Health insurance models decide how you enter Switzerland’s healthcare system and how much you pay for the privilege—often shaving 20 % to 30 % off premiums compared with the default Standard plan. Yet 7 in 10 residents still stick to Standard because they don’t understand the trade-offs. In the next few minutes you’ll learn the four legal models, see their pros & cons side-by-side, discover which deductible pairing multiplies savings, and leave with an action checklist you can finish before dinner.
Think of each model as a “rules of engagement” contract. The stricter the rules you accept, the more predictable you become for the insurer—and the more of their cost savings they pass back to you. Layer in the right deductible (franchise) and you can cut a family’s annual bill by four-figures while keeping identical medical benefits under LaMal.
Contents – Health Insurance Models Guide
- 1. Why the Model Matters
- 2. Model-by-Model Comparison Table
- 3. Best Deductible Pairings
- 4. How to Choose in 60 Seconds
- 5. Three Extra Savings Hacks
- 6. FAQs
1. Why the Model Matters
Your premium is a cocktail of three levers: canton, deductible, and health insurance model. Canton you can’t change easily. Deductible is the portion you front-load. The model is the lever most people overlook—even though it controls up to one-quarter of your bill.
Here’s the invisible handshake: move from Standard to Telmed or HMO and you promise the insurer a predictable first step—either a phone triage or a fixed network doctor. That predictability lets actuaries forecast costs with tighter margins, so the insurer happily refunds part of the savings to you each month.
2. Model-by-Model Comparison Table
| Model | How It Works | Prime Benefit | Main Trade-off | Premium Impact* |
|---|---|---|---|---|
| Standard | Free choice of any doctor | Total flexibility | Highest cost | Baseline |
| Family-Doctor (GP) | Your GP is mandatory first contact | 10–15 % cheaper, continuity of care | Need referrals for specialists | -10 % to -15 % |
| HMO | Care inside an HMO clinic or network | 15–20 % cheaper, on-site labs | Must stay in network, rural gaps | -15 % to -20 % |
| Telmed | 24/7 tele-doctor screens cases first | Cheapest model, instant phone advice | Must follow phone protocol | -20 % to -25 % |
*Percentages differ by canton and insurer, but the direction is universal: stricter access rules → lower premium. Crucially, medical benefits remain identical under LaMal once you’re referred.
3. Best Deductible Pairings
Quick rule: If your medical bills are under CHF 1’800 a year, choose the biggest deductible, CHF 2’500.
- Standard + CHF 300 — Highest premium, but no rules on which doctor you see. Good if you need many specialists.
- HMO / Telmed + CHF 2’500 — Lowest premium. Best for healthy people with small yearly bills (under CHF 1’800).
Why? Adding up premiums and bills, the CHF 2’500 plan is cheaper when your costs stay below CHF 1 800, even if an extra test pops up.
4. How to Choose in 60 Seconds
- Need unrestricted specialists? Stick to Standard.
- Like a single GP gatekeeper? Pick Family-Doctor.
- Live near an HMO super-clinic? Grab HMO for on-site labs & physio.
- Comfortable with phone triage? Telmed is unbeatable for price.
5. Three Extra Savings Hacks
- Stack model + high deductible: Telmed/HMO + CHF 2’500 is the legal price floor in most cantons.
- Remove accident cover if your employer already insures accidents—worth another 7 % off.
- Compare every October via our premium tool; insurers adjust Telmed & HMO pricing aggressively.
Full legal definitions of the four health insurance models are available at the Federal Office of Public Health (BAG).
6. FAQs – Health Insurance Models
Can I switch health insurance models mid-year?
No. Model changes take effect on 1 January. Submit your request before 30 November.
Does a cheaper model reduce my medical benefits?
No. Under LaMal, benefits are identical once you follow the access rules.
Which model works best for children?
Many parents keep kids on GP or Standard so referrals to paediatric specialists are faster.
Is Telmed tricky for older people?
If they are tech-savvy, Telmed is fine; otherwise GP model provides familiar in-person care with decent savings.
Bottom line: Decide how much gatekeeping you tolerate and select the health insurance model that matches—then bolt on the right deductible. Standard + CHF 300 buys pure freedom; Telmed or HMO + CHF 2’500 buys the lowest legal premium. Everything else is a compromise: pick what fits your lifestyle and risk tolerance.