telmed model health insurance switzerland

Swiss Telmed Health Insurance Model Explained

Find out everything you need to know about the telemedicine model of obligatory health insurance in Switzerland.

The telemedicine option is the third most popular take on the Swiss obligatory insurance policy, behind the standard and family doctor models.

The logic behind this policy type is simple: Before you visit a doctor, pharmacy or hospital, you must contact a consultation center via telephone. This medical hotline is available 24/7, throughout the entire year. Making the call is obligatory in order for insurance coverage to apply.

Contacting the call center is required in every case except for precautionary gynecological check-ups, medical visits relating to pregnancy, vaccinations, dental surgery and medical treatment of children below the age of 6.

In the case of an emergency, you may not be able to make the required phone call. Insurers understand this. However, they do require that you contact the call center within a limited time period after an emergency occurs. The exact time-frame is set by each insurer.

Compact One, issued by the Sanitas Group, requires that you report the emergency within 10 days. Atupri has a 20-day requirement, and Sanacall from Sanagate only gives you 5 days to report the incident.

At the very latest you will want to contact your insurer before undergoing post-emergency medical treatment. If you don’t meet the deadline, you will be in danger of being bumped up to a “standard” insurance plan with higher premiums, or worse yet, you may have to pay for the full cost of your treatment out of your own pocket.

Telmed insurance policies are popular in Switzerland

Telemedicine options have been available on obligatory health insurance plans for around a decade. In the meantime, the Swiss telmed model has developed substantially, and now enjoys relative popularity.

More than 1.25 million insured persons have opted for a telmed-based insurance policy. More than 20 percent of young adults (19 to 25 years old) choose the telmed option, while around 20 percent of adults (over 26 years old) use this model. Likewise, around 20 percent of children are covered by a telemedicine insurance policy.

Health insurers that offer telmed policies

In 2018, 31 of the 52 Swiss health insurance providers offer telemedicine-based policies. For the sake of reference: The family doctor model is offered by 44 insurers and the HMO model is offered by 18 insurers in Switzerland.

In contrast to the HMO model, you can choose from a wide selection of telmed policies regardless of where you live. Depending on your place of residence, you can choose from anywhere from 25 to 30 different insurance providers that offer telmed policies. However, some major health insurers do not provide a telemedicine option.

Low premiums are the prime attraction

Telmed insurance policies owe their popularity to one main factor: premiums are low.

Health insurers estimate that requiring policyholders to explain their medical issues over the phone before being referred for medical treatment radically lowers the costs they incur by paying out benefits for petty health issues. The lower premiums you pay match the lower risks for insurers.

Premiums for telmed policies were as much as 26 percent lower than standard policy premiums. On average, telmed policy premiums are 14 percent lower than premiums for standard policies.

An assessment by moneyland.ch showed that the telmed option worked out the cheapest in about one-third of all premium variables for Swiss health insurance policies.

Limitations are a drawback

Different telmed models come with different limitations, and many people do not fully understand these limitations when they take out their policy.

The limitations aren’t generally a problem for healthy policyholders who rarely visit a doctor. However, for those who do require medical attention, telmed models can present a number of drawbacks.

One possible limitation may affect the doctors you can choose to be treated by. While some telmed policies limit your choice of doctor, others do not impose these limitations. Those with fewer limitations have higher premiums.

For example, Groupe Mutuel’s PrimaTel policy combines the telemedicine and family doctor models. In order to be eligible for coverage, you must first contact Medi24’s hotline by phone and then visit your preselected family doctor, if the phone consultation establishes that this is necessary. If you choose their SanaTel policy instead, you will be free to consult any doctor you see fit, but you pay higher premiums for the privilege.

Then there are policies which take limitations even further, like Atupri’s Flexcare policy which requires that you select a family doctor which participates in a specific medical network. In the case of Atupri, only doctors who partner with the Medbase medical network would be eligible. More expensive policies like TelFirst from Atupri only require that you call the Medgate call center.

Remote consultation may be obligatory

How significantly the phone consultation session will affect your access to further medical care poses another limitation for telmed policy holders. The rule of thumb here is: telmed policies that require a primary consultation are cheaper than those that do not. For example, with the Compact One policy from Compact, the primary consultation you receive over the phone is binding.

Any necessary steps to take regarding further treatment will be explained over the phone. Policyholders who visit a doctor when the phone consultation established that the issue could in fact be treated without visiting a doctor will receive a warning. If they repeat this breach of contract, their insurer may transfer their policy to an expensive standard health insurance policy in arrears, starting from the beginning of the year in which the breach occurred. The policyholder will be required to pay the difference in premiums for the entire period.

Medgate, Medi24 and Sante24 compared

The Swiss telemedicine infrastructure is operated by three telmed service providers: Medi24, Medgate and Sante24.

Medi24 is an “independent” service. Unlike Medgate, the consultants at Medi24 are not doctors, but medical caregivers. A number of insurance companies make use of the Medi24 call center, including Groupe Mutuel, Helsana, KPT, Visana, Galenos and Sumiswalder.

Medgate, like Medi24, also operates independently, but it’s larger and employs around 90 qualified doctors. Many health insurance companies partner with Medgate, including Agrisano, Aquilana, Atupri, Birchmeier, CSS, EGK, Krankenversicherung Flaachtal, Galenos, Glarner, Helsana, Innova, Klug, Kolping, ÖKK, Rhenusana, Sanagate, Sanitas, SLKK, Sodalis, Krankenkasse Steffisburg, Swica, Sympany, Visana und KKV.

Sante24 is a telmed service operated by health insurance company Swica.

Telmed: Pros

  • Lower premiums are the primary benefit of telmed policy models. The savings potential they offer can be remarkable.
     
  • Free consultation via telephone is another benefit of telemedicine-based policies. You can, for example, get consultation for minor health issues without having to visit a doctor.

Telmed: Cons

  • A correct diagnosis can be difficult to achieve over the telephone. In the worst case, an incorrect diagnosis could have fatal consequences for a patient. Additionally, a conflict of interests may occur: From an economic perspective, telemedicine call centers may be inclined to recommend the most cost effective option, even when a more expensive solution would be a better medical decision. This is especially the case with insurer-operated call centers.
  • Telmed policies with very low premiums often limit your choice of doctors.
     
  • Telmed consultation is often obligatory. If you as the policyholder prefer an alternative form of treatment, you will be at the mercy of your insurance provider. Getting a telmed insurance policy is only a good idea if you enjoy overall good health.

More information:
Swiss health insurance comparison
Swiss supplementary hospital insurance comparison
Swiss supplementary outpatient insurance comparison
HMO health insurance model explained
Family doctor health insurance model explained

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