Health Insurance Models

The health insurance model refers to different types of basic insurance offered by health insurance companies. There are 4 health insurance models that offer insured persons different options depending on their needs and preferences in Switzerland.

To determine the most suitable health insurance model, individual needs and preferences should be analysed, the models and their costs compared and the benefits offered as well as the flexibility and convenience of each model evaluated. Experience and recommendations can also be helpful when choosing a health insurance model. Deciding on the right health insurance model should also take into account your personal state of health, life circumstances and financial situation. A change of health insurance model is normally possible annually, subject to certain deadlines.

Insured persons can choose between different models to organise their health insurance. The health insurance models offer different approaches to medical care and each has its own advantages and disadvantages. In this blog post, we will compare the 4 main health insurance models in Switzerland in detail and find out which one best suits your needs.

Health Insurance Models
15.03.2024  |  Reading time: 5 Minute

Standard model

The most expensive health insurance model is the standard model. The standard model gives you the freedom to consult any doctor of your choice without needing a referral first. The standard model gives you the flexibility to visit the medical professionals and healthcare facilities of your choice. If you need to see a specialised doctor, you can go straight to them without consulting your GP first. The Standard model is well suited to people who value freedom of choice in their healthcare and already know which doctors they want to consult.

General practitioner model

The most frequently selected health insurance model is the GP model. The family doctor model means that you see your family doctor first when you need medical care. Your GP then coordinates your healthcare and can refer you to specialists if necessary. The family doctor model promotes continuous care from your family doctor and is designed to improve the coordination of medical care. The GP model is a good option for people who value a personal relationship with their GP and prefer coordinated care.

HMO model

The health insurance model with group practices is the HMO model. The HMO model is a more cost-effective option where you receive your healthcare from a specific network of doctors and healthcare facilities. The HMO model offers savings on monthly premiums, but requires you to work with a fixed network of healthcare providers. The HMO model is well suited for people who are willing to accept this limitation in order to save money.

Telmed model

The most favourable health insurance model is the Telmed model. The Telmed model, also known as telemedicine, allows you to receive medical advice and diagnoses over the phone or other digital means of communication. With this health insurance model, you can speak directly to a doctor without physically visiting a practice. The Telmed model offers convenience and is often more cost-effective. The Telmed model is well suited for people who are interested in using technology in healthcare and do not require physical doctor visits unless it is urgent.

How to determine the health insurance models? 

Determining the appropriate health insurance model in Switzerland depends on the individual needs, preferences and circumstances of the insured person. Here are the steps and considerations that can help you choose the right health insurance model:

Analyze needs and preferences:

  • Think about how often you seek medical help and what type of medical care you prefer.
  • Consider whether you value a free choice of doctor or whether you are satisfied with a predefined network of doctors.

Understanding health insurance models:

  • Find out about the different health insurance models available: standard model, family doctor model, HMO model and Telmed model.
  • Understand the differences between the models, particularly in terms of choice of doctor, coordination of treatment and premium costs.

Compare costs:

  • Compare the premiums of the various health insurance models, taking into account your chosen deductible and your canton of residence.
  • Also take into account the possible co-payments and deductibles.

Performance comparison:

  • Check which medical services and what type of care each health insurance model offers.
  • Consider whether and how easily you can be referred to specialists or hospitals if necessary.

Flexibility and comfort:

  • Consider the importance of flexibility in your choice of doctors and medical facilities.
  • Evaluate the comfort and accessibility of medical care in the different models.

Experience and recommendations:

  • Search for testimonials or reviews of the various models and health insurance companies.
  • Seek professional advice or talk to people you know about their experiences, if it isnecessary.

Consider your personal situation:

  • Take into account your personal circumstances, e.g. whether you are a frequent traveller or have specific medical needs.

Which health insurance model makes sense?

Choosing the right health insurance model in Switzerland depends on your personal needs, preferences and state of health. Here is a brief overview of which health insurance model may make sense under which circumstances.

Standard model (free choice of doctor):

  • Ideal if you value the freedom to choose your doctor or medical centre.
  • Suitable for people who may need specialised medical care and want to go directly to specialists without having to consult a GP first.

House doctor model:

  • This makes sense if you prefer continuous care from a familiar family doctor who knows your medical history.
  • A good choice for people who value coordinated care and are prepared to forego direct visits to specialists for lower premiums.

HMO model:

  • Advantageous if you prefer integrated care in a facility with various specialists under one roof.
  • Suitable for people who wish to receive comprehensive care in a group practice and for whom a limited choice of doctor is acceptable in order to benefit from lower premiums.

Telmed model:

  • Ideal for people who value flexibility and don't mind seeking medical advice over the phone or online.
  • Suitable for younger, healthy people or those who travel a lot and want an initial assessment or consultation from the comfort of their own home or while travelling.

Is it possible to change the health insurance model within a year?

In Switzerland, it is possible to change the health insurance model, but certain deadlines and conditions apply. It is usually possible to change health insurance model at the end of the calendar year, for which the cancellation of the existing model must usually be submitted by 30 November at the latest. Some health insurance models, in particular the standard model, also allow termination at the end of June, whereby the notice of termination should be submitted by 31 March at the latest.

Are there differences in benefits between health insurance models?

No, there are no differences in benefits between the various health insurance models. Basic insurance in Switzerland is prescribed by law and offers a fixed minimum standard of benefits that is the same for all insured persons. This means that basic insurance is the same in terms of covered medical services in all models.

How can you compare the health insurance models?

Health insurance models can be compared using online tools such as the health insurance comparison or premium calculator. These tools make it possible to compare the premiums and benefits of different health insurance models based on individual details such as place of residence, age and desired insurance cover. This allows insured persons to find the right health insurance model that best suits their needs and budget.

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