Alternative insurance models

What are alternative insurance models?

Alternative insurance models are forms of compulsory basic health insurance that depart from the free choice of physicians. In the standard model, you can go directly to any licensed doctor or therapist for outpatient treatment. In an alternative model, you commit to contacting a specific point of contact first. Together with you, it decides whether and where you are referred on. In return, your insurer gives you a discount on your premium.

The law calls these variants “special types of insurance”. In everyday language they are also called managed care or money-saving models. The most important are:

• GP model: You choose a GP practice from the insurer’s list. It is your first point of contact.
• HMO model: Your first point of contact is a group practice (Health Maintenance Organization) that the insurer works with.
• Telemedicine model: Before every visit to the doctor, you call a medical advice service that advises you or refers you on.
• Pharmacy model: The first consultation takes place in a partner pharmacy.
• Bonus insurance: No restriction on the choice of doctor, but the premium falls after years without claims. It is a separate special type of insurance.

Important: the benefits are the same in all models. In the GP model, basic health insurance pays for exactly the same treatments, medicines and hospital stays as in the standard model. The only differences are access and price. The models have nothing to do with supplementary insurance under the Insurance Contract Act (ICA).

How it works

You choose the model with your insurer, in addition to your deductible. Each insurer sets out the details in its own regulations: which practices are available, when you can go directly without a referral and what happens if you break the rules.

Premium discount: In models with a restricted choice, the insurer may only reduce the premium to the extent that the model actually saves costs, for example through the coordination of care or a special form of remuneration for doctors. It may not give a discount because the model has more healthy insured persons. The savings must be backed by figures from at least five accounting years. Without these figures, the premium may be at most 20% below the premium in the same insurer’s standard model (Art. 101 KVV).

Deductible and retention fee: The co-payment also applies in alternative models. However, in models with a restricted choice, the insurer may fully or partly waive the deductible and the retention fee (Art. 99 para. 2 KVV).

Switching: You can switch into a model with a restricted choice at any time. The route back to the standard model or to another insurer is only possible at the end of a calendar year, with the notice periods under Art. 7 KVG (Art. 100 KVV). So if your premium increases, you can change model or insurer at the end of the year. You can only start bonus insurance on 1 January.

Living abroad: If you live in the EU, Iceland, Norway or the United Kingdom and have basic health insurance in Switzerland, you cannot choose special types of insurance (Art. 101a KVV).

Legal basis

Art. 41 para. 4 of the Federal Health Insurance Act (KVG) allows you, in agreement with your insurer, to restrict your choice to service providers that the insurer selects with a view to more cost-effective care. The insurer then only has to cover services provided or ordered by these service providers. The benefits required by law are covered in every case.

Art. 62 para. 1 KVG allows the insurer to reduce the premium for such insurance. Para. 2 permits other forms, such as the optional deductible and bonus insurance. Para. 2bis prohibits insuring the higher co-payment or the loss of the discount with another insurance policy.

The details are set out in the Health Insurance Ordinance (KVV): Art. 99 (principle, possible waiver of deductible and retention fee), Art. 100 (joining and leaving), Art. 101 (premiums, a discount of at most 20% without five years of claims data) and Art. 101a (no offer for insured persons living in EU/EFTA states or the United Kingdom). Bonus insurance is governed by Art. 96–98 KVV: its starting premium is 10% above the premium for standard insurance, and it may not be combined with an optional deductible.

Example: premiums 2026 in Zurich by model

Lukas is 34 years old (year of birth 1992) and lives in the city of Zurich (premium region 1). He compares the 2026 monthly premiums of all insurers with accident cover, broken down by model. Source: FOPH, health insurance premiums 2026.

The figures are monthly premiums for adults including accident cover. The premium calculator shows the current premiums for your municipality and your age.

What this means for you

An alternative model is worthwhile if you can live with a first point of contact. Three questions will help you:

1. Do you have a GP who is on the list? Then the GP model is often a small step. Without a regular practice, Telmed may suit you better.
2. Do you often go straight to specialists? Then you will need a referral every time. If you forget, you risk your insurer not paying the bill.
3. How big is the discount at your insurer? Compare not only models but also insurers. The profiles under health insurers show which models an insurer offers.

You can apply to switch to an alternative model at any time. If you want to change insurer at the same time, the dates under switching apply. The model finder helps you find the model that suits your daily life.

Common mistakes

• Believing the model cuts benefits. You receive the same compulsory benefits. Savings come from coordinating care, not from cuts.
• Not reading the regulations. Each insurer decides for itself which cases are allowed without a referral and what a breach costs.
• Comparing only the model. In Zurich in 2026, the premium differences between insurers within the same model are larger than the difference between the cheapest offers of the models.
• Trying to combine bonus insurance and a high deductible. The law rules out this combination (Art. 96 para. 4 KVV).

We explain how we analyse premiums under how we calculate.