Is the Telemedicine Health Insurance Model Right For Me?

Some people appreciate having a medical hotline or chatline that they can contact with their health concerns. The telemedicine managed care model for Swiss mandatory health insurance takes this concept a step further. If you want the insurance to cover your medical bills, you have to contact a telemedicine center for approval first before getting medical care.

Depending on the health insurance provider, the contact point may be a phone hotline or an app-based solution.

What is the telemedicine model?

The telemedicine model is a form of managed care for basic, mandatory Swiss health insurance. By using a telemedicine offer, you agree to always contact the telemedicine center first before visiting a doctor or hospital. 

Compared to standard mandatory health insurance, which does not require you to get permission before getting medical care, insurance with the telemedicine model typically costs between X and Y percent less.

Estimates place the portion of residents who use the telemedicine model at around 20 percent.

When is the telemedicine model worth considering?

The telemedicine model could be a good choice if you do not mind having to contact a medical hotline by phone or app before getting medical care.

You should be aware that with most mandatory health insurance providers, the recommendations made by the telemedicine center are binding.

Which rules apply to the telemedicine model?

By choosing a telemedicine-based mandatory health insurance offer, you commit to always contacting the specified telemedicine center by phone or app before getting medical treatment.

The exact terms and conditions vary between health insurance providers. Typically, the telemedicine center will tell you which steps you have to take next. Depending on the offer, the telemedicine center may also specify which doctor or hospital you have to receive treatment from.

In addition to the requirement to contact the telemedicine center, offers may include other restrictions as well. For example, the contract may limit insurance cover to generic medicines, or to medicines bought in specific pharmacies only. If you have a chronic illness, you may be contractually obliged to join a disease management program in order for the costs to be covered by your insurance. However, limitations like these are not unique to telemedicine offers, as other managed care offers may also include them.

Good to know: Although managed care models can limit the way in which you can access medical care, the actual health insurance cover itself is identical across all mandatory health insurance offers.

Are there any situations in which I do not have to contact the telemedicine center?

If a real medical emergency occurs, you can call an ambulance or visit the emergency ward without having to get an approval from the telemedicine center first. However, you still have to contact the telemedicine center as soon as possible afterwards and report the incident. Most health insurance providers require you to do this within five to 20 days after receiving emergency medical care. 

Depending on the health insurance offer, there may be other exceptional cases in which contacting the telemedicine center is not necessary. Common exceptions include:

• Preventative checkups at eye doctors.
• Preventative gynaecological examinations.
• Treatment by dentists.
• Treatment by paediatricians.
• Medical care related to maternity.

Are there any telemedicine offers that do not limit me to contacting a telemedicine center remotely?

Yes. Some health insurance providers have hybrid offers in addition to regular telemedicine offers. These hybrid models are often referred to as flex models.

These hybrid offers use more than one gatekeeper. You can choose which one you want to contact as a first stop before getting further treatment.

Depending on the offer, you can choose between contacting the telemedicine center, or getting in-person consultation from one of these gatekeepers:

• Your preselected family doctor.
• A listed medical center.
• A listed pharmacy.

There are big differences between hybrid offers with regard to which gatekeepers you can use. Make sure to carefully check the terms and conditions.

What are the advantages of the telemedicine model?

Using the telemedicine model has a number of advantages:

• Lower insurance premiums: Mandatory health insurance with the telemedicine restriction is cheaper than standard mandatory health insurance from the same provider.
• Time and location are less important: You can contact the telemedicine center for approvals and referrals no matter where you are. Many telemedicine hotlines remain available in the evening and on weekends.
• Direct prescriptions and referrals: The telemedicine center can prescribe medicines and refer you to specialists. That saves you the time and cost of visiting a family doctor or a medical center, as is the case with some other managed care models.

What are the disadvantages of the telemedicine model?

There are also disadvantages to using the telemedicine model:

• Less freedom: Before every checkup or treatment, you first have to contact the telemedicine center. 
• Less choice: The telemedicine center decides on your course of treatment, the timeframe, and in some cases even the doctor.
• Strict rules: There are strict contractual rules. Failure to follow the correct process can result in penalties.

Conclusion: Is the telemedicine model a good fit for me?

The telemedicine model can work well if you are content to always contact a medical hotline first before each treatment.

If you want to also be able to get face-to-face medical consultation at a pharmacy or doctor’s practice, a hybrid telemedicine gives you the freedom to choose every time.

On the other hand, if you need regular medical attention, having to contact a telemedicine center before each treatment by a specialist can be inconvenient.

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