Health insurance

Family doctor model


By choosing the family doctor model, policyholders forgo free choice of physicians. As with the HMO model, they commit themselves to always consulting their fixed family doctor (gatekeeper) in the event of illness. Emergencies as well as the annual gynaecological check-up and regular eye examinations are exempt from this duty. 

The health insurance companies define which doctors can be chosen by policyholders as their family doctor in the family doctor model. These doctors are either affiliated to the family doctor networks or independently practising doctors. While some health insurance companies have specific lists of physicians, others allow their policyholders to choose among all internal specialists, GPs and paediatricians within the insurance company's region.

The family doctor is responsible for the medical care of the policyholders who have chosen him/her. If it is medically necessary, he will refer them to a specialist.

The selective referral of policyholders to specialists is expected to bring about a reduction of costs compared to standard basic insurance. Therefore, premiums for family doctor insurance products are about 15 to 20 percent cheaper than those for standard basic insurance.