Family doctor model
The family doctor model is a version of mandatory basic insurance. You always ask your family practice first whenever you have concerns about your health.
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The advantages for you
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The family practice you know and trust is always your first point of contact.
- You get a discount of at least 10% on the premium for your basic insurance.
- Medical advice is available 24/7 on 058 277 77 77.
- CSS clients can find fantastic offers in the enjoy365 Health Shop and use the active365 app for free.
How the family doctor model works
You like to consult your family practice about health problems but would also like to save on premiums? Then the family doctor model is perfect for you.
What should you do in the event of illness?
Under the family doctor model, you always ask your family practice first. Your own doctor is familiar with your medical history and knows what treatment is best for you.
How much will the premium cost each month?
Premiums depend on where you live, your age and what deductible you choose.
What you need to know about the family doctor model
Practically nothing will change for you on switching to the family doctor model. Except, of course, that you can save on premiums.
Specialist treatment
If necessary, your family practice will refer you directly to a specialist or hospital. Most doctors automatically inform us of this via digital channels. But not all of them do. Please check with your family doctor whether the practice is planning to notify us of the referral. Otherwise, kindly send us the referral confirmation before treatment begins. No referral is required for eye doctors, gynaecologists or midwives.
Go straight to a therapist if you have a prescription
You can go straight to physiotherapists, occupational therapists, issuers of aids and appliances, pharmacies, Spitex and dieticians with a prescription from your family practice. You don’t need confirmation of referral for this.
What to do in an emergency
You must always go to your family practice first in an emergency. If they cannot be reached, you must contact their locum or the emergency service.
What are the rules?
The rules include always asking your family practice first when you have a health issue you wish to discuss. Don’t forget about the referral confirmation. Under the family doctor model you buy low-cost generics, thus helping to lower healthcare costs. That way, you pay lower premiums.
Anyone not following the rules will face financial consequences. You will have to pay up to CHF 500 per doctor’s bill from your own pocket. If you use original products, additional costs may arise.
No family practice?
If you don’t have a personal family practice, you can choose a telemedicine family practice as your first point of contact. Depending on the problem, you’ll either be consulted by a doctor by telemedicine, or referred to a doctor near you. Telephone and video consultations are carried out by a team of doctors from the provider in question (Medi24 or Medgate). You pay a share of your healthcare costs through the deductible and retention fee.
Basic insurance benefits
Overview of benefits
Outpatient treatment / classical medicine
Cost coverage according to the tariff, throughout Switzerland, for treatment by recognised doctors, chiropractors, dieticians, midwives, speech therapists, physiotherapists, ergotherapists, nurses and nursing auxiliaries
Outpatient treatment / alternative medicine
Acupuncture, anthroposophic medicine, Chinese medicine, homeopathy and phytotherapy: Cost coverage according to the tariff, throughout Switzerland, for treatment by recognised doctors with an FMH qualification in the respective field of complementary medicine
Hospitalisation
Cost coverage without limit to sum or duration in the general ward (hospital/acute-care hospital) in accordance with the current cantonal hospital list
Health promotion / prevention
As stipulated in article 12 of the Health Insurance Benefits Ordinance
Abroad
Cost coverage in the general ward in emergencies for outpatient or inpatient treatment, up to a maximum of twice the tariff of the canton of residence in Switzerland. The special provisions in force under the bilateral agreements apply in the case of EU countries (incl. Iceland, the Principality of Liechtenstein and Norway)
Medication
Medically prescribed medication on the Federal Office of Public Health (BAG) «New list of generic medicine with differentiated retention fees for original preparations and generic medicines», the drug formulary or the Specialty List
Spa treatments / recovery cures
Spa treatments: CHF 10 per day, 21 days per year, plus the cost of medical treatment
Recovery cures: The cost of medical treatment only
Maternity / breastfeeding
7 check-ups during pregnancy and one following the birth, 2 ultrasound examinations for a normal pregnancy, home birth or hospital birth, maximum CHF 150 for antenatal courses, maximum 3 sessions of breastfeeding advice. Maternity benefits under basic insurance
Aids
Contributions to aids in accordance with the aids and appliances list
Preventive examinations / vaccinations
Contributions to preventive health measures e.g. vaccination of children, preventive gynaecological examinations, etc.
Transport and rescue costs in Switzerland
Cost of transport: 50% of costs, max. CHF 500 per calendar year
Rescue costs: 50% of costs, max. CHF 5,000 per calendar year
Spectacle lenses / contact lenses
Up to age 18: CHF 180 per year, on a doctor’s prescription
Home care / care in a nursing home
Cost coverage for medically prescribed examinations, treatment and nursing care by recognised Spitex organisations at home or in nursing homes
Dental treatment
Cost coverage for severe jaw disease or if treatment becomes necessary because of a serious general illness. Primary treatment of dental accidents (if accident cover included)
Psychotherapy
Cost coverage for psychotherapy with a doctor
Frequently asked questions
The easiest way to find recognised doctors near you is to use the premium calculator or the family doctor search function. You can change your doctor’s practice at any time.
Save the number 058 277 77 77 to obtain free medical advice. If you contact other telemedicine service providers or use apps other than Well or myCSS, you will be billed for their services.
We’re here for you
Submitting a bill
Checking, paying, submitting.
Report an accident
Notify us of an accident.
Change doctor's practice
Choose a doctor directly online.
Upload referral confirmation
Submit completed referral confirmation.
What does CSS pay?
Check benefits with myCSS.
Insurance advice
Find an agency nearby.
How to save on premiums
Premiums depend on where you live, your age and what deductible you choose.
