Alternative insurance models

Alternative insurance models are versions (alternatives) of compulsory basic health insurance.
They include:

HMO models

HMO = Health Maintenance Organization:

The policyholder of a HMO model agrees to always consult a specified doctor based at the HMO centre in the event of illness. This doctor is referred to as a gatekeeper Emergencies as well as the annual gyneacological check-up and check-ups at the eyedoctor are exempt from this duty.

The HMO doctor receives a lump sum every month for the medical treatment of his registered policyholders. This covers all services claimed by policyholders either from the HMO doctor, from external specialists or from hospital treatments.

The gatekeeper principle allows the HMO doctor to coordinate his patients' treatment. By receiving a lump sum, the doctor can limit himself to giving the patient the treatment he or she really needs - there is no incentive to extend the treatment beyond this. Therefore, premiums for HMO insurances are up to 25% lower than for standard basic insurance, while offering the same benefits.

Emergencies for HMO policyholders:

In case of an emergency, the policyholder always contacts his HMO doctor first. If he cannot be contacted, or the policyholder is not at his usual place of residence or work, the nearest available emergency practitioner should be consulted. After the emergency treatment, the policyholder should contact his HMO doctor to discuss further procedure.

Please find a list of HMO practices here.

GP models

Policyholders of GP models do without free choice of doctors and commit themselves (as with HMO) to always consult their fixed GP (gatekeeper). Emergencies as well as the annual gyneacological check-up and check-ups at the eyedoctor are exempt from this duty.

The health insurances companies define which doctors can be chosen by the policyholders as an own GP in the GP model. These doctors are either affiliated to the GP networks or are nonattachedly practicing doctors. While some health insurance companies have explicit lists of doctors, others allow the choice of doctor from the range of all internists, GPs and paediatricians within the insurance company's region.

The chosen GP is responsible for the medical care of the policyholders who have chosen him/her. If there is a medical necessity, the GP will refer the policyholders to a specialist.

It is expected that the selective referral of policyholders to specialists will bring about a reduction of costs in comparison to thestandard basic insurance. Therefore, the premiums for GP model insurance products are up to 20% lower than those for standard basic insurance.

Telmed models

For every newly appearing health problem, the policyholder has to call a telephone consultation hotline before consulting a doctor. There, the medical experts give information, give recommendations on how to behave or refer patients to a different doctor, a hospital or a therapist.

Thanks to the consultation by phone before consulting a doctor, costs can be saved. The policyholders in the Telmed model receive a premium reduction of up to 15% compared to the standard basic insurance.

Health insurance Name of model Partner Number Possibility of expulsion* Special features
Atupri TelFirst Medgate 0844 844 777 Yes
Avanex Premed 24 Medgate 0800 773 633 Yes
Carena Carena 24 Medi24 0800 227 362 Yes
Compact Compact One Medgate 0844 111 365 Yes
Groupe Mutuel Sanatel Medi24 0800 726 283 Yes All Groupe Mutuel insurance companies offer this product
Helsana Premed 24 Medgate 0800 773 633 Yes Also applies to subsidiary companies Aerosana, Avanex, Progrès and Sansan
Innova Telcare Medgate 0844 000 911 Yes If telephone helpline is not consulted, only 50% of the costs are covered.
Innova Telgate Medgate 0844 911 222 Yes If telephone helpline is not consulted, only 50% of the costs are covered.
Innova Wallis
(former KK Saastal)		 Telcare Medgate 0844 000 911 Yes If telephone helpline is not consulted, only 50% of the costs are covered.
Innova Wallis
(former KK Saastal)		 Telgate Medgate 0844 911 222 Yes If telephone helpline is not consulted, only 50% of the costs are covered.
Intras FirstCall Medgate 058 277 77 77 Yes If telephone helpline is not consulted, only 50% of the costs are covered. The costs, however, are limited to a maximum of 5 times the annual reduction.
KK Visperterminen Telmed Medgate 0844 844 911 Yes
KPT/CPT Win.win Medgate 0844 946 946 Yes Bonus system that rewards "loyalty to the system".
Maxi.ch Casamed24 Medgate 0800 800 803 Yes
Moove Sympany Casamed24 Medgate 0844 057 057 Yes
ÖKK Casamed24 Medgate 0848 227 224 Yes If telephone helpline is not consulted, none of the costs are covered.
Progrès Premed 24 Medgate 0800 773 633 Yes
Sana 24 Med Call Medi24 Yes
Sanitas Callmed Medgate 0844 124 365 Yes
Sansan Premed 24 Medi24 0800 800 803 Yes
Sodalis Telmed Medgate 0844 844 911 Yes
Swica Telmed Own doctor-/adviser-team 044 404 86 86 Yes The health advisory line sante24 arranges appointments with the SWICA health centres or directly with a uncommitted doctor. In case of non-use of the help-line, policyholders can switch to the standard model.
Sumiswalder KK sumis24Telmed Medi24 0800 786 4724 Yes
Vivacare Med Call Medi24 Yes
Vivao Sympany Casamed24 Medgate 0844 852 852 Yes If telephone helpline is not consulted, none of the costs are covered.
Wincare Callmed Medgate 0844 124 365 Yes

* The general terms of contract envision various procedures for dealing with policyholders who consult a doctor without having called the telephone helpline before. They range from refusal of coverage of the costs to allocation into the standard basic insurance (exclusion from the Telmed model).
A telephone consultation before seeing a doctor is unnecessary for the following cases:

  • Emergencies
  • Annual gynaecological preventive check-ups
  • Examinations by an eye specialist (in some cases only for children)
  • Other services (depends on insurance company)

Other models

In this category, special insurance models are listed which only have restrictions that cannot be assigned to one of the other insurance models, such as:

  • to only be treated in a hospital which is on the list of the health insurance,
  • or to only buy medication from a certain pharmacy/pharmacy group defined by the health insurance.

Please note the following for alternative insurance models:

  • If insured persons claim direct outpatient or inpatient treatment without previous instruction by their HMO doctor or GP outside of an emergency situation, they have to cover the costs themselves with some health insurances.
  • If the insured persons select an original medical product instead of a generic medical product from the list, the costs are not always completely covered.

These regulations are not standardized, but they are stated in the general terms of contract (AVB) of the health insurance companies.

Back