Health insurance: Insurance models with a restricted choice of service providers
Insurance models enable insured persons to restrict their right to choose to selected service providers. These are determined by the insurer with a view to more cost-effective care.
Insurance models are insurance plans with a restricted choice of service providers. They enable insured persons, in agreement with the insurer, to restrict their right to choose selected service providers. These are determined by the insurer with a view to more cost-effective care.
As compensation for the restricted choice of service providers, insurers may reduce the premiums for these insurance models. As a result, premiums may be lower than those for insurance plans without a restricted choice of service providers.
Insured persons undertake to first consult the designated point of contact provided for in the selected model in the event of health problems. The models may, for example, include requirements regarding the choice of specific service providers or the dispensing of medicines. They are divided into different categories, which differ regarding the first point of contact for health-related questions.
Starting with the 2027 premiums the new categories PRAXIS, PHARM, TEL_DIG and FLEX will be introduced in the premium calculator on www.priminfo.admin.ch.
The new categories better reflect the models with restricted choice of service providers currently offered by insurers. Due to the further development of insurance models on the insurance market, it was no longer possible to distinguish the previous categories from one another clearly enough. In particular, the difference between the “GP” and “HMO” models was no longer significant.
The “GP” and “HMO” categories will therefore be grouped together under the name ‘PRAXIS’ in future. The “Other Models” category, which mainly comprised telephone models, will be renamed “TEL_DIG”. In addition, two new categories are being created: “PHARM” and “FLEX”.
The PRAXIS category
For models in the PRAXIS category, the first point of contact for health-related questions is always a designated medical practice (e.g. a general practitioner or a medical centre). If necessary, this practice refers the insured person to a specialist for further treatment.
The TEL_DIG category
For models in the TEL_DIG category, the initial contact takes place by telephone or digitally, for example via a telemedicine centre or an app.
The PHARM category
For models in the PHARM category, the first point of contact for health-related questions is a partner pharmacy of the insurer.
The FLEX category
For models in the FLEX category, several first points of contact for health-related questions are available to choose from. Insured persons are free to choose between several first points of contact, for example between a GP’s practice and a telemedicine centre, or between a telemedicine centre and a partner pharmacy.
Note:
Insurers offer different models. Before making a choice, insured persons should carefully review the terms and conditions of insurance and the relevant documentation (product descriptions, website, etc.) and assess whether the model is suitable for their personal circumstances.
Further information
Federal Office of Public Health FOPH
Insurance Supervision Division
Schwarzenburgstrasse 157
Switzerland - 3003 Bern