telmed health insurance model switzerland
Insurance

The Telemedicine Model for Swiss Mandatory Health Insurance Explained

October 11, 2023 - Benjamin Manz

Get informed about Swiss telmed mandatory health insurance based on the telemedicine model in this guide.

The telemedicine model – or telmed as it is known in Switzerland – is the second most popular managed care model for Swiss mandatory health insurance, after the family doctor model.

The telemedicine model works like this: Before you visit a doctor, pharmacy or hospital, you must first contact a medical support center remotely (by telephone, for example). The medical support hotline is available at any time of the day and year. Medical care is only covered if you contact the telemedicine center first, and follow their instructions.

There are exceptions for which contacting the telemedicine center is not required. These are: gynecological check-ups; medical care relating to pregnancy; vaccinations; dental surgery; and medical treatment of children below the age of 6.

There are also emergency situations in which you may not be able to contact the medical support center before getting treatment, and health insurance providers make allowances for these emergencies. In these cases, you are still required to contact the telemedicine center after receiving emergency treatment. The time limits within which you need to contact the support center vary between health insurance providers.

At the very latest, you must contact your insurance provider before receiving any further medical treatment after the initial emergency treatment. If you don’t meet the deadline, your insurance policy may be changed to the standard model with higher insurance premiums retroactively, or you may have to pay the medical bills yourself.

Various telemedicine centers are operated throughout Switzerland, including Medi24, Medgate, and Sante24.

Health insurers that offer telmed policies

In 2024, 31 of the 39 Swiss health insurance providers offer telemedicine-based policies. For the sake of comparison, the family doctor model is offered by 35 insurers and the HMO model is offered by 16 Swiss health insurance providers.

Low premiums are the prime benefit

Telmed insurance policies owe their popularity to one main factor: The insurance premiums you pay are lower than the standard model with free choice of doctors.

Health insurance providers know that requiring people to first contact a medical support center raises the threshold for getting medical care, resulting in less unnecessary treatments, and lower costs. The insurance premiums charged for telemedicine offers are up to 20 percent lower than those charged for offers that use the standard model. 

The limitations are the biggest drawback

Different telemedicine offers come with different limitations. Many people do not fully understand these limitations when they get mandatory health insurance based on the telmed model.

The limitations are relatively insignificant for healthy individuals who rarely need medical care. But for people who regularly need medical attention, the telemedicine model has a number of drawbacks. For example, some telemedicine centers will only refer you to certain doctors, while some let you choose where you want to receive treatment. As a general rule, the more limitations a telmed insurance offer has, the less it costs.

You have less control over your healthcare decisions

Another limitation of the telemedicine model is the importance placed on remote consultation. How binding the recommendations made by the remote medical support center are depends on which health insurance company you use. Here too, the general rule is that telemedicine insurance offers with obligatory remote consultation is cheaper than those without this requirement.

The remote support center will decide on how to proceed with your medical care, and make referrals as they deem necessary. If you visit a doctor without first being referred to that doctor by the telemedicine center, you will receive an initial warning. If you ignore the rules again, then your insurance policy will be converted to the standard model retroactively from the beginning of that insurance year. You will be billed for the difference between the low premiums for telemedicine insurance, and the high premiums for standard health insurance.

The advantages of the telemedicine model

  • The primary benefit of the telemedicine model is that it costs much less than the standard model.
  • The remote consultation can, in some cases, be considered an advantage. Particularly for less important health issues, the medical consultation you get remotely may be enough, and you can save yourself the trip to the doctor.

The disadvantages of the telemedicine model

  • Correctly diagnosing a problem remotely can be difficult. In the worst case, an incorrect diagnosis could have severe consequences for your health. There is also potential for a conflict of interests, as there may be an incentive for telemedicine call centers to recommend the most cost-effective option, even if a more expensive treatment would be more effective from a medical point of view. This is particularly true when your telemedicine service is run by your health insurance company.
  • The most affordable telemedicine health insurance offers often limit your choice of doctors and specialists.
  • Insurance coverage is often limited to treatments recommended by the telemedicine center. If you want to choose a different path for your healthcare, the health insurance company may not cover the costs.

More information:
Compare all Swiss mandatory health insurance offers now
Compare Swiss supplementary hospital insurance offers now
Compare Swiss supplementary health insurance offers now
HMO health insurance model guide
Family doctor health insurance model guide

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Expert Benjamin Manz
Benjamin Manz is CEO of moneyland.ch and an independent expert on banking and finance.
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