Changing your insurance model

What does changing your insurance model mean?

In basic health insurance, you choose not only your insurer and your deductible, but also an insurance model. The standard model gives you a free choice among all approved doctors, therapists and hospital outpatient departments. The alternative insurance models restrict this choice: in the GP model, you see your GP first; in the HMO model, a group practice; in the telemedicine model, you first call a medical advice line. In return, the premium is lower.

Changing your model means switching between these options, either with your current insurer or together with switching insurer. It only concerns basic health insurance. The benefits required by law stay the same in every model. Only the premium and the route to treatment change.

Changing your model is different from changing your deductible and from switching health insurer. You can combine all three, but the deadlines are not the same.

How it works

The rules are asymmetric:

• Into an alternative model: at any time. You tell your insurer that you want to switch to a GP, HMO or telemedicine model. The insurer decides from when the new premium applies. If you have bonus insurance, its switching dates apply.
• Out of an alternative model: only at the end of the year. If you want to go back to the standard model or switch to another model, you can only do so with effect from 1 January. The notice periods for switching insurer apply.

There are two deadlines for a change at the end of the year. If your insurer notifies you of a new premium in the autumn, a one-month notice period applies: your notification must reach your insurer by 30 November. The insurer must notify you of the new premium at least two months in advance. If the premium does not change, the ordinary three-month notice period applies, so your notification must arrive by 30 September.

If you switch insurer at the same time, you cancel your basic health insurance with your old insurer and register with the new one in the model you want. The old insurance relationship only ends once the new insurer has confirmed to the old one that you are insured without interruption.

Legal basis

Under Art. 41 para. 4 of the Federal Health Insurance Act (KVG), you can limit your choice to selected service providers in agreement with your insurer. Changing your model is governed by Art. 100 of the Health Insurance Ordinance (KVV). Under para. 2, you can switch from insurance without to insurance with a restricted choice of service provider at any time; Art. 97 para. 2 KVV on bonus insurance is reserved. Under para. 3, you can switch to another form of insurance or another insurer with effect from the end of a calendar year, subject to the notice periods of Art. 7 para. 1 and 2 KVG.

Art. 7 para. 1 KVG provides for a three-month notice period. Under Art. 7 para. 2 KVG, you can switch with one month’s notice when you are notified of a new premium; the insurer must notify you of the new premium at least two months in advance. Art. 7 para. 5 KVG states that the old insurance relationship only ends once the new insurer has confirmed that you are insured without interruption. Under Art. 7 para. 7 and 8 KVG, the insurer may not force you to cancel your supplementary insurance when you switch insurer, and may not cancel it for that reason. The rules for deductibles and bonus insurance are set out in Art. 94 and 97 KVV.

Example: same insurer, three models

Jonas is 36 years old, lives in the city of Zurich, has the CHF 2,500 deductible and is insured with Atupri in the standard model. He checks what a switch within the same insurer would bring. 2026 premiums, municipality of Zurich (region 1), born in 1990, with accident cover; source: FOPH.

Model (tariff)	Per month	Per year	Difference from standard per year
Standard (the insurer’s basic tariff)	CHF 495.40	CHF 5,944.80	–
Telemedicine (“TelFirst”)	CHF 451.70	CHF 5,420.40	CHF 524.40
HMO (“HMO”)	CHF 389.40	CHF 4,672.80	CHF 1,272.00

At the median of all offers in Zurich, the standard model is CHF 511.50 and the GP/HMO group CHF 437.50 a month. So the differences between insurers are large; changing your model combined with switching insurer can save more. The premium calculator shows all offers for your municipality.

What this means for you

Plan a change of model like a small contract with yourself:

1. Does the model fit your everyday life? Do you have a GP nearby, or are you willing to call before every doctor’s visit? The model finder helps you assess this.
2. Clarify ongoing treatment. If you are being treated by specialists, ask how referrals work in the new model.
3. Think about the way out. The way back is only open at the end of the year. Make a note of 30 November.
4. Compare insurer and model together. The discounts vary a lot. You will find an overview of insurers under health insurers.

All dates are under deadlines, and switching explains how to switch insurer. The entry deadline for switching also explains the deadline for a change.

Common mistakes

• Believing the way back is open at any time. Only the switch into an alternative model is possible at any time; you can only go back at the end of the year.
• Calculating the deadline from the postmark. Your notification must reach the insurer on time.
• Confusing a change of model with a cut in benefits. The compulsory benefits stay the same; only access changes.
• Not reading the model rules. If you do not follow the rules on referrals or calling first, you risk your insurer refusing to pay bills.