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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.
  • Medical advice is available 24/7 on +41 58 277 77 77.
  • You get a discount of at least 14% on the premium for your basic insurance.

Good to know

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.

Treatment by a doctor
Always go to your own doctor from the medical network or group practice first.
Availability
The HMO model is available in many, but not all, regions of Switzerland.
Go directly to a specialist
You can see an eye doctor, gynaecologist, dentist or midwife directly.

How the HMO model works

Always go to your chosen doctor first

Under the HMO model, you always ask your doctor from the medical network or group practice first.

Treatment by a specialist

Your doctor will refer you directly to a specialist, therapist or hospital if necessary.

In an emergency

The phone number of your medical network or group practice is also your emergency number. If you cannot reach anyone there, you should contact the local emergency service.

Your premium at a glance

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Basic insurance benefits

Overview of 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

Frequently asked questions

Health Maintenance Organisation Insurance is the name of CSS's HMO or group practice insurance. You'll find it mentioned under this name on the policy.

HMO stands for health maintenance organisation. Under the HMO model, you promise to always consult a designated doctor from the medical network or a group practice first when feeling ill.

A group practice consists of several doctors working together in the same place. A medical network is made up of doctors in different locations.

Your doctor from the medical network or group practice will coordinate your treatment. What's more, the HMO model lets you benefit from the experience of all the members of the network.

Yes. Please notify your doctor from the network or group practice of any emergency treatment within 10 days. Please ask the emergency doctor to send their treatment report to your regular doctor.

No. Your first point of contact should always be your doctor from the medical network or group practice. If you require specialist treatment, you will be referred by them. If you do not stick to the rules, it will not be possible to reimburse your treatment costs.

You can change your doctor at any time. Please notify us of your new doctor.

The easiest way to find recognised doctors near you is to use the premium calculator or the HMO doctor search function.

Pay the bill and send us the refund form. It couldn’t be easier!

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Personal advice

Get in touch for a personal consultation.

How to save on premiums

Premiums depend on where you live, your age and what deductible you choose.

Higher deductible
The higher the deductible, the lower the premium. How to make the right choice.
Find out more
Switch model
Change your medical point of contact and pay less.
Here’s how
Exclude accident cover
If you work at least 8 hours a week, you can save on premiums.
Change accident cover