Rules under alternative basic insurance models
Alternative models of basic insurance come with clear rules. Following them means you save on premiums and always have the same points of contact.
What you need to remember under basic insurance
Not feeling well? Make sure your first point of contact is the right one under your basic insurance model:
- HMO model: Your doctor’s practice in the medical network is your first port of call..
- Family doctor model: You always go to your family practice first.
- Telmed: Ask the telemedicine centre or use the Well app first.
- Multimed: The Multimed practice, telemedicine centre or Well app is your first point of contact.
Ask for cheaper generics or biosimilars and let your point of contact know about emergencies within ten days. You can go to an eye doctor, gynaecologist or midwife directly.
Important: This rule also applies when you have an accident if that accident is covered by basic insurance. In this case too, you should always go to your chosen point of contact first. Only then will the insurance pay the costs.
What happens if you don't follow the rules?
- CSS will remind you of the correct procedure. We'll cover the doctor's fees – minus the deductible and retention fee.
- Each time you go directly to another doctor after that, you will have to pay up to CHF 500 per bill from your own pocket. This amount will not count towards the deductible or retention fee.
- If you buy originator products instead of generics or biosimilars, you'll have to pay the difference in price yourself.
- Would you rather have a free choice of doctor? You can change model as of 1 January each year.
Referral to another doctor?
Your doctor or therapist would like to refer you? Then they need the agreement of your first point of contact (doctor's practice or telemedicine centre). Only then are we able to cover the costs.
Regular visits to the doctor and check-ups
Do you require prolonged specialist attention due, for example, to a chronic medical condition? Or maybe you need to go for regular check-ups? Depending on the model of basic insurance, your doctor's practice or the telemedicine centre can write you a referral for an extended period.
What to do in an emergency
You must always go to your doctor's practice first in an emergency. If it can't be reached, contact the locum or the emergency service. Let your designated point of contact know about this emergency within the next ten days.
