HMO model – all the benefits of a medical network
The HMO model is a version of mandatory basic insurance. Your doctor’s practice from the medical network is your first point of contact in health-related matters.
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The advantages for you
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The chosen doctor’s practice from the medical network or the group practice is your first point of contact.
- You get a discount of at least 13% on the premium for your basic insurance.
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No matter which basic insurance model you choose – you always receive the same benefits for illness, accident and maternity.
- 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 HMO model works
Would you like to benefit from the experience of all the doctors in the network? And are you looking for the cheapest possible premium? Then the HMO model is perfect for you.
What should you do in the event of illness?
Under the HMO model, you always turn to your doctor’s practice from the medical network first. You decide which will be your HMO doctor’s practice when taking out the insurance.
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 HMO model
A group practice consists of several doctors working together in the same place. A medical network is made up of doctors in different locations.
Special treatment
Your doctor's practice will refer you directly to a specialist, for therapy or to a hospital if necessary. You can continue to go to your gynaecologist without a referral for screenings and routine consultations during pregnancy. Because basic insurance pays important maternity benefits.
What to do in an emergency
The phone number of your medical network is also your emergency number. If you can’t reach anyone there, follow the instructions given in the practice’s answering machine message.
What are the rules?
The rules include informing your doctor’s practice about all treatments and referrals, and obtaining its approval. 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.
What does HMO mean?
HMO stands for health maintenance organisation. You benefit from the knowledge and experience of the medical network. The exchange between its members enables a high quality of treatment.
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). Insurance cover abroad
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
You can go to any ophthalmologist you choose for a prescription for glasses or contact lenses. CSS pays towards glasses under supplementary insurance and not basic insurance. However, please consult your doctor’s practice if you're experiencing a new problem, or if you're planning to have an operation, such as cataract removal.
You require a referral from your chosen doctor’s practice for physiotherapy and chiropractic treatment.
The easiest way to find recognised doctors near you is to use premium calculator or the HMO doctor search function. You can change your doctor 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.
How to save on premiums
Premiums depend on where you live, your age and what deductible you choose.
