Everything you need to know about the Telmed health insurance model
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The Telmed model, for telemedicine, is one of the most popular in Switzerland. It offers the same coverage as basic health insurance, at a preferential rate. To obtain this discount, however, policyholders must comply with certain obligations, which may vary from one health insurance company to another, or depending on the plan chosen. Here's a look at the insurance obligation. What are the basic benefits? What is the Telmed model? What are the advantages and disadvantages of this model? What are the other alternative models?
The obligation to take out health insurance
The federal law of March 18, 1994 on health insurance (LAMal) stipulates that all persons domiciled in Switzerland must contribute to a health insurance to cover the risks of illness and accident, as well as maternity. The aim here is to enable everyone to benefit from basic coverage for the most common healthcare needs.
Insured persons must therefore approach an insurance company in order to join. Health insurance is not centralized. The FOPH, the Federal Office of Public Health, is responsible for overseeing the administration of the health protection part of private insurers.
Joining a health insurance scheme is not free. The amount of the premium varies according to several factors, including the insured's age and place of residence. It is possible to benefit from a premium reduction, particularly for people on lower incomes. Subsidy applications are administered by the cantons.
LAMal: basic health insurance
All insurers offer basic health insurance, commonly known as LAMal, after the law governing its application. This minimum cover must necessarily cover the most common treatments such as reimbursement for prescription drugs, specialist consultations, hospitalization in a shared room, etc.
As a reminder, each individual is free to choose the insurance company with which he or she wishes to cover the risk of illness and accidents. It is therefore advisable to contact a structure represented in your canton.
Note that insurance companies do not have the right to refuse an application for membership. They are also forbidden to present a health questionnaire to their future members when signing their contracts.
Each company is free to offer the rate it wishes. It is therefore essential to comparison several proposals before committing yourself. To do this, you can use an insurance comparator such as Comparea.
Telmed: zoom in on one of the alternative health insurance models
There are several alternative models to LAMal. Among them is the Telmed model for telemedicine.
Policyholders choosing a Telmed health insurance plan are required to contact a dedicated telephone platform before visiting a healthcare professional. The online advisors, all healthcare professionals, are responsible for listening to policyholders, possibly making a preliminary diagnosis, then referring them to a healthcare professional according to their care needs. Insureds can also send a photo to help advisors gain a better understanding of their state of health, particularly in the event of injury.
There are different variants of the Telmed model, depending on the formula chosen:
- Insureds are obliged to call the call center before consulting a doctor or any other healthcare professional. However, they may not follow the advice of their caller and remain free to consult the doctor of their choice.
- Policyholders must imperatively contact the platform. They are obliged to follow their advisor's recommendations. If they fail to do so, they will not be able to receive coverage for their care.
- In addition to having to follow their advisor's recommendations, policyholders must imperatively consult a healthcare professional partnered with the insurance company.
Please note, certain treatments are among the exceptions and can therefore be received without first going through the Telmed platform. These include:
- Emergencies;
- Preventive annual gynecological examinations
- Preventive ophthalmological examinations.
What are the advantages and disadvantages of the Telmed model?
The big advantage of the alternative Telmed model is that it allows you to benefit from a substantial premium reduction. Indeed, policyholders choosing this option can claim a 15% to 20% reduction in premium compared with the basic model.
Another advantage is that this system provides 24/7 access to healthcare professionals who can answer any questions their policyholders may have. Some companies even offer the possibility of being called back by a doctor if the situation requires it.
Receiving a detailed care pathway also saves time and thus limits unnecessary consultations.
But choosing the Telmed model also requires compliance with a number of constraints:
- It is imperative to call the health platform before receiving care (except in emergencies, of course);
- Some insurance companies require their policyholders to follow the care pathway drawn up by their advisors;
- Some health insurance companies impose a list of doctors who must be consulted to receive coverage for care;
- In the event of failure to comply with the procedure imposed by the insurance company, policyholders cannot receive coverage for care received and may even sometimes be excluded by their insurer.
Other alternative health insurance models
LAMal and Telmed are not the only models that can be chosen by people domiciled in Switzerland to cover sickness, maternity and accident risks. There are two others:
- the HMO;
- The family doctor.
HMO
The HMO model, for Health Maintenance Organization, works on the same principle as Telmed. However, in this case, policyholders are not required to contact a telephone platform. Instead, they must approach a doctor who is part of an HMO center. These places bring together several healthcare professionals, from various disciplines. Each policyholder has a referring HMO doctor to whom he or she must give priority. It is this doctor who determines the care protocol and directs his or her patient to specialists and/or colleagues who can meet their needs. An HMO doctor can also refer patients to a hospital.
The advantage of using this model of health insurance is that HMO centers are often very well equipped. For example, they frequently include a medical analysis laboratory, a radiology center and so on. Insureds can therefore receive a maximum of care and examinations on the spot. What's more, like all other alternative models, the HMO allows you to benefit from a premium reduction.
The only limitation of this system is that there are still too few HMO centers to cover the whole of Switzerland.
Family doctor
The family doctor model is the most popular after the basic formula. In this case, the policyholder designates a referral doctor whom he or she must consult first before being referred to another practitioner.
Here too, policyholders benefit from a premium reduction compared with standard health insurance.
The family doctor model enables the patient to maintain a close relationship with his or her referral healthcare professional. On the other hand, if the patient wishes to receive a second opinion, he or she cannot consult another healthcare professional without the approval of his or her family doctor. Indeed, if they ignore this obligation, they will not be reimbursed not only for the consultation, but also for any care arising from it.
List of Telmed models by company
Updated on: 01.02.2024Written by Alexis MilonHead of health insurance department at Comparea.To learn more about our team click here.
Frequently Asked Questions
Telephone advice before each visit to the doctor helps you keep medical costs down. In addition, the telmed model offers average premium savings of 15-20%.
In the following cases, you are not required to consult the telemedicine center first:
- In case of emergency
- Consultation with a gynecologist
- Consultation with an ophthalmologist
- Consultation with a midwife
