5,500, 10% is CHF 550. Daily charge: CHF 75. Total: 2,500 + 550 + 75 = CHF 3,125.
The difference is CHF 2,050 for this stay. Yet moving from a CHF 300 to a CHF 2,500 deductible saves roughly CHF 1,500 in premiums per year: worthwhile if your costs stay below CHF 1,900. A hospital stay falls outside this zone.
The CHF 700 co-payment cap is annual. If you have already paid CHF 400 in co-payment earlier in the year, you only have CHF 300 left to pay on the stay.
What to do: if an operation is planned during the year, calculate your budget using the deductible you have actually chosen. You can change deductible for the following year, generally until 30 November, depending on your insurer.
Insurer's share invoiced
CHF 300 deductibleCHF 8'000
CHF 2'500 deductibleCHF 8'000
Deductible
CHF 300 deductibleCHF 300
CHF 2'500 deductibleCHF 2'500
Co-payment (10% of CHF 7'700 = CHF 770, capped)
CHF 300 deductibleCHF 700
CHF 2'500 deductible
Daily charge (5 x CHF 15)
CHF 300 deductibleCHF 75
CHF 2'500 deductibleCHF 75
Total at your expense
CHF 300 deductibleCHF 1'075
CHF 2'500 deductibleCHF 3'125
Co-payment (10% of CHF 5'500)
CHF 300 deductible
CHF 2'500 deductibleCHF 550
Key takeaway
For a 5-day stay, the high deductible costs CHF 2'050 more, whereas it only saves about CHF 1'500 in premiums per year.
Source: Art. 64 LAMal and OAMal — fedlex.admin.ch (amounts in force as of October 2026, to be checked on bag.admin.ch)
Hospital list: which hospital should you choose?
Can you go to any hospital? No, not without financial consequences. Each canton draws up a hospital list: the institutions on it have a performance mandate and are funded according to the canton/insurer split.
Hospital on the list: LAMal pays its share, and so does the canton. You only pay your cost-sharing.
Hospital not on the list: as a rule, the insurance does not reimburse, except in an emergency or particular case. Check before booking.
Emergency: if you cannot choose (accident, sudden illness), coverage applies even in a hospital outside your canton, under the conditions of LAMal.
Outside the canton: if you choose to be treated elsewhere without medical necessity, the canton of residence and the insurer pay at most the reference tariff applicable in your canton (art. 41 LAMal). If the chosen hospital charges more, the difference remains at your expense. A supplementary insurance may sometimes cover it, but this is not automatic.
Under art. 41 LAMal, for hospitalisation outside the canton without medical necessity, coverage is limited to the reference tariff of the canton of residence. Any difference is invoiced to the insured person.
What to do: consult your canton's hospital list before choosing an institution, and ask your insurer for a written guarantee of coverage for any hospitalisation outside the canton.
Geneva: HUG, private clinics and supplementary insurance
What do I gain from supplementary hospital insurance in Geneva? Two layers need to be separated.
Basic LAMal, which is compulsory: stay in the general ward (multi-bed room), treatment by the doctor on duty or the ward team doctor, in a hospital on the Geneva list. The HUG are among them. Some private Geneva clinics are also on it for specific services, but not all of them for all procedures.
Supplementary insurance, which is optional: semi-private (two-bed room) or private (single room) ward, free choice of doctor, sometimes choice of clinic. It falls under the Insurance Contract Act (LCA), not LAMal. The insurer may refuse or limit it according to your state of health, via a health questionnaire.
A private room and free choice of doctor are never guaranteed by basic LAMal. If you only have the basic cover and you ask for a single room at the clinic, the difference will be invoiced to you.
Points to check in your supplementary policy: the ward category covered, the clinics or hospitals admitted, any limits on amounts or duration, and the exclusions for pre-existing conditions. Supplementary insurance does not replace LAMal: the two overlap.
What to do: reread your general conditions. If you change your basic insurer, do not cancel the supplementary insurance before you have a new offer accepted in writing.
Cross-border workers: CMU or LAMal for the hospital?
I work in Geneva and live in France: who pays for my hospital stay? It depends on your choice of insurance, made once.
The cross-border worker's right of option is exercised once: 3 months after taking up employment, the choice of CMU (French Universal Health Coverage) or LAMal becomes final.
If you opt for LAMal, you are subject to Swiss rules and can be treated in Switzerland under the conditions of LAMal (list, cost-sharing, etc.). Coverage in France depends on what your contract provides and on the applicable rules; check it with your insurer before any stay.
If you opt for the CMU (French Social Security), hospital costs follow French rules. For care received in Switzerland, coverage and the advance of costs must be checked beforehand with your fund, because the arrangements vary from case to case.
Who advances the costs? In practice, a hospital invoice may be sent to you. Ask the institution whether your insurer can be invoiced directly. Without prior guarantee, you may have to advance the sum and claim reimbursement afterwards.
What to do: before a planned stay, obtain written confirmation of coverage from your insurer or your fund, including any advance of costs. The precise rules depend on your situation: check them on bag.admin.ch or with your insurer.
Subsidies and unpaid premiums: what is at risk?
Can I get help to pay my premiums? In Geneva, the health insurance subsidy reduces the premium of insured persons with a modest income. It is calculated according to the determining income and the composition of the household. The conditions and scales change from one year to the next: consult the canton's website or the Geneva health insurance service for the up-to-date threshold.
The subsidy is in principle paid directly to the insurer, who deducts the amount from your premium. It is applied for or renewed each year according to cantonal procedures.
And if premiums are not paid? The procedure follows stages: reminder, formal notice, then debt enforcement proceedings. Under the law in force, some cantons may suspend the coverage of benefits for insured persons subject to enforcement proceedings, except in emergencies. In Geneva, check what is currently applied with the competent cantonal service, because practice depends on cantonal law and may change.
Even in case of difficulty, urgent care remains guaranteed. But a planned stay may pose a problem if your file is in arrears.
What to do: if you receive a reminder, contact your insurer within the following days to request a payment arrangement. At the same time, check your entitlement to the Geneva subsidy. Acting early costs less than waiting for enforcement proceedings.
"This article, published for purely informational purposes on hospital care and healthcare coverage, constitutes neither legal advice nor a personalised recommendation; assurance-genevoise.ch is registered with FINMA under number F01502264, and we invite you to consult a qualified professional before making any decision."
FAQ
Your share comprises the deductible (CHF 300 to CHF 2,500), the 10% co-payment capped at CHF 700 per year, and CHF 15 per day of stay. The canton and the insurer pay the rest.
Julie Favre
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