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HMO

HMO is short for Health Maintenance Organisation.

HMO is a health insurance model, in which the policyholder agrees to always first consult a specific 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 gynaecological check-up and regular eye examinations are exempt from this obligation.

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

The gatekeeper principle allows the HMO doctor to coordinate treatment of his patients. This lump sum payment is an incentive for the HMO doctor to only administer treatment the patient actually needs. Therefore, premiums for HMO insurance are up to 25 percent lower than those for standard basic insurance while offering the same benefits.

What do HMO policyholders do in case of an emergency?

In case of an emergency, the policyholder always contacts his HMO doctor first. If the latter is unavailable, or if the policyholder is not at his/her usual place of residence or work, he/she should see the nearest available emergency doctor. After the emergency treatment, the policyholder contacts his/her HMO doctor to discuss further procedure.

Follow this link to find a list of HMO practices.

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