Doctors’ network

What is a doctors’ network?

A doctors’ network is a group of medical practices, usually GPs, that have concluded a contract with one or more health insurers. On this basis, the insurer offers an insurance model within basic health insurance: you commit to going first to a doctor in the network whenever you have a health issue. If you need a specialist, a therapy or a hospital stay, the network refers you on. In return, you pay a lower premium.

The doctors’ network is one of the models with a restricted choice of service provider, often grouped under the umbrella term managed care. Related models are the HMO, in which the doctors work in a shared health centre, and the GP model, in which you choose a single practice. A doctors’ network links independent practices that work together according to common rules.

The term is not a legal term. The law speaks of “insurance with a restricted choice of service provider”. Each insurer decides for itself exactly what a model is called and which practices belong to it. Two offers with similar names can therefore work differently.

The doctors’ network only concerns basic health insurance. Your supplementary insurance continues independently.

How it works

The process follows the principle of gatekeeping: one point of contact decides which treatment makes sense next.

1. Choosing a practice: When you sign up, you choose a practice from the network. The insurer provides the list.
2. The network first: If you have symptoms, you go there first. The doctor treats you or issues a referral.
3. Referral: The referral applies to a specific specialist or treatment and often for a limited period or number of consultations. The rules are set out in the insurer’s conditions.
4. Exceptions: Emergencies are always excepted. Some insurers also except individual specialist fields, such as gynaecological check-ups or eye examinations. Check this in your insurer’s conditions.

If you do not follow the rules, the insurer may refuse to pay the costs. The law allows it to pay only for services provided or ordered by the network. What applies if you break the rules repeatedly, for example a move back to the standard model, is set out in the insurer’s conditions.

The premium may be lower if the model causes lower costs. However, the law only permits discounts for cost differences that result from the restricted choice and the type of remuneration, not from a healthier group of insured persons. The insurer must back them up with figures from at least five accounting years. If it does not yet have these, the premium may be at most 20% below its standard premium.

In the network model, the insurer may also fully or partly waive the deductible and the retention fee. Whether it does so is stated in the offer.

Legal basis

The basis is Art. 41 para. 4 of the Federal Health Insurance Act (KVG): insured persons may, in agreement with their insurer, restrict their choice to service providers that the insurer selects with a view to more cost-effective care. The insurer then only has to cover the costs of 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 premiums for such insurance. The Health Insurance Ordinance (KVV) sets out the details:

• Art. 99 KVV: The insurer may offer models with a restricted choice alongside standard insurance and may fully or partly waive the deductible and retention fee (para. 2).
• Art. 100 KVV: The models are open to all insured persons in the area in which the insurer offers them. You can switch from the standard model to such a model at any time (para. 2). A switch to another model or to another insurer is possible at the end of the calendar year with the notice periods under Art. 7 KVG (para. 3).
• Art. 101 KVV: The models are not separate risk pools. Discounts are only permitted for cost differences that result from the restricted choice or the remuneration of service providers, backed by figures from at least five accounting years (para. 2). Without these, the premium is at most 20% below the insurer’s standard premium (para. 3).

The exact rules of your model, for example on referrals and exceptions, are set out in the insurer’s additional conditions. They form part of your contract.

Example: standard model and GP/HMO in Zurich

Sara, 34, lives in the city of Zurich, has a CHF 300 deductible and compares the models. The figures come from the 2026 premiums for the municipality of Zurich (region 1), adults, with accident cover; source FOPH. The FOPH groups GP, HMO and network models together.

What this means for you

• The practice first: Check whether your current GP belongs to a network and which insurers work with that network. This is often more important than the discount.
• Read the conditions: Pay attention to the rules on referrals, exceptions (gynaecologist, ophthalmologist, paediatrician), emergencies and sanctions.
• Compare premiums: In the premium calculator, you can see all the offers in your municipality with their model. The model finder works out which model suits your daily life.
• Plan your switch: You can switch to a network model with your insurer at any time. The deadlines for changing insurer are under switching insurer.
• Know the insurers: Key figures and models of each insurer are under health insurers.

Common mistakes

• Going straight to a specialist. Without a referral, the insurer may refuse to pay the costs, even if the treatment made sense.
• Assuming all network models are the same. Referral rules and exceptions differ from insurer to insurer. The additional conditions are what count.
• Looking only at the discount. If there is no suitable practice in the network or you regularly need different specialists, the effort can outweigh the discount.
• Confusing the model with supplementary insurance. The doctors’ network only applies to basic health insurance. Supplementary insurance has its own rules.

We explain how we analyse premiums by model under how we calculate.