Basic insurance of health insurance: standard basic insurance and alternative insurance models.
Standard basic insurance
The standard basic insurance is the compulsory health care insurance (OKP) which is offered by all health insurances. The
benefits are identical with all helath insurance companies.
There is free choice of doctors.
Alternative insurance models
The alternative insurance models include the HMO model, GP model, Telmed model and other models. Compared to standard basic insurance, the
policyholder benefits from premium reductions of up to 25% in the compulsory health insurance.
- HMO model
HMO (Health Maintenance Organization):
In the case of illness, the policyholder is obliged to always consult a certain doctor who practices in a HMO center first.
This doctor is called gatekeeper. Emergencies are exempt
from this obligation.
The premiums of the HMO model are up to 25% lower than the premiums of
the standard basic insurance.
Find more information on HMO model here.
- GP model
In the case of illness, the policyholder is obliged (as with HMO) to always consult his/her GP
(Gatekeeper) first.
Emergencies are exempt from this obligation.
The chosen GP is responsible for medical supervision of the policyholders who have decided for this particular GP. If it is necessary
for medical reasons the policyholders are then referred to a specialst by the GP.
The premiums of the GP insurance products are 5 to 20% lower than those of the standard basic insurance.
Find more information on GP model here.
- Telmed models
For every new health problem, the policyholder has to consult a telephone consultation helpline before seeing a doctor. There,
the medical experts provide information, recommend what to do or refer the patients to a doctor, a hospital or a therapist.
Exceptions from this obligation are emergencies, the annual gynaecological preventive medical check-up, check-ups at the eye
specialist (partly only for children) and other services depending on the health insurance company.
Compared to the standard basic insurance, the policyholders in the Telmed model receive a premium reduction of up to 15%.
Find more information on the Telmed model here.
- Other models
In this category, special insurance models are listed which only include restrictions which cannot be allocated
to one of the other insurance models, such as:
- only to be treated in hospitals which are on the hospital list of the health insurance company
- or to always buy medication at a certain pharmacy/pharmacy group defined by the health insurance.
|
|
