Cartel allegation against FINMA: who sets hospital add-on prices
Hannes Germann wants to topple the add-on benefits model. The Federal Council defends transparent billing – and denies direct price supervision over hospitals.
The wording is sharp, the legal situation less clear-cut: SVP Councillor of States Hannes Germann calls the model for hospital supplementary insurance an «inadmissible cartel». With his motion 26.3749 he demands that the rules gradually enforced since 2020 be scrapped. On 23 September the Council of States did not decide on the substance but referred the matter to the responsible committee for preliminary examination.
For now, that only opens the political dispute. Neither the Competition Commission nor any court has qualified the industry model as an unlawful cartel. In this case, the term cartel is Germann's allegation – not a legally binding finding.
Why FINMA intervened
The starting point was inspections by the Swiss Financial Market Supervisory Authority. In 2020 it found that invoices for semi-private and private hospital stays often did not make clear which service had been provided on top of mandatory health care insurance. In some cases, reimbursements appeared unjustifiably high.
Five years later, too, FINMA still saw gaps. It reported medical services that had in part been billed through both basic and supplementary insurance. In one particularly striking individual case, an insurer had calculated an internal reference value of 191 francs per night for hotel services on the semi-private ward, but agreed on 855 francs with the hospital. The example does not prove a sector-wide average, but it shows why the supervisor demands comprehensible justifications.
Two markets, two supervisors
Basic insurance follows the Health Insurance Act and is supervised by the Federal Office of Public Health. Hospital supplementary insurance, by contrast, rests on private-law contracts under the Insurance Contract Act; the insurers are subject to FINMA.
This is exactly where the disputed boundary runs. The Federal Council states that FINMA may not directly supervise hospitals and doctors and may not prescribe tariffs to them. It may, however, require insurers under its supervision to change premium tariffs or contractual conditions in individual cases. Effective control of service providers' invoices is also part of proper business management.
Common rules, individual prices
In response to FINMA's criticism, the Swiss Insurance Association (SVV) drew up eleven principles for «add-on benefits under the Insurance Contract Act». They are meant to define how benefits beyond basic insurance are described, assessed and billed. According to the association, 94.1 percent of contracts met these requirements in April 2026. That figure comes from the SVV's own project measurement.
The association denies that this has created a common tariff. Contracts and prices, it says, are still negotiated individually by each insurer with hospitals and doctors; the competition authorities had been informed about the work. Informing the authorities, however, is not the same as formal clearance under competition law.
Even the insurers draw a line
The SVV's differentiated position is notable. It rejects Germann's motion, because abolishing the add-on benefits principle would endanger the transparency achieved. At the same time it warns that abuse supervision must not turn into general price supervision. FINMA should not replace negotiated tariffs simply because they look high.
This lays bare the core of the conflict: transparency rules can prevent double remuneration without fixing a uniform price. But as soon as the supervisor assesses economic appropriateness using its own reference models and objects to clear deviations, it exerts indirect influence on the negotiations. Whether this is covered by its statutory mandate in an individual case can ultimately be reviewed by a court.
What the Federal Supreme Court ruling actually says
Germann relies among other things on the leading decision BGE 135 V 443. In it, the Federal Supreme Court set out how, for patients treated privately or semi-privately, the mandatory benefits of basic insurance are to be distinguished from the privately agreed tariff. The decision confirms the room for private-law tariffs. It does not, however, assess the industry framework developed later, nor does it establish a competition-law infringement.
The reference to the ruling therefore does not answer the whole of today's question. What needs clarifying is rather whether FINMA merely demands verifiable add-on benefits or in fact enforces a price level for which it lacks direct competence.
For the insured, more is at stake than the legal dispute
Germann warns that lower returns in the supplementary segment could shift costs into basic insurance and weaken hospitals. The motion offers no robust impact analysis for this. FINMA, conversely, points out that prices and premiums of many hospital supplementary products have stagnated or fallen since 2020. This, too, does not amount to clear causal proof.
For supplementary insurance policyholders, what matters is which add-on benefits their policy actually promises and what costs arise for them. According to FINMA, contractual cover remains in place even if there is temporarily no contract between insurer and hospital. Before a planned treatment, insured persons should nevertheless check the cost guarantee and their free choice of hospital or doctor.
The committee must now separate the conflict cleanly: which common minimum standards create transparency, where do coordinated market practices begin, and from what point does supervision become price steering? Only this examination can show whether Germann's cartel allegation is more than a political slogan.
Sources
- Swiss Parliament: Motion 26.3749 and the Federal Council's opinion
- FINMA: progress and challenges in benefit billing, 16 January 2025
- FINMA: shortcomings in benefit billing, 17 December 2020
- Swiss Insurance Association: autumn 2026 session briefing
- Federal Supreme Court: BGE 135 V 443
- Medinside: the «inadmissible cartel» of supplementary health insurers
