The classic insurance model of health insurance in Switzerland may still have its justification for existence, but it is almost a thing of the past. Why is this actually so?

This short article shows why an alternative insurance model is almost always better nowadays and which aspects you should never lose sight of.

The number one advantage is that every health insurance in Switzerland offer their customers exactly the same services as with the standard model, but at a much lower price.

This is because for the insured only the first point of contact for health questions changes, which usually means that there is no free choice of doctor.

Since the primary contact point is defined in advance, health insurances can guarantee better organization and save costs.

Since health insurance is obligatory here in Switzerland, it must be guaranteed that this is also regulated by law. This is done through the Federal Law for Compulsory Health Insurance (KVG). Therefore all basic insurances have to provide the same services in a legally binding way.

Examples of this are:

  • Outpatient treatment either by a doctor or chiropractor
  • Hospitalization and treatment in the general ward of the canton of residence
  • Legally approved drugs, laboratory tests (according to medical prescription)

Thus, favorable premiums without compromising on benefits.

The 4 alternative models for health insurance in Switzerland

1. Family doctor model

2. Telmed (medical advice by telephone)

3. HMO model (health centers)

4. Pharmacy (partner pharmacies of health insurance as first point of contact)

Family doctor model

The family doctor model is the most common alternative to the standard model, because most policyholders would consult their family doctor first in any case when they had health questions.

Those who choose the general practitioner model do not have the freedom to choose their own doctor, so a specialist cannot be consulted directly. Since most humans as well as do not know which specialist they must visit for their request, this is practically no disadvantage.

If a health concern arises, the agreed upon family doctor must be visited first. Exceptions apply for example for emergencies, annual gynecological preventive medical checkups and regular eye examinations. Because the visit to the family doctor can be avoided here.

The health insurances determine which doctors in the family doctor model may be selected as “family doctor” or general practitioner. These doctors are either connected to family doctor networks or are independent practicing doctors.

While some health insurance companies list certain doctors, others allow their policyholders to choose any family doctor or pediatrician in the health insurance’s region.

The general practitioner chosen by the customer is responsible for his medical care. This doctor will refer the insured to a specialist if necessary.

Due to this targeted method, cost savings are expected compared to the standard basic insurance.

Cost savings: 15-20% compared to the standard model

Change of family doctor

Change of family doctor is possible once a year, by written notification to the health insurance.

The most common reasons for changing are:

  • Move
  • Closure of the medical practice
  • Breach of trust
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Telmed

If a health concern arises, the insured must call a medical consultation hotline before the first visit to the doctor. There you will be advised by medically trained experts and receive helpful advice.

In many cases, provided the health concern is not serious, self-medication or similar is recommended, which saves the customer a visit to the doctor and the resulting costs.

In case of a major concern, the client is referred to a doctor, hospital or therapist.

While there are Telmed models where the insured must follow the recommendations of the medical hotline, there are also some where the insured can choose to visit a doctor after the conversation.

If you are not quite sure which insurances are more flexible and have a less strict regulation, you can obtain information from us here free of charge.

Insured who avoid the contractually agreed consultation by medical hotline, must accordingly expect refusal of service and exclusion from the Telemed insurance as well as downgrading to the standard basic insurance.

Cost savings: 15-20% compared to the standard model

Telephone consultation prior to the visit to the doctor is not necessary in the following cases:

  • Emergencies
  • Annual gynecological check-ups
  • Regular eye examinations

However, the medical hotline must be informed about the visit at a later date, deadlines vary between health insurances.

HMO model (health center)

HMO stands for Health Maintenance Organisation. Basically the customer commits himself to visit a health center defined in advance in case of health concerns.

Exceptions are made, for example, for emergencies, annual gynecological check-ups and regular eye examinations. This is because a visit to the family doctor can be avoided.

What is an HMO practice?

An HMO practice is a group practice, which not only includes family doctors, but normally also specialists and therapists from various fields. For this reason a very broad spectrum of medical services is often guaranteed.

HMO centers have their own catchment area. This means that each center has its own geographical area of activity.

As there are not many health centers at the moment, it can often be disadvantageous for clients who live far away from the city to choose this model, as they often have to travel a long way for a visit. However, if such a center is located close to the customer, this disadvantage is eliminated.

Since HMO doctors receive a lump sum from the insurance for the treatment of the insured patient, there is an incentive to only carry out treatments that the patient actually needs. Therefore, the savings potential for the insured is often the greatest with this model.

Cost savings: Up to 25% less expensive than the standard model

Pharma

A relatively new model not offered by every health insurance in Switzerland is the pharmaceutical model.

Here, the insured person chooses the desired pharmacy from a list of available partner pharmacies of the health insurance, which always has to be visited first.

If possible, self-medication is used. If self-medication is not reasonable, a referral to a doctor or specialist is made.

For this the customer receives a referral form, which he must immediately send to his health insurance.

Cost savings: 15-25% compared to the standard model

Attention! Limited selection of health insurance in Switzerland for foreigners

Health insurances usually cannot offer foreigners from EU countries, Iceland and Norway an alternative insurance model, but only the standard model.

Health insurance in Switzerland – Which model is the best?

The best health insurance in Switzerland as well as Model is the one that covers all needs at the most attractive price.

Often, convenience as well as accessibility is the decisive factor in choosing the insurance model. If you have been seeing your family doctor for years and have a good relationship with him, you will find it difficult to change your doctor completely just to save a few percent.

Therefore, each insured person must decide for himself what value freedom, flexibility, price, etc. have for him.

Furthermore, it is important to know the exact procedure that is stipulated in the contract, so that these are adhered to and there are no reductions in benefits.

There are still people who are afraid of receiving poorer benefits or being restricted too much in their choice, an unnecessarily expensive standard model, although the benefits are regulated by law and are the same everywhere.

There is something for everyone and if life situation changes, the model can be changed as well once a year, at the end of the calendar year, without difficulties.

Not sure which model is the right one? Get free information now and save time with ajooda.ch

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