Health Insurance Models in Switzerland: HMO, Telmed & Hausarzt Explained

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. The more restrictive the pathway, the larger the discount.

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. Choosing the right model for your situation can save you CHF 1’000 to CHF 3’000 per year — without changing your coverage one bit.

The Four Models at a Glance

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 420–480 per month (adult 26+, Zurich, CHF 300 franchise, with accident coverage).

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 370–420 per month (same baseline as above).

Best for: Families, older adults, anyone who already has a trusted GP, and people who value a coordinated approach to healthcare.

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 12–18% 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 355–400 per month (same baseline as above).

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:

• Highest premium savings of 15–25% compared to standard model
• 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 320–380 per month (same baseline as above).

Best for: City dwellers who want maximum premium savings, 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 approximate annual savings for each model compared to the standard model, for an adult aged 26+ in Zurich with a CHF 300 franchise.

*Figures are illustrative averages across major insurers in Zurich. Your actual savings depend on your insurer, canton, age, and franchise level. Source: BAG-approved 2026 tariffs.

Combining a model change with a higher franchise amplifies the savings. An adult switching from Standard + CHF 300 franchise to HMO + CHF 2’500 franchise could save CHF 2’500 to CHF 3’600 per year.

Which Model Should You Choose?

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.

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.

About the Author

Insurance Guide

Our editorial team has over 15 years of experience in the Swiss insurance market and has helped over 2,500 clients navigate the federal KVG system.

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