Health insurance models in Switzerland compared
When it comes to basic insurance in Switzerland, you can choose between different health insurance models. Comparis provides an overview with the pros and cons.
23.09.2025
iStock/Stígur Már Karlsson/Heimsmyndir
1. Health insurance models: what options exist?
Basic health insurance is available in different insurance models. Depending on the model, you have a different first point of contact for medical issues.
The standard model gives you a free choice of doctor. With alternative insurance models, this choice is limited – but you can save up to 25% on health insurance premiums.
Alternative health insurance models in Switzerland include:
Family doctor model: you first go to your family doctor in the event of health problems.
HMO model: if you have any medical questions, you first contact a group practice.
Telemedicine model: you contact a telemedicine centre by phone or video call if you have any medical problems.
Hybrid models: you have several first points of contact in the event of health issues.
The names of the models vary depending on the health insurer.
2. Alternative health insurance models: what should I consider?
With an alternative insurance model, you must turn to the specified first point of contact if you have any health problems or questions. This means you can’t go directly to a specialist or straight to hospital for minor issues. You must obtain advice and a referral from the designated contact beforehand. This principle is also referred to as “gatekeeping”.
However, there are also exceptions to the restricted choice of doctor. These typically include:
Emergencies
Gynaecological check-ups
Check-ups by ophthalmologists and dentists
Check-ups by paediatricians
The exceptions vary slightly from one health insurer to the next. It’s best to contact your health insurer for more information.
The conditions regarding the first point of contact vary depending on the health insurer. They are set out in the general insurance conditions. If you don’t follow the rules, health insurers will act in accordance with the general insurance conditions.
Examples of consequences include the health insurer refusing to cover costs or downgrading your policy to the standard model. Downgrading means that you’ll lose your premium discount and will have to pay the premiums of the standard model.
3. What are the different health insurance models?
The health insurance models differ primarily in the first point of contact, but also in the coordination of treatments after the first point of contact. Depending on the model, you have different advantages and disadvantages. The chart compares the different health insurance models.
Important: the names of the models may vary depending on the health insurer. Therefore, pay attention to the listed first points of contact and the information on the further coordination of treatment.
What are the pros and cons of the health insurance models?
The table compares the different Swiss health insurance models. The pros and cons of the models are also listed.
| Model | Pros | Cons |
|---|---|---|
| Standard model | You can decide for yourself which doctor you want to see.You can go directly to a specialist. | Higher premiums than alternative models.You must coordinate appointments with doctors yourself.If you visit too many different doctors, the health insurer may reclassify you to an alternative model. |
| Family doctor model | You always have the same contact person for medical questions.By coordinating with your family doctor, unnecessary treatments can be avoided.Premium discount of up to 25%. | You usually need a referral for an appointment with a specialist.Depending on the insurance and type of model, your family doctor’s practice must be on the health insurer’s list of family doctors. Therefore, it’s possible that you have to change your family doctor after a change of health insurer. |
| HMO model | By coordinating with a single practice, unnecessary treatments can be avoided.Medical devices (e.g. ultrasound, X-ray, etc.) and specialists in various fields are available.Premium discount of up to 25%. | You usually need a referral for specialists.There may be no HMO practice covered by your health insurer nearby – especially in rural areas. |
| Telephone consultation (telemedicine or “Callmed”) | You can often get medical advice around the clock.You do not have to leave the house for medical advice.By coordinating with the telemedicine centre, unnecessary treatments can be avoided.Depending on the health insurer, the telephone consultation may be free of charge.In some cases, you can get medical advice via an app before making the call.Premium discount of up to 25%. | You must always contact the medical helpline first before you can arrange an appointment with a doctor.In the worst case, the lack of a physical examination can lead to incorrect assessments.The technical requirements can be overwhelming, especially for older people.In some cases, you have a specified time window for a treatment. If the treatment takes longer, you must contact the helpline again. |
| Pharmacy model | Cheap or free initial consultation at a pharmacy.Usually several first points of contact.Premium discount of up to 25%. | Often restricted to partner pharmacies.Doctors are only the second point of contact.You usually need a referral for specialists.Partial restrictions on the choice of doctor after a referral – for example, only the health insurer’s network of doctors may be available. |
| Hybrid models | Flexible choice of first point of contact according to your needs.Premium discount of up to 25%. | You usually need a referral for specialists.Partial restrictions on the choice of doctor after a referral – for example, only the health insurer’s network of doctors may be available. |
Compare health insurance premiums by first point of contact
In the Comparis health insurance comparison tool, you can compare health insurance premiums by the first point of contact:
The family doctor and HMO models have the doctor as the first point of contact. You can also see how good the availability of doctors is in your area.
The standard model offers a free choice of doctor.
You can show or hide all other models using the “Other” filter. You can also choose different first points of contact:
Emergency pharmacy
Telephone
Video call and chat
App
This way, you can find the right health insurance model for you.
4. What is the best insurance model for me?
The best insurance model depends on your personal needs and wishes. You have to decide for yourself what you value in your health insurance. It’s important that you are aware of the conditions for the selected model and have access to the first point of contact. Access is particularly important considering the shortage of family doctors.
Compare the conditions of different health insurers and models. This will help you to find out what suits you best – and you may even save money.
5. Frequently asked questions about alternative health insurance models
How much you can save depends on:
Your place of residence and age
Your current insurance model
Your deductible
However, the premiums for alternative models are up to 25% lower than the premium for the standard model.
Good to know: some health insurers offer additional cost advantages for certain models. For example, the deductible may be lower or you do not pay a deductible for certain treatments.
Health insurance benefits are regulated by law. This law also applies to alternative insurance models. This means that the benefits offered are the same for the standard model and for alternative insurance models.
With an alternative insurance model, you have the same insurance cover as with the standard model. This is because the benefits of basic insurance are defined by law – and are therefore the same for all health insurers and models. Good alternative insurance models also include quality measures.
When you can change the model depends on your current insurance model. If you are insured under an alternative model, you can change the model on 1 January.
Do you have the standard insurance model? Then you can switch to an alternative model for the following month.
This article was first published on 14.08.2023
