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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

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

Aids

Contributions to aids in accordance with the official aids and appliances list compiled by the Federal Office of Public Health (FOPH)

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

Frequently asked questions

What is Health Maintenance Organisation Insurance?

Health Maintenance Organisation Insurance is the name of CSS's HMO or group practice insurance.

What does HMO mean?

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.

What is the difference between a group practice and a medical network?

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

Who coordinates my treatment?

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.

Do I have to report an emergency?

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.

Can I go straight to a 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.

Can I change my doctor in the medical network or group practice?

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

Is my family doctor recognised?

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

1249785334

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. What deductible would you like?
Change insurance
Switch model
Change your medical point of contact and pay less.
Choose option
Exclude accident cover
Do you work at least eight hours a week? Then you can save on premiums.
Change accident cover
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