Telmed model explained and important phone numbers

What is the Telmed model?

The Telmed model is a telephone model for health insurance companies. It is one of the alternative insurance models for basic health insurance.

With Telmed, free choice of doctor is restricted. This means that in the event of health problems, you must always contact the health insurance company’s telephone helpline first.

2. How does Telmed work?

Medical professionals help patients in various ways via the helpline:

• They provide information and determine the next treatment steps.

• If necessary, they will refer the insured to a suitable specialist for a physical consultation.

3. Telmed in Switzerland: what are the exceptions?

For some medical exceptions, you are not required to contact the helpline under the Telmed model. These exceptions are the following:

• Emergencies – you need to report them afterwards 

• Annual gynaecological check-ups

• Examinations by an eye specialist (in some cases for children only)

• Dental treatment (with most providers)

• Visits to the paediatrician (with most providers)

• Other services (depends on insurance company)

4. What if I go directly to the doctor?

The health insurance companies act differently in the event of a breach of the terms of the contract. A violation means that you go to a doctor without a prior call to the helpline. 

The consequences range from the health insurer refusing to cover costs to downgrading your policy to the standard basic health insurance model with free choice of doctor (exclusion from the Telmed model). Downgrading means that you lose your premium discount and will have to pay the premiums of the standard model. You will find out more about how Telmed works with the largest providers in the table below.

5. Pros and cons of Telmed

Pros

• Providing advice over the phone allows you to pay lower premiums. In the Telmed model, a premium reduction of around 1% to 30% is possible compared to the standard basic insurance model.

• For medical helplines, waiting times are often shorter than for walk-in visits to the doctor.

• You can discuss and resolve problems on the telephone without having to go to the doctor at all.

• Health insurance companies’ telemedicine specialists can often issue a doctor’s note. Many employers accept this. 

Cons

• Remote diagnosis over the phone can lead to incorrect assessments. This can have health consequences.

• In the event of a dispute, the Telmed doctor’s note has no probative value due to the lack of a personal examination.

6. How is Telmed different to the family doctor model and the HMO model?

The HMO model and the family doctor model are also alternative health insurance models.

Telmed vs. HMO

With the HMO model, your first point of contact for medical treatments is a specific group practice or a network of doctors. There, you will clarify the further treatment steps.

Telmed vs. family doctor model

With the family doctor model, you have a fixed family doctor or GP as a contact person for health problems. If necessary, they can then refer you to a specialist.