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  • When costs are incurred for doctors, hospital treatment or medicines, the insured person must at first agree to pay the costs himself/herself. The first share of the costs is called a franchise. The health insurance company will only contribute financially when the costs exceed the arranged franchise amount and in the case of any further costs. In that case the health insurance company pays 90%, and the insured person pays 10%. The maximum the insured person has to pay is 700 Swiss francs per year for adults, and 350 Swiss francs for children up to 18 years old.
  • The amount of the franchise can be fixed by the insured party himself/herself. The higher the franchise, the higher the premium discount.
  • The franchise has to be paid only once per calendar year.
  • Increased franchise amounts can always be reduced at the end of the year.
  • For benefits in the case of a normal pregnancy the insured person pays no costs.
family doctor / GP model
  • In this form of insurance (as in the HMO model) the insured person undertakes always to go to one particular doctor (the gatekeeper). The insured person has already chosen this doctor from a list of doctors who have agreed to take part in this family doctor model.
    Emergencies are the exception to this rule.
  • As a rule the chosen family doctor is a general practitioner or .a doctor for internal medicine. He/She is responsible for the medical care of the insured parties who have chosen him/her as their doctor. When necessary, this doctor will refer the insured person to a specialist.
  • Before arranging a first appointment with a doctor (except in the case of gynaecological check-ups, emergencies and trips/stays abroad) you should first contact the independent telephone medical consultants of the Health Insurance Centre Switzerland. There, highly-qualified specialist staff will give you competent information and concrete recommendations – every day around the clock. 6-8% premium discounts, depending on the health insurance company.
HMO-model HMO = Health Maintenance Organization :

  • HMO is a health Insurance model. In case of illness the insured party undertakes always to go to one particular doctor. This doctor is called the “gatekeeper”. Emergencies are the exception to this rule.
  • Emergencies in the case of HMO insured parties:
    In emergencies the HMO insured parties should always go first to their HMO doctor. If this doctor is not available or it the insured person is not at his/her home or place of work, he/she should go immediately to the nearest available emergency doctor. After the emergency treatment, the insured person should contact his/her HMO doctor to discuss any further action.

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Swiss Health Insurance

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