Insurance Models: Standard, Family Doctor, HMO, Telmed and More Compared
Anyone who chooses an alternative model in basic insurance saves up to 25 percent. Compando shows all six variants with first point of contact and savings potential.
1. Insurance models at the insurer: what is it?
Anyone who takes out health insurance in Switzerland chooses not only the insurer, but also an insurance model of basic insurance. The model determines whom you turn to first in the Swiss health insurance system for health questions. This first point of contact is the central difference between the tariffs.
In the standard model, you decide for yourself whether you go to the family doctor, to the pharmacy or directly to the specialist. With alternative models, the choice is restricted. In return, you receive a premium discount of up to 25 percent compared to the standard variant.
Among the alternative insurance models in Switzerland are:
- Family doctor model: Your self-chosen family doctor's practice is the first point of contact for health problems.
- HMO model: An HMO health centre coordinates the further treatment.
- Telmed model: You contact a telemedical centre by phone, video call, chat or symptom app.
- Pharmacy model: A partner pharmacy is your first point of contact for minor complaints.
- Hybrid and mix models: You combine several first points of contact, such as family doctor, pharmacy and Telmed.
The names of the models and the exact discounts differ from insurer to insurer.
Compare models for your insurer
Compando compares the premiums of all insurance models for your place of residence and your age insurer-neutrally.
2. Alternative insurance models: what do I have to note?
With alternative models, you always turn first to the agreed first point of contact for health problems or questions. This principle is called gatekeeping. You can therefore not go directly to specialists and for minor matters not to the hospital without prior notification. The first point of contact advises you and refers you to specialists if needed.
Exceptions to the restricted choice of doctor
With most insurers, you also have direct access in the alternative model in the following cases:
- Real emergencies (accident, acute danger to life, severe pain)
- Gynaecological preventive examinations and pregnancy check-ups
- Ophthalmological check-up examinations
- Examinations at the paediatrician
- Psychiatry and psychotherapy
Important: The details differ between providers. Check the general insurance conditions (AVB) of your insurer before signing the contract.
For benefits, you are not worse insured
The benefits of basic insurance are legally laid down and apply identically in all models. Different is only how you get to the treatment, not which treatment you receive.
Consequences of non-compliance
Anyone who, despite the alternative model, goes directly to the specialist without referral risks, according to the AVB, two consequences:
- The insurer refuses to cover costs or pays only a part.
- The insurer downgrades you to the standard model. The premium discount lapses retroactively or for the next contract year.
3. Which insurance models exist in Switzerland?
In Swiss basic insurance, there are today six model variants, from the standard tariff with free choice of doctor to hybrid models with several first points of contact. Click on a card for details.
Standard model
Family doctor model
HMO model
Telmed model (phone, video, app)
Pharmacy model
Hybrid and mix models
4. Advantages and disadvantages of alternative models compared
The models do not differ in benefits, but in comfort, flexibility and costs. An alternative model brings a premium discount, but restricts the choice of doctor. The following overview summarises the most important points.
Model | Strengths | Weaknesses |
|---|---|---|
Standard | Free choice of doctor, direct to specialists | Highest premium, no coordination |
Family doctor | Personal care, 10-18 % discount | Contract list obligation, referral needed |
HMO | 25 % discount, everything under one roof | Mainly available in cities |
Telmed | Advice around the clock, 15-22 % discount | No physical examination, app hurdle |
Pharmacy | Advice nearby, 10-18 % discount | Mostly combination model, only partner pharmacies |
Hybrid/mix | Flexible first point of contact, 15-22 % discount | Complex rules, strongly insurer-dependent |
Which tariff combination is cheaper for your situation depends on place of residence, age and municipality. Between models and insurers, several hundred francs difference per year quickly arise. The ten ways to save on insurance premiums show how you use the full savings potential.
Compare models of all insurers
Compando calculates the premium differences between standard, family doctor, HMO, Telmed, pharmacy and hybrid models for your place of residence.
5. Which is the best insurance model for me?
The right insurance model depends on your personal needs and life circumstances. You decide yourself what you value in your health insurance: maximum flexibility, personal care by a familiar family doctor practice, quick advice via phone and app or the highest discount in the HMO model. Important is that you know the conditions for the chosen model and above all have access to the first point of contact. This is decisive with shortage of family doctors in many Swiss regions, especially in French-speaking Switzerland and in rural municipalities.
Compando tip: Model and provider you can adjust simultaneously when switching insurer for 1 January. Check both in parallel; this way you reach the maximum savings potential.
Six models in direct comparison
Switching from the standard to the HMO model lowers the premium for an adult per place of residence by 800 to 1'400 francs per year. For a family of four, the advantage is up to 3'200 francs. Compando compares all six models of all Swiss insurers. A comparison pays off.
