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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

  • The chosen doctor’s practice from the medical network or the group practice is your first point of contact.
  • You get a discount of 14 – 16% on the premium for your basic insurance. The choice of doctor’s practice determines the amount of premium discount.
  • 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.

The HMO model at a glance

Medical treatment
You choose a doctor’s practice from the medical network and always go there first.
14 – 16% discount
The choice of doctor’s practice determines the amount of premium discount.
Go directly to a specialist
You can see an eye doctor, gynaecologist or midwife directly.
Health Maintenance Organisation Insurance
That’s the full name of CSS’s HMO model. You'll find it mentioned under this name on the policy.

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. The chosen doctor’s practice determines the premium discount.

Your premium at a glance

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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. Under the HMO model you buy low-cost generics, thus helping to lower healthcare costs. 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


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

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.

The discounts are displayed as T1, T2, T3 at Under the HMO model, there are premium discounts of 16% (T1), 15% (T2) and 14% (T3) on the standard model which offers a free choice of doctor. The chosen doctor’s practice determines the premium discount.

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.

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