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.
Calculate premiumWould 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.
Under the HMO model, you always ask your doctor from the medical network or group practice first.
Your doctor will refer you directly to a specialist, therapist or hospital if necessary.
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.
Cost coverage according to the tariff, throughout Switzerland, for treatment by recognised doctors, chiropractors, dieticians, midwives, speech therapists, physiotherapists, ergotherapists, nurses and nursing auxiliaries
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
Cost coverage without limit to sum or duration in the general ward (hospital/acute-care hospital) in accordance with the current cantonal hospital list
As stipulated in article 12 of the Health Insurance Benefits Ordinance
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)
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: CHF 10 per day, 21 days per year, plus the cost of medical treatment
Recovery cures: The cost of medical treatment only
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
Contributions to aids in accordance with the aids and appliances list
Contributions to preventive health measures e.g. vaccination of children, preventive gynaecological examinations, etc.
Cost of transport: 50% of costs, max. CHF 500 per calendar year
Rescue costs: 50% of costs, max. CHF 5,000 per calendar year
Up to age 18: CHF 180 per year, on a doctor’s prescription
Cost coverage for medically prescribed examinations, treatment and nursing care by recognised Spitex organisations at home or in nursing homes
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)
Cost coverage for psychotherapy with a doctor
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 don’t stick to the rules, you will face financial consequences.
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.
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!
Premiums depend on where you live, your age and what deductible you choose.
