Changing GP with the family doctor model
The family doctor model is the most popular health insurance model. How does it differ from the standard model? And what if I want to switch to a different doctor?
15.07.2022
iStock / SDI Productions
1. What is the family doctor model?
The family doctor model is an alternative health insurance model. Your first point of contact in the event of illness is always your designated family doctor. In return, you will pay lower premiums than if you choose the standard model.
A family doctor treats all minor cases directly. If necessary, they will refer you to the appropriate specialist. This means that, unlike in the standard model , you are no longer free to choose your doctor.
Why is the family doctor model cheaper than the standard model?
The family doctor will coordinate your examinations and treatments. This helps avoid unnecessary treatment. Health insurance companies therefore expect cost savings compared to the standard model. The cost savings are passed on to the insured person in the form of reduced premiums.
2. Family doctor model: exceptions to the limited choice of doctor
Health insurance companies grant exemptions from the obligation to consult your family doctor first. Depending on the health insurance company, family doctor models differ as to which doctors you may consult without referral. Most insurers make the following exceptions:
Emergencies
Annual gynaecological check-up
Pregnancy check-ups
Eye tests and adjustment of glasses by an ophthalmologist
Dental treatment
Treatment by a paediatrician (maximum age of the child varies depending on the health insurer)
Check the insurance conditions of your health insurance company to find out which exceptions apply to you.
3. When can I switch to the family doctor model?
When it is possible to switch to the family doctor model depends on your current insurance model:
Insured persons in the standard model with a deductible of 300 may switch to an alternative health insurance model at any time with effect from the 1st day of the new month. This only applies if you remain with the same health insurance company. You can cancel and switch health insurance by 31 March or 30 November.
Insured persons with a higher deductible or in an alternative model must notify their health insurance company that they are switching or cancel by 30 November.
How can I switch?
Are you staying with the same health insurance company? Contact your health insurance company. You will then receive a new quote for basic insurance under your chosen model.
Would you like to switch health insurer? Compare deals using the basic insurance comparison. Request a quote and take out a new basic insurance policy. Cancel your current basic insurance policy by 30 November.
4. When and how can I change my family doctor?
You are allowed to switch to a different family doctor. When and under what conditions varies depending on the health insurance company. Some health insurers require you to justify the change. Others only allow you to switch twice a year.
Reasons for changing your family doctor:
Moving home
Closure or relocation of doctor's practice
Breach of trust
Find out from your insurance company what your options are. Many health insurance companies provide a web form for changing doctors.
5. Can I choose any family doctor if I am insured under the family doctor model?
The health insurance companies provide a choice of doctors. So you can't choose any doctor.
6. What happens if I do not go to the family doctor first?
Under the family doctor model, you are contractually obliged to contact your family doctor first in the event of illness. For this, you receive a premium discount. If you do not comply with this agreement, the consequences vary.
Some health insurance companies may not pay for some of the services you received. If this happens repeatedly, the health insurance company can transfer you to the standard model. In this case, some insurers won't allow you to switch to another model for a longer period of time.
7. "Genuine family doctor model" versus list model
Family doctor models can be divided into "genuine family doctor models" and list models.
In a "genuine family doctor model", the insurance company agrees on contractually defined details of care with a doctor or a network of doctors. For example, it can be contractually agreed that patients should receive generic drugs instead of original drugs whenever possible.
The family doctors listed in list models have not concluded a contract with the health insurance company. Health insurance companies create their family doctor lists unilaterally and primarily according to cost criteria. The doctors do not know the conditions of the respective insurance product.
