The right health insurance model can save you several hundred francs in premiums each year without giving up the statutory benefits of basic insurance. But which model is right: HMO, family doctor, Telmed or the standard model with free choice of doctor?
Insurance models mainly differ in who you must contact first when you have a health concern. With the standard model, you can generally choose your doctor freely, while cheaper models require you to follow certain procedures.
Since 2027, Switzerland also has a new official classification of insurance models.
This guide explains how each model works, its advantages and disadvantages, and what to consider when comparing health insurers.
Health insurance models compared
All models are part of compulsory basic insurance under the Swiss Health Insurance Act (KVG/LAMal). Statutory benefits are generally identical.
The main differences are the first point of contact, free choice of doctor and monthly premiums.
| Model | First point of contact | Choice of doctor | Premium |
|---|---|---|---|
| Standard | Freely chosen practice | Generally free | Usually higher |
| Family doctor | Chosen family doctor’s practice | Coordinated through family doctor | Usually cheaper |
| HMO | Designated practice or medical centre | Coordinated through medical network | Usually cheaper |
| Telmed | Telephone or digital advice | Following initial advice | Usually cheaper |
Important: there is no universal answer to which alternative model offers the lowest premium. Offers vary by insurer, where you live, deductible and specific tariff.
1. Standard model: free choice of doctor without additional model rules
The standard model is the traditional form of Swiss basic insurance. It offers the greatest freedom in choosing your doctors.
If you have a health concern, you can generally go directly to an authorised doctor or specialist of your choice. Prior consultation with a designated family doctor or telemedicine centre is not required.
Advantages of the standard model
- Generally free choice of authorised doctors
- Direct access to specialists without a model-specific referral
- No compulsory initial telephone or digital consultation
- Particularly flexible when you have several treating doctors
Disadvantages of the standard model
The main disadvantage is the premium. Because you do not restrict your choice of doctor in favour of a cheaper care model, you do not receive the corresponding model discount.
The standard model is therefore often among an insurer’s most expensive offers.
Who is the standard model suitable for?
The standard model may suit you if you want to choose your own doctors, regularly see different specialists or do not want to follow the rules of a particular care model.
It is not automatically the best choice for people with high healthcare costs. Alternative models can also provide comprehensive care, provided their access rules are followed.
2. Family doctor model: your family doctor as the first point of contact
With the family doctor model, you choose a practice from your insurer’s directory. This practice is your first point of contact for health concerns.
If you need specialist treatment, your family doctor’s practice arranges a referral to an appropriate specialist.
The idea is that one central point of contact coordinates your care and helps avoid unnecessary duplicate examinations and treatment.
Advantages of the family doctor model
- Personal care from a familiar practice
- Coordination of treatment and referrals
- Generally lower premiums than the standard model
- Particularly practical for long-term medical care
Disadvantages of the family doctor model
Free choice of doctor is restricted. You cannot simply go directly to any specialist; you normally have to contact your chosen family doctor’s practice first.
Your preferred practice must also participate in the particular insurance model.
Before signing up, check that your current family doctor is listed in the insurer’s directory. A doctor may be accepted by one insurer but not included in another model.
Who is the family doctor model suitable for?
The family doctor model is particularly suitable for people who already have a regular family doctor’s practice and like receiving care there.
Coordinated care can also be useful for families or people with chronic conditions.
3. HMO model: treatment through a group practice or medical network
HMO stands for Health Maintenance Organization. With the HMO model, basic medical care is provided through a designated practice, health centre or affiliated medical network.
For health concerns, you contact this designated provider first.
If you need a specialist, the medical centre or responsible practice coordinates further treatment.
What is the difference between HMO and the family doctor model?
Traditionally, the difference lies in how medical care is organised:
- The family doctor model centres on a chosen family doctor’s practice.
- In the HMO model, care is often provided within an organised medical network or health centre.
In practice, these differences are now often small. Family doctor models also work with medical networks, while some HMO models use individual partner practices as the first point of contact.
Since the 2027 premium year, both types of model are therefore grouped under PRAXIS in the federal government’s official premium comparison.
Advantages of the HMO model
- Coordinated medical care
- Sometimes several specialists within one medical centre
- Usually cheaper premiums than the standard model
- Central point of contact for further treatment planning
Disadvantages of the HMO model
Your choice of treating practice is limited to participating medical centres or networks.
Referrals to specialists are also normally arranged through your HMO provider.
Depending on where you live, the available network may be small. Especially in rural areas, check whether a suitable practice is easy to reach.
Who is the HMO model suitable for?
The HMO model is attractive if you like receiving care at a medical centre, value coordinated care and have a suitable medical network nearby.
4. Telmed model: telephone or digital advice first
With the Telmed model, you must contact a medical advice service before an ordinary doctor’s visit.
Depending on your insurance offer, this first contact is by phone, app or another digital service.
Medical staff assess your concern and recommend the next steps.
For simple concerns, telemedical advice may be enough. If an in-person examination is needed, you are directed to an appropriate practice or specialist.
Advantages of the Telmed model
- Initial medical advice without travelling
- Available around the clock depending on the provider
- Practical for simple health questions
- Often attractive premiums
- Particularly suitable for people who like using digital services
Disadvantages of the Telmed model
Before a doctor’s visit, you normally have to contact the prescribed advice service.
This can be inconvenient for recurring symptoms or regular doctor visits.
Telmed models also differ: some providers accept an initial digital assessment, while others require a binding telephone consultation or specific approvals.
Who is the Telmed model suitable for?
Telmed may suit people who rarely visit a doctor in person, want to discuss medical questions easily by phone or are comfortable with digital services.
If you prefer to go straight to your familiar practice, a family doctor model might suit you better.
New since 2027: PRAXIS, TEL_DIG, PHARM and FLEX
With health insurance premiums for 2027, the Federal Office of Public Health (FOPH) reorganised the categories for alternative insurance models in the official premium calculator.
The change aims to make Swiss insurers’ many offers clearer and easier to compare.
The new categories are:
| 2027 category | Meaning |
|---|---|
| PRAXIS | First contact is a designated practice or medical centre |
| TEL_DIG | First contact is telephone or digital advice |
| PHARM | First contact is a partner pharmacy |
| FLEX | Choice between several designated initial contact points |
PRAXIS: family doctor and HMO combined
PRAXIS groups together the previous family doctor and HMO models.
For health questions, you first contact the agreed practice or medical centre, which coordinates further treatment.
TEL_DIG: telephone and digital models
TEL_DIG includes models where the first medical contact is by phone or digitally.
These include traditional Telmed offers and models with compulsory initial digital advice.
PHARM: the pharmacy as the first point of contact
With PHARM models, you first consult an insurer’s partner pharmacy about health questions.
The pharmacy assesses whether advice is sufficient or medical treatment is needed.
FLEX: a choice of first points of contact
FLEX models combine different options for initial contact.
Depending on the offer, you might choose between a family doctor’s practice, a telemedicine centre or a partner pharmacy.
Important: FLEX does not mean free choice of doctor as in the standard model. You can only choose between the initial contact points specified in your insurance contract.
The new classification does not automatically change the terms of your existing insurance. The specific rules of your chosen offer remain decisive.
Are benefits worse with HMO, family doctor and Telmed models?
No. Statutory benefits under compulsory basic insurance are generally the same across all insurers and insurance models.
These include medically necessary doctor treatment, certain medicines, hospital treatment covered by law and other compulsory benefits.
The key difference is access to medical care, rather than the statutory list of benefits.
With alternative models, you agree to follow certain procedures. These may include rules about initial contact, specialist referrals or dispensing medication.
Failure to follow these terms may have financial consequences depending on the contract.
Can I go directly to a specialist?
That depends on your chosen insurance model.
With the standard model, you can generally go directly to an authorised specialist, provided the service does not otherwise require a medical prescription.
Family doctor, HMO and Telmed models normally require a prior referral or approval.
Exceptions for gynaecology, eye care and emergencies
Many insurers allow certain direct doctor visits without prior contact.
Such exceptions often include:
- Gynaecological screening and certain pregnancy examinations
- Certain eye examinations
- Medical emergencies
However, these exceptions are not the same for every insurer and model.
For eye care, for example, a distinction may be made between a routine check and further specialist treatment.
Check your insurer’s model terms before going directly to a specialist.
What happens in a medical emergency?
In a genuine medical emergency, necessary care comes first. You do not have to delay life-saving treatment to contact your usual model provider first.
However, many alternative insurance models require you to report an emergency afterwards.
How quickly you must report it and which details are needed depend on the insurer and model.
Learn these rules before an emergency and save your insurer’s relevant phone number.
What happens if I do not follow my insurance model’s rules?
A common mistake is going directly to a specialist practice even though the chosen model requires a prior referral.
Depending on the insurance terms, this may have financial consequences.
For example, the insurer may require additional cost sharing or apply other measures specified in the contract.
The possible consequences differ between insurers.
A lower premium only pays off if you can and want to follow the chosen model’s rules in everyday life.
How much can I save with an alternative insurance model?
With an alternative insurance model, you often pay a lower monthly premium in return for restricted choice of doctor.
The saving depends on your insurer, where you live, age, deductible and specific model.
Example: CHF 60 in premium savings per month
Suppose you receive the following offers with the same deductible and accident cover:
| Standard model | Alternative model | |
|---|---|---|
| Monthly premium | CHF 450 | CHF 390 |
| Annual premium | CHF 5'400 | CHF 4'680 |
| Annual saving | – | CHF 720 |
This fictional example shows that a difference of just CHF 60 per month produces an annual saving of CHF 720.
For a household with several insured people, the total premium saving can be higher.
This does not mean every family doctor, HMO or Telmed model is automatically cheaper than every standard model offered by another insurer.
You should therefore compare offers from different insurers.
Which health insurance model suits me?
Choosing the right model mainly depends on how you want to use medical services.
You want to choose your own doctor
The standard model then offers the greatest freedom, but you should normally expect a higher premium.
You already have a family doctor you trust
A family doctor model may suit you if your practice participates in the desired model and you already go there first.
You want coordinated care at a medical centre
An HMO model may suit you if a suitable medical centre or network is available nearby.
You like using digital services
A Telmed or TEL_DIG model may be attractive if you want straightforward initial medical assessments by phone or online.
You want to combine different contact points
A FLEX model may be a suitable alternative if you do not want to commit exclusively to a family doctor’s practice or telemedicine centre.
You regularly need medical treatment
Pay particular attention to referral rules, the organisation of ongoing treatment and the accessibility of medical contact points.
A chronic condition does not rule out a cheaper insurance model. What matters is that the chosen care structure meets your needs.
Insurance model and deductible: what is the difference?
The insurance model and deductible are two separate decisions.
The insurance model mainly determines how you access medical services and which provider you must contact first.
The deductible determines how much you initially pay yourself towards covered healthcare costs each calendar year.
Adults can choose deductibles between CHF 300 and CHF 2,500.
You can generally also choose a high deductible with a family doctor, HMO or Telmed model, benefiting from two ways to save.
However, a high deductible increases your potential financial contribution. Check your expected healthcare costs as well as the monthly premium.
Further reading: Which deductible is right for you? CHF 300 or 2,500?
Can I change my health insurance model?
Yes. You can change your insurance model under Swiss basic insurance.
You need to distinguish between choosing another model with your existing insurer and switching health insurer at the same time.
Changing model with the same insurer
If you are already insured under an alternative model, you can generally switch to another model on 1 January.
Switching from the standard model to a model with restricted choice of providers is generally also possible during the year.
Ask your insurer in good time about your specific switch.
Switching to another insurer
If you also want to switch insurer, the statutory cancellation deadlines for basic insurance apply.
To switch on 1 January 2027, your cancellation must reach your current insurer by 30 November 2026 at the latest.
Further reading: Switching health insurer in 2027: deadlines, cancellation and steps
Compare health insurance models for 2027
Premiums differ between insurers and between the insurance models they offer.
Before signing up, it is worth checking different combinations of insurer, model and deductible.
Pay particular attention to the annual premium, your preferred practice, available medical networks and the rules for referrals and initial consultations.
Compare health insurance premiums now: on K-Check, you can compare premiums for where you live and find suitable offers for 2027.
Frequently asked questions about HMO, family doctor, Telmed and standard models
Which health insurance model is cheapest?
No model is cheapest for every insurer and location. HMO, family doctor and Telmed models are often cheaper than the same insurer’s standard model. What matters is the actual premium offered for where you live, your age and deductible.
What is the difference between HMO and the family doctor model?
The traditional family doctor model centres on a chosen practice. HMO models often use organised medical networks or health centres. As these models increasingly resemble each other, the official premium calculator groups them under PRAXIS from the 2027 premium year.
Do I have to call before every doctor’s visit with Telmed?
You generally need to use the designated initial telephone or digital advice service before medical treatment. Whether this is required for every consultation and which exceptions apply depend on your model’s terms.
Can I keep my current family doctor in the HMO model?
This is possible if your current practice belongs to the relevant medical network or is approved as a contact point for the model. Check before switching.
Can I go directly to a gynaecologist with the family doctor model?
Many insurers allow certain gynaecological examinations without prior referral. The exact exceptions are defined in the insurance terms.
Does Telmed cover the same benefits as the standard model?
Yes. Statutory benefits under compulsory basic insurance are generally the same. Differences concern access rules and potentially other model requirements.
What do PRAXIS, TEL_DIG, PHARM and FLEX mean?
These are the official categories for alternative basic insurance models used from the 2027 premium year. They differ in whether first contact is through a practice, digital advice, partner pharmacy or a choice of several contact points.
Is the standard model with free choice of doctor always better?
No. It offers more freedom in choosing doctors but is often more expensive. If you can comfortably follow an alternative model’s rules, you still receive statutory basic insurance benefits with a cheaper insurance option.
Conclusion: the right model combines low premiums with suitable care
HMO, family doctor, Telmed and standard models generally offer the same statutory Swiss basic insurance benefits. The main difference is how you access medical treatment.
The standard model allows largely free choice of doctor. The family doctor model centres on your chosen practice, while HMO often uses medical networks and health centres. Telmed models require initial telephone or digital advice.
Since 2027, the new PRAXIS, TEL_DIG, PHARM and FLEX categories make the options clearer.
The cheapest premium is not the only consideration. Choose a model whose rules fit your everyday life and medical needs.
Compare current health insurance premiums on K-Check and find out how much you can save with a suitable insurance model.