The four models
Who do you see first?
Standard: You can visit any licensed doctor or specialist without prior approval. There is no gatekeeper and no telephone call required. Premium savings: none (baseline)
Family doctor: You visit your designated GP first. The GP then decides whether to treat you directly or refer you to a specialist. Premium savings of 10–15% compared to standard model
Telmed: You call a medical hotline before visiting any doctor. Medical professionals assess your symptoms and direct you to the appropriate level of care. Premium savings of 10–15% compared to standard model
HMO: All non-emergency care goes through a designated group practice, with GPs and specialists under one roof. Premium savings of 10–20% compared to standard model
What Are Insurance Models in Switzerland?
In Switzerland, every resident must hold basic health insurance (Grundversicherung) under the KVG. The benefits are identical no matter which insurer you choose or which model you select. What differs is how you access care — and how much you pay in premiums.
An insurance model (Versicherungsmodell) determines the pathway you must follow before receiving non-emergency medical treatment. By agreeing to a specific access pathway, you receive a premium discount. How large it is depends on the model and the insurer.
There are four main models available in Switzerland: Standard (free choice of doctor), Hausarzt (family doctor), Telmed (telephone triage), and HMO (group practice). Each has distinct rules, advantages, and limitations. According to the 2026 BAG premium data, the alternative models are typically about 10–13% cheaper than the standard model (adults, CHF 300 franchise, with accident cover). In Zurich, that means a median saving of about CHF 870 to CHF 1,080 per year, without changing your coverage at all.
Important
Regardless of which model you choose, your medical benefits remain exactly the same. The KVG law defines what is covered, not your insurer or model. The only difference is how you access care and what you pay in premiums. In emergencies, all models allow you to go directly to the nearest hospital or emergency department.
The Four Models at a Glance
| Model | How It Works | Premium Savings | Flexibility |
|---|---|---|---|
| Standard | Free choice of any doctor or specialist | None (baseline) | Maximum |
| Hausarzt (Family Doctor) | Must visit your designated GP first | 10–15% | Moderate |
| Telmed (Telephone Triage) | Must call a medical hotline before any doctor visit | 10–15% | Moderate |
| HMO (Group Practice) | Must use a designated group practice for all care | 10–20% | Limited |
Standard Model: Maximum Freedom
The standard model (freie Arztwahl) is the default option. You can visit any licensed doctor, specialist, or hospital in Switzerland without prior approval. There is no gatekeeper and no telephone call required.
How it works: You feel unwell, you go to whatever doctor you want — GP, specialist, walk-in clinic, or hospital outpatient department. You present your insurance card and receive treatment.
Advantages:
- Complete freedom in choosing your healthcare provider
- No referral needed for specialists
- No phone calls or prior authorisation steps
- Ideal if you travel frequently within Switzerland or live near a cantonal border
Disadvantages:
- Highest premiums — you pay the full base rate
- No incentive to coordinate care through a single doctor
Typical premium: CHF 605.20 to CHF 724.00 per month, median CHF 639.80 (adult 26+, Zurich 8001, CHF 300 franchise, with accident cover, 2026).
Best for: People who want maximum flexibility, those with complex medical needs requiring multiple specialists, and anyone who dislikes gatekeeping processes.
Hausarzt Model: The Family Doctor Pathway
The Hausarzt model (also called the family doctor model or GP model) requires you to designate a specific general practitioner as your first point of contact. For any non-emergency medical issue, you must visit this GP first. The GP then decides whether to treat you directly or refer you to a specialist.
How it works: You register a specific GP with your insurer. When you need medical care, you visit this GP first. If your condition requires specialist attention, your GP writes a referral. Without a referral, specialist visits are not covered (except emergencies and certain exceptions like gynaecology and ophthalmology).
Advantages:
- Premium savings of 10–15% compared to standard model
- Continuity of care — your GP knows your medical history
- Coordinated treatment reduces unnecessary duplicate tests
- Many people prefer having a trusted doctor who oversees their health
Disadvantages:
- Must always visit your GP first, even for issues you know require a specialist
- If your GP is on holiday or fully booked, you may face delays
- Changing your designated GP usually requires notifying your insurer
- Not all GPs accept new patients — popular doctors may have waiting lists
Typical premium: CHF 522.80 to CHF 639.30 per month, median CHF 564.60 (same profile as above, cheapest Hausarzt offer of each insurer).
Best for: Families, older adults, anyone who already has a trusted GP, and people who value a coordinated approach to healthcare.
Pro Tip
In most Hausarzt models, direct visits to gynaecologists and ophthalmologists (eye doctors) are permitted without a GP referral. Check your specific insurance conditions — this exception is standard but not universal.
Telmed Model: Phone First, Then Doctor
The Telmed model (also called telephone model or telemedical model) requires you to call a medical hotline before visiting any doctor. The hotline is staffed by qualified medical professionals who assess your symptoms, provide initial advice, and direct you to the appropriate level of care.
How it works: You fall ill or have a medical concern. Before visiting a doctor, you call the insurer’s medical hotline (available 24/7). A nurse or doctor assesses your symptoms over the phone. They may advise self-care, recommend a GP visit, direct you to a specialist, or suggest hospital attendance. You then follow their recommendation.
Advantages:
- Premium savings of 10–15% compared to standard model
- 24/7 professional medical advice — useful for evening and weekend concerns
- Often resolves minor issues without a doctor visit (saving you time and the franchise)
- No need to designate a specific GP — you retain some doctor choice after the call
Disadvantages:
- Must call the hotline before every non-emergency doctor visit
- Some people find the phone call inconvenient or awkward
- Wait times on the hotline can reach 15–30 minutes during flu season
- Language barriers may be an issue for non-German/French speakers (though most hotlines offer English)
Typical premium: CHF 527.90 to CHF 628.50 per month, median CHF 571.90 (same profile as above, cheapest Telmed offer of each insurer).
Best for: Young, healthy adults who rarely visit the doctor, expats comfortable with telephone consultations, and anyone who wants solid savings without committing to a single GP.
What Happens During a Telmed Call?
A typical Telmed call lasts 5–15 minutes. The medical professional will ask about your symptoms, medical history, and any medications you take. Based on this assessment, they issue a recommendation — which you are expected to follow. Common outcomes include:
- Self-care advice: Rest, hydration, over-the-counter medication. No doctor visit needed.
- GP visit: You are directed to visit a general practitioner within a specified timeframe.
- Specialist referral: You receive a recommendation for a specific type of specialist.
- Emergency attendance: You are advised to go to the nearest emergency department immediately.
If you skip the hotline and visit a doctor directly (outside an emergency), your insurer may refuse to cover the costs.
HMO Model: Maximum Savings, Least Flexibility
The HMO model (Health Maintenance Organisation) requires you to receive all non-emergency care through a designated group practice (Gruppenpraxis). These practices employ GPs, specialists, and sometimes physiotherapists and other professionals under one roof.
How it works: You register with a specific HMO centre. For all medical needs, you visit this centre first. The doctors within the HMO coordinate your care. If specialist treatment outside the HMO is needed, the HMO doctors provide a referral.
Advantages:
- Premium savings of 10–20% compared to standard model, often similar to Telmed
- Integrated care — multiple specialists under one roof reduce fragmented treatment
- Short referral paths within the practice
- Particularly cost-effective when combined with a high franchise
Disadvantages:
- Must use the designated HMO centre for all care
- Limited to the doctors available at that centre
- HMO centres are mainly located in cities — limited availability in rural areas
- Changing HMO centres is more restrictive than changing a Hausarzt
- Personal relationship with a specific doctor is less guaranteed
Typical premium: CHF 517.70 to CHF 630.90 per month, median CHF 561.25 (same profile as above, cheapest HMO offer of each insurer).
Best for: City dwellers who want a solid premium discount, healthy individuals who rarely need care, and people comfortable receiving all care at a single location.
How Much Can You Actually Save?
The following table shows real 2026 premiums for one insurer, Concordia, for an adult aged 26+ in Zurich (postcode 8001) with a CHF 300 franchise and accident cover. We chose Concordia because its standard premium and its discounts are close to the Zurich median.
| Model | Monthly Premium | Annual Premium | Annual Savings vs. Standard |
|---|---|---|---|
| Standard | CHF 636.20 | CHF 7,634.40 | None (baseline) |
| Hausarzt | CHF 563.10 | CHF 6,757.20 | CHF 877.20 |
| Telmed | CHF 553.50 | CHF 6,642.00 | CHF 992.40 |
| HMO | CHF 544.00 | CHF 6,528.00 | CHF 1,106.40 |
Source: BAG premium data 2026, Zurich premium region 1, cheapest offer per model. Across all insurers in Zurich that offer each model, the median annual saving against the insurer’s own standard premium is CHF 874 (Hausarzt), CHF 1,019 (Telmed) and CHF 1,083 (HMO). Your actual savings depend on your insurer, canton, age and franchise.
Combining a model change with a higher franchise amplifies the savings. An adult in Zurich switching from Standard + CHF 300 franchise to HMO + CHF 2,500 franchise with the same insurer saves CHF 2,030 to CHF 3,070 per year, depending on the insurer (median CHF 2,623; both with accident cover, 2026). Employees who have accident cover through their employer and drop it from their health insurance save CHF 2,312 to CHF 3,424. Keep in mind that with the higher franchise you pay up to CHF 2,200 more yourself in a year with high medical costs.
Which Model Should You Choose?
| Your Situation | Recommended Model | Why |
|---|---|---|
| You see multiple specialists regularly | Standard | Direct access to specialists without referrals |
| You already have a trusted GP | Hausarzt | Formalises what you already do, with a premium discount |
| You are young and healthy, rarely see a doctor | Telmed or HMO | Good savings, minimal inconvenience if rarely used |
| You live in a major city (Zurich, Bern, Basel) | HMO | Best availability of HMO centres, discounts similar to Telmed |
| You live in a rural area | Hausarzt or Telmed | HMO centres may not exist near you |
| You are an expat with limited German/French | Standard or Telmed | Standard for flexibility; Telmed hotlines often offer English |
How to Switch Your Insurance Model
Switching your model follows the same rules as switching your insurer or franchise:
- Switching to a more restrictive model (e.g., Standard to HMO): You can do this when switching insurers (deadline: November 30) or sometimes mid-year with your current insurer — check your policy conditions.
- Switching to a less restrictive model (e.g., HMO to Standard): Usually possible at the next renewal date. Some insurers allow mid-year changes with notice.
- Switching models when changing insurer: You can freely choose any model offered by your new insurer when you switch. The deadline is November 30 for a January 1 start.
Always confirm model availability with your new insurer before cancelling your current policy. Not every insurer offers every model in every region.
Important
Switching your insurance model does not affect your medical benefits in any way. You receive exactly the same treatments, medications, and hospital coverage regardless of model. The only thing that changes is the pathway you follow to access care and the premium you pay.
Common Mistakes When Choosing a Model
Choosing HMO Without Checking Availability
HMO centres are concentrated in urban areas. If you live in a smaller town or rural area, the nearest HMO centre may be 30 minutes away. Always verify that a convenient HMO location exists before committing. Your insurer’s website will list available centres by postcode.
Worrying About Emergencies
All models — including HMO and Telmed — permit direct emergency department visits without prior calls or referrals. If you have a genuine emergency (chest pain, severe injury, breathing difficulties), go straight to the hospital. No insurer will deny coverage for emergency treatment regardless of your model.
Ignoring Models Entirely
Many residents — especially expats — stay on the standard model simply because they do not know alternatives exist. If you are healthy and rarely visit the doctor, switching to Telmed or HMO is one of the easiest ways to reduce your insurance costs significantly.
Want help choosing the right model?
Book a free consultation — 45 minutes by video, no obligation.
Frequently Asked Questions
Do I get the same medical benefits with all models?
Yes. The KVG mandates identical benefits across all models and insurers. What changes is the access pathway (how you reach a doctor) and the premium you pay. Your treatments, medications, and hospital coverage are exactly the same.
Can I go to the emergency room with an HMO or Telmed model?
Yes. In emergencies, you can go directly to the nearest hospital or emergency department without calling a hotline or visiting your GP first. All models explicitly allow this. If in doubt about whether something is an emergency, call the hotline — they will direct you appropriately.
What happens if I visit a specialist without a referral in the Hausarzt model?
Your insurer may refuse to cover the costs. In practice, some insurers issue a warning for a first offence, but repeated violations can result in denied claims. Gynaecology and ophthalmology visits are usually exempt from the referral requirement.
Can I switch models mid-year?
It depends on your insurer and the direction of the switch. Some insurers allow mid-year model changes; others only permit changes at renewal (January 1). When switching to a new insurer, you can always choose any available model. Check your policy conditions or call your insurer to confirm.
Are Telmed hotlines available in English?
Most major insurers (SWICA, Helsana, CSS, Sanitas) offer English-language Telmed services. However, availability may vary — especially late at night or on weekends. Ask your insurer about language options before committing to a Telmed model.
How much can I save by combining a model change with a higher franchise?
The combined effect is significant. In Zurich, switching from Standard + CHF 300 franchise to HMO + CHF 2,500 franchise with the same insurer saves CHF 2,030 to CHF 3,070 per year (adult, with accident cover, 2026). This is one of the largest premium savings available within basic insurance without changing insurer. With the higher franchise, you pay up to CHF 2,200 more yourself in a year with high medical costs.
Is the Hausarzt model the same as having a family doctor?
Functionally, yes. The Hausarzt model formalises the practice of always seeing your GP first. If you already visit a GP for all initial consultations, switching to the Hausarzt model simply gives you a premium discount for doing what you already do.
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Nicole Bohne
Pension & Relocation Advisor
Nicole Bohne has worked in insurance and pensions for 10 years, including at Basler and Zurich. She specialises in pensions (pillar 3a, risk cover, tax) and in the insurance questions that come with moving to Switzerland. FINMA-registered intermediary (F01536402); she advises in German, English and French.
