What are the alternative models for KVG/LAMal health insurance?

As a general rule, the Standard Model is the most expensive model among insurers. Nevertheless, it's the model that offers you the most flexibility and freedom in the event of health problems.

With the standard model, you're covered for the benefits provided by the LAMal in the event of illness, maternity or accident (unless accident insurance is taken out by your employer)

If necessary, you can call on the doctor of your choice without going through your regular doctor.

The standard model also allows you to reduce your premium by increasing your deductible. As a reminder, adult deductibles range from CHF 300 to CHF 2,500.

Alternative models include family doctor, HMO and Telmed models. Through these models, premium reductions of up to 25% are possible. How do you choose the right model for your profile?

The main contact for policyholders who have chosen a family doctor model is a doctor of their choice, provided that this doctor is included in the insurer's model. To choose a specific doctor, you need to determine whether that doctor is part of your health insurer's family doctor model.

The family doctor is responsible for the insured's care and medical coordination. If medically necessary, he or she will refer the insured to a specialist. Depending on the health insurer and the general practitioner model, the insured may choose a doctor independent of the recommended specialist.

HMO stands for Health Maintenance Organization. Those who have chosen this model should always start by contacting the chosen medical center, which must be within a radius of the insured's home or work. The medical center plans and coordinates the rest of the care pathway.

When a new health problem arises, those who have chosen the Telmed model must first contact a medical consultation center. Then, by telephone or visio, healthcare professionals can give them information and recommendations on what to do next, issue a prescription or medical certificate, or refer them to a doctor, hospital or therapist. Accessible 24 hours a day, free telephone interview.

With Telmed's classic model, customers are free to choose their doctor after a telephone interview. However, there are also models that impose medical care and follow-up (hybrid or mixed models). For example, these models may offer a choice between a GP, a health center or a pharmacy.

From 2020, there are also so-called hybrid or mixed models. The number of first contacts is two or three from among family doctors, health centers, call centers or pharmacies. Depending on the model, the policyholder chooses the primary contact from among those offered, which remain in force for the duration of the contract or may change over time.

HMO models generally offer the most attractive premium discounts, but they can also be very limited. Make sure the hospitals, doctors and pharmacies that are part of your healthcare network are close to home.

In general, take the time to read the General Terms and Conditions of Insurance before drawing any conclusions, even if the discounts corresponding to alternative models seem tempting. Indeed, if you choose an insurance model and do not respect it (for example, consult a doctor who is not on the list drawn up by your mutual insurance company), you risk not being reimbursed for your medical expenses.

Therefore, it's important to know in advance what the circumstances will be in the event of abuse. If you still wish to retain your choice of doctor, you have the option of opting for the traditional model.