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 for treatment by recognised doctors, chiropractors, dieticians, midwives, logopedists, physiotherapists, ergotherapists, nurses and nursing auxiliaries throughout Switzerland
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
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
In accordance with Article 12 of the Ordinance on Compulsory Health Insurance Benefits
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
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: CHF 10 per day, 21 days per year plus medical costs
Convalescence cures: only medical costs
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
Contributions to aids in accordance with the official aids and appliances list compiled by the Federal Office of Public Health (FOPH)
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
Cost of rescue: 50% of costs, max. CHF 5,000 per calendar year (Switzerland)
Up to 18 years of age: CHF 180 per year with a medical prescription
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
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)
Costs for psychotherapy by 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 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!
Premiums depend on where you live, your age and what deductible you choose.
