Guide

Swiss health insurance models: standard, family doctor, HMO and Telmed

Alejandro Redondo Lázaro · 9 min read · Published 22.08.2026

Swiss basic health insurance, the mandatory cover for almost everyone living in Switzerland, comes in different models. The four most common are the standard model, the family doctor model (Hausarztmodell in German), the HMO model and telemedicine (Telmed), and the main difference between them is who you turn to first when you fall ill. The benefits covered by the law (KVG in German, LAMal in French and Italian) are the same in all of them; what changes is the way you come in and the premium you pay every month. The alternative models bring that premium down in exchange for a commitment.

The four most common Swiss health insurance models, one by one

Standard model (free choice of doctor)

You go straight to any recognised doctor or specialist, with no step in between. It’s the default model, the one that applies if you don’t choose another.

Pros: complete freedom, with nobody in between. Cons: you pay the full premium, with no discount.

Family doctor model (Hausarztmodell)

You choose a named doctor from the product list (the product is the specific version of the policy you take out) and that doctor is always your first point of contact. If you need a specialist, the referral comes from them. For anyone used to registering with a GP practice, this is the model that feels most familiar.

Pros: you’re seen by someone who knows you. Cons: you always go through them.

HMO model (a health centre)

Your first point of contact is one specific medical centre with several doctors. Look at where it is on the map before you sign.

Pros: everything starts in the same place, and its discount is usually among the highest. Cons: it ties you to that centre; if it isn’t close to your home or your work, it stops paying off.

Telemedicine model (Telmed)

Your first point of contact is a phone call or the product app. The service deals with your case or refers you to the right doctor; the commitment is to call before you go, not to give up seeing a doctor. Some cases are settled entirely remotely, prescription included, and whether you get a medical certificate for sick leave (a sick note) depends on the service and on the case. Many services operate in German, French, Italian and English; if you don’t speak any of them, bear that in mind. And teleconsultations aren’t always free. Depending on the product and the type of consultation, they can be billed and count towards your deductible (Franchise, the word printed on your policy) and your co-payment (Selbstbehalt in German, quote-part in French).

Pros: you sort it out from home, with no travelling and no waiting for an appointment. Cons: describing symptoms over the phone doesn’t suit everyone.

What happens if you skip your first point of contact?

If your model says “your family doctor first” and you go straight to a specialist, the insurer can charge you extra, take the discount away, move you back to the standard model or apply whatever penalty its terms provide for; the exact penalty depends on the product. When in doubt, call your insurer before you book the appointment and ask whether that visit has to go through your first point of contact. The rule has two exceptions, and they are worth knowing.

Emergencies: the general exception

In an emergency the model restriction does not apply. You go to the emergency department or call an ambulance, whatever your model. Depending on the product, you may have to tell your insurer or the telemedicine service afterwards; the deadline is in your terms and conditions, and meeting it saves you arguments over the bill.

Gynaecologist and ophthalmologist: the exception in many products

Many products let you go straight to the gynaecologist and to the ophthalmologist (the eye doctor) without going through your first point of contact, normally for check-ups and routine screening. It’s an exception that comes with the particular product, not a rule of the law. Two people on the same model may or may not have it, depending on the product each of them holds. Before you sign, check it in the product terms and conditions, the document you are given when you take out the policy (AVB in German, CGA in French). If you don’t have it, ask your insurer for it.

How much do you save with an alternative model?

The discount isn’t a fixed figure. Each insurer decides it and it changes with your region; the law only obliges the insurer to justify it with a real saving and puts a ceiling on it. So you do the sum with your own numbers, in two steps:

1. Open the premium calculator with your postcode and look at what the standard model costs and what the other three cost.
2. Subtract, then multiply by twelve. 20 francs a month sounds like very little, and it adds up to 240 francs a year.

With the same insurer, the same region, the same deductible and the same accident cover, the standard model is the baseline with no discount and the alternative models offer reduced premiums. Which of the three alternatives wins for you changes from one insurer to another. That’s why a general average is of no use to you.

When can you change your health insurance model?

There are three rules for changing model:

• Moving from the standard model into an alternative one. Since 2025 you can switch from the standard model to a model with limited choice, such as HMO, family doctor or telemedicine, with the same insurer at any time of the year. Ask your insurer through one of the channels it accepts, and ask them to confirm in writing when the change and the new premium take effect.
• Going back to the standard model, or moving from one alternative model to another. Wait for January. It only takes effect on 1 January, and your notice has to REACH the insurer in writing by 30 November at the latest; if that day isn’t a working day, make sure it arrives earlier. Send it in mid-November and it gets there with time to spare.
• Changing insurer. That’s a different matter, with its own timetable, and normally takes effect on 1 January.

If you took out the standard model in a hurry when you arrived in Switzerland, you can ask for the change today.

How to choose your health insurance model

Three questions decide your model:

• Do you rarely see a doctor and sort almost everything out by phone? Telemedicine.
• Do you want a doctor who knows you and follows your case? Family doctor.
• Is there an HMO centre close to home? Look at its price, because sometimes it’s the model that wins.

That leaves the standard model. Paying the full premium in exchange for free choice of doctor is a legitimate call, as long as it’s a conscious decision and not the model you were left with by default. For a newcomer who makes little use of the health system, telemedicine is usually one of the first options worth comparing.

Frequently asked questions

The short version

The main difference between the four models is who you turn to first. The benefits of the basic insurance are the same in all of them; what changes is what you pay. Compare the four prices with your postcode in the premium calculator and, before you sign, read the terms and conditions of the particular product, which is where the exceptions are.

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