Supplementary Health Insurance Coverage Dispute for Non-Recognized Hospital Stay

The court addressed a dispute regarding the coverage of supplementary health insurance benefits for a hospital stay, where the policy stipulated coverage for general ward costs in Swiss public and private hospitals on the insurer's approved list with an agreed tariff, per Article 13.1 lit. l of the General Insurance Conditions (GIC). The court reasoned that the contract's content must be determined based on the agreed-upon GIC and specifically agreed clauses, explicitly excluding insurer communications in customer magazines as contractually binding declarations or a basis for deriving further claims, as these documents only provide an overview of services. Given that the specific hospital in question was not on the insurer's recognized tariff list at the time of treatment, and finding no evidence of a mutual understanding or a binding guarantee in the GIC or related regulations to cover treatments in non-recognized hospitals, the court concluded that the plaintiff had no claim for reimbursement under the supplementary insurance policy for the costs incurred.