HMO, Telmed or family doctor? Insurance models compared

Choosing the insurance model is one of the most impactful decisions you can make about your health insurance. Yet most insured people stay on the standard model out of inertia, paying more than necessary. Here is a practical guide to understand the differences and choose consciously.

The standard model: total freedom, maximum cost

With the standard model you can go directly to any Swiss doctor, specialist or hospital, without needing a referral or a first point of contact. It is the most flexible model but also the most expensive. At a time when telemedicine and alternative models offer the same quality of care, paying the surcharge of the standard model is often hard to justify.

The family doctor model: continuity and savings

With this model you commit to always going to your primary care doctor first. They decide whether a specialist is needed and, if so, refer you. The premium saving compared with the standard model is on average 10–20%. The advantage is not only financial: having a primary care doctor who knows your medical history improves the overall quality of care.

The HMO model: the clinic as the entry point

With HMO (Health Maintenance Organization) you register with a specific outpatient facility under contract. That is where you go for any health problem. The advantage is that the facility’s medical staff have immediate access to your whole medical history. Savings can reach up to 25%. The drawback is geographical: you must live near the HMO facility under contract with your insurer.

• HMO: savings up to 25%, ideal if you live near the facility
• Family doctor: savings 10–20%, great for families with children
• Telmed: savings 10–15%, ideal for those who prefer digital convenience
• Standard: no savings, absolute freedom of choice

The Telmed model: the digital revolution

With the Telmed model, before going to any doctor you call a telephone or video medical advice service (available 24/7). The doctor on the phone assesses your case and guides you: can you go to your primary care doctor, do you need a specialist, or is it enough to follow a treatment at home? The saving is 10–15%. It is particularly suitable for those who are comfortable with technology and want to avoid unnecessary queues at doctors’ practices.

How to change model

You can change insurance model at the same deadline as when you change insurer (30 November) or, in some cases, also mid-year if you stay with the same insurer. Important note: the model is always chosen in combination with the deductible. Changing both at the same time is the most effective way to maximise savings. CassaOK automatically shows you all insurer/model/deductible combinations sorted by price in your canton.