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Change insurance model and save on your insurance premiums

13.11.2023

Want to do a check-up on your healthcare provision in addition to your finances and retirement planning? Thanks to our partnership with Sanitas, you have been able to do just that at any PostFinance branch since the end of 2023. So why not take the opportunity to find out what health insurance models are available in Switzerland and how you can save on premiums?

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At a glance

  • Choosing the right insurance model (e.g. telmed, family doctor or HMO model) can significantly reduce your monthly premium – without losing any benefits in your basic insurance.
  • You could save even more, for example by choosing a higher deductible or using generic rather than original drugs.
  • Those who pay their premiums in advance or avoid duplicate examinations can also save, usually without much effort.

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What influence does the health insurance model have on our monthly premium?

By law, anyone living in Switzerland must have basic insurance with a health insurance provider. In this blog post, Sanitas will show you which insurance models are common for basic insurance and how you can save on premiums when choosing a health insurance model.

What does Swiss basic insurance cover?

Basic insurance guarantees fundamental healthcare provision in the event of illness, accident and pregnancy. The basic insurance services are the same for all health insurance providers – regardless of the health insurance model and deductible you choose. The services covered by health insurance are regulated in the Health Insurance Act (HIA).

What health insurance models are available for basic insurance?

Health insurance providers in Switzerland generally offer various health insurance models for basic insurance. The difference lies in your point of contact in the event of illness. These are the common models:

Standard model for health insurers

  • The free choice of doctor model allows you seek out a specialist straight away, without the need to be referred by your GP or any other point of contact. The standard model is suitable for people who want to be able to choose the doctors they are treated by. The free choice of doctor model offers a great deal of flexibility, but it is more expensive than alternative health insurance models.

Alternative health insurance models

  • With the telmed model, you are obliged to call a medical advice hotline stipulated by the health insurer for an initial consultation prior to any doctor’s appointment/hospital visit – unless it’s an emergency or any other case that is not covered by the health insurance provider, such as gynaecological examinations or check-ups with an ophthalmologist. During the initial telmed consultation, you describe your health issues to the hotline staff, who then recommend treatment. Whether this recommendation is binding or not depends on the insurance model. If you choose a telmed model, the premiums are generally lower compared with the standard health insurance model.

  • The family doctor model obliges you to first contact your family doctor practice, which will be familiar with your medical history. If need be, your family doctor will refer you to specialist doctors. The family doctor model does not allow you to go straight to a specialist. In an emergency, and occasionally in the case of gynaecological check-ups and examinations with an ophthalmologist, many health insurance providers make exceptions. However, if you wish to switch to the family doctor model, be sure to check your health insurance provider’s list of doctors, as not all family doctors are recognized.

  • HMO stands for Health Maintenance Organization and is an alternative health insurance model where you always have to consult a group practice or physicians’ network specified by the health insurance provider in the first instance. They will then refer you to specialized doctors if need be. Policyholders can also enjoy a premium discount with the HMO model.

    In addition to these three fundamental alternative models for basic insurance, health insurance providers also offer mixed variants and other health insurance models. At Sanitas, this is known as the network model, which gives policyholders access to the expert network at Medbase.

What is the difference between the family doctor model and the HMO model?

With the HMO model, you select an HMO practice as your first point of contact, rather than your family doctor’s practice. Specifically, this is a group practice or a healthcare center that offers not only GPs, but usually also specialists and therapists in various fields in one place.

Which health insurance models allow a free choice of doctor?

Free choice of doctor is only possible with the standard model. This is the only model that allows you to select the doctor(s) you want for any treatment without the need to consult another point of contact first. All other health insurance models require you to call a medical advice hotline (telmed model), contact your family doctor practice (family doctor model) or a group practice/physicians’ network specified by the health insurance provider (HMO model) in the first instance, before then being referred to specialists if needed. These health insurance models restrict your right to choose your doctor, but you save on premiums.

Do I receive fewer benefits depending on the health insurance model?

No, the services provided under all the basic insurance models are identical.

Do all policyholders with the same health insurance model and deductible pay the same premium for basic insurance?

No, the premium amount also depends on age and place of residence.

What is the difference between basic insurance and additional insurance?

Basic insurance is mandatory, whereas the additional insurance policies are not. While health insurance companies are obliged to accept basic insurance, additional insurance is subject to freedom of contract. In other words: the health insurance provider is free to choose which additional insurance policies it offers and to decide whether to take you on as a policyholder or not.

What do additional insurance policies cover?

Additional insurance policies offer certain services that are not covered (or are only partially covered) by basic insurance, such as dental treatment, alternative medicine and gym membership contributions.

How much can I save if I choose an alternative health insurance model?

As a rule, the telmed, family doctor and HMO models are cheaper for the policyholder than the standard model with free choice of doctor. This is because these health insurance models guarantee efficient and cost-effective medical care that your health insurance providers pass on to you in the form of a premium discount.

Calculate your individual savings potential with the Sanitas premium calculator The link will open in a new window

How can I save on my health insurance premium – savings tips from Sanitas

  • Are you employed at least eight hours a week with the same employer? If so, you are insured through your employer against occupational and non-occupational accidents, and you can remove accident insurance from your basic insurance. This will save you 6.9 percent.

  • If you need to undergo treatment, you have to pay a certain maximum amount towards treatment costs each year as the policyholder. This contribution towards costs is known as a deductible. You can decide for yourself how much this should be: 300, 500, 1,000, 1,500 or 2,500 francs (for adults). As a general rule, the higher the deductible, the lower the premiums. If you select a low deductible, you will pay less towards your treatment costs accordingly. However, the monthly premium is higher. If you increase your deductible, you can save up to 1,540 francs a year on your health insurance premiums. Change your deductible by 31 December for the following year.

  • If you pay your health insurance a whole year or six months in advance instead of monthly, you will get a 1 percent or 0.5 percent discount respectively.

  • If you opt for generic medications, you will normally pay a retention fee of just 10 percent. For original drugs, this fee amounts to 20 percent.

  • If you change doctors or are referred to a specialist, you will frequently end up undergoing duplicate examinations – for instance, if different doctors take X-rays of the same joint in quick succession. Did you know that these records and all examination results in general, such as lab results, belong to you? Request these and bring them to your next doctor’s appointment. This will save you a lot of time and money.

    The link will open in a new window Calculate your individual savings potential with the Sanitas premium calculator

Comprehensive advice on finance, retirement planning and healthcare provision

At 34 PostFinance branches, you can now seek advice not only on finance and retirement planning, but also on healthcare provision. This has been made possible by our partnership with the health insurance company Sanitas. Together with our new healthcare partner, we offer you an even more comprehensive consultation experience in a single place.

With over 800,000 satisfied customers, Sanitas is one of the biggest health insurance companies in Switzerland and offers customized solutions for mandatory basic insurance and additional insurance policies to suit all needs.

Just like PostFinance, Sanitas also consistently promotes simple, innovative and digital solutions and supports customers from all walks of life with optimal services.

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