HMO model – all the benefits of a medical network
The HMO model is a version of mandatory basic insurance in which a doctor from your medical network or group practice is always your first point of contact.
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The advantages for you
- A doctor you know and trust from your medical network or group practice is your main point of contact.
- You benefit from the wide-ranging experience of all the doctors in the network.
- Medical advice is available 24/7 on +41 58 277 77 77.
- You can consult eye doctors and gynaecologists directly.
How it works
HMO stands for Health Maintenance Organisation and is built around group medical practices.
Under the HMO model, you always consult your doctor from your medical network or group practice first. A group practice consists of several doctors working together in the same place. A medical network is made up of doctors in different locations.
In an emergency, you can go straight to your doctor, their locum or an A&E department. You should then inform your doctor or the telemedicine centre about the emergency and any follow-up treatment that may be required.
This model lets you benefit from the experience of all the members of the network. You always contact your own doctor first and, in return, enjoy an attractive discount. Are you looking for the cheapest possible premium? Then the HMO model is perfect for you.
Your premium at a glance
Overview of basic insurance benefits
Benefits
Outpatient treatment – classical medicine
Cost coverage according to the tariff for treatment by recognised doctors, chiropractors, dieticians, midwives, logopedists, physiotherapists, ergotherapists, nurses and nursing auxiliaries throughout Switzerland
Outpatient treatment – alternative medicine
Acupuncture, anthroposophic medicine, Chinese medicine, homeopathy and phytotherapy: costs are covered according to the tariffs prevailing in the canton of residence or at the place of work for treatment by recognised doctors with an FMH qualification in the discipline of complementary medicine
Hospitalisation
Cover for all costs in the canton of residence according to the HIA (public hospital/acute hospital), unlimited as to sum or duration in a general ward
Health promotion/prevention
In accordance with Article 12 of the Ordinance on Compulsory Health Insurance Benefits
Benefits abroad
Cover for costs incurred in emergencies for outpatient or inpatient treatment on a general ward up to a maximum of twice the tariff of the canton of residence in Switzerland. Special conditions apply in EU states (incl. Iceland, the Principality of Liechtenstein and Norway) as determined in the bilateral agreements
Medication
Medically prescribed medication on the list of generic drugs maintained by the Federal Office of Public Health (FOPH), the list of medicines with tariffs or the specialities list
Spa cures/convalescence cures
Spa cures: CHF 10 per day, 21 days per year plus medical costs
Convalescence cures: only medical costs
Maternity/breastfeeding
Eight check-ups, two ultrasound examinations for a normal pregnancy, home birth or hospital birth, max. CHF 150 for prenatal courses, max. three sessions for breastfeeding advice
Apparatus
Contributions to apparatus according to the “Apparatus and devices” list (MiGeL)
Preventive examinations/vaccinations
Contributions to preventive health measures e.g. vaccination of children, preventive gynaecological examinations, etc.
Transport and rescue costs
Cost of transport: 50% of costs, max. CHF 500 per calendar year
Cost of rescue: 50% of costs, max. CHF 5,000 per calendar year (Switzerland)
Glasses/contact lenses
Up to 18 years of age: CHF 180 per year with a medical prescription
Home nursing/care in a nursing home
Costs are covered for examinations, treatment and nursing care prescribed by a physician and carried out at home or in nursing homes by recognised Spitex organisations
Dental treatment
Costs are covered for serious jaw disease or if treatment becomes necessary because of a serious general illness. Initial treatment in case of accident (if accident cover included)
Psychotherapy
Costs for psychotherapy by a doctor
Downloads
- Product sheet - Health Maintenance Organization Insurance (PDF)
- Regulations - Health Maintenance Organization Insurance CSS (PDF)
- The essential in brief - Health Maintenance Organisation Insurance (PDF)
- Calculation of co-payment (Deductible and retention fee) (PDF)
- Accident Notification Form (basic and supplementary insurance) (PDF)
Tips: how to save on premiums
Premiums depend on where you live, your age, and what deductible you choose. Save on premiums each year – thanks to the right retention fee and a low-cost version of basic insurance.
