GP

What is a GP?

Your GP (general practitioner, also called a family doctor) is the doctor you go to first with most health questions. Your GP knows your medical history, treats common illnesses, looks after chronic conditions and, if needed, sends you to a specialist or to hospital. In Switzerland, GPs usually hold the postgraduate title in general internal medicine; for children, specialists in paediatrics take on this role.

The Federal Health Insurance Act (KVG) does not treat GPs as a separate professional group. For basic health insurance, GPs are service providers like all doctors. They need approval from the canton in which they work. To get it, they must have worked for at least three years in the specialist field applied for at a recognised Swiss postgraduate training centre and must prove their knowledge of the language of their region. Cantons with insufficient provision may waive the three years for general internal medicine, general practitioners and paediatrics.

GPs gain a special role in health insurance through the GP model. There, the GP is the agreed first point of contact. This function is also called gatekeeping.

How it works

Without a model

In the standard model of basic health insurance, you choose freely from all approved doctors who are suitable for treating your illness. So you can go straight to a dermatologist or an orthopaedic surgeon without seeing your GP first. The insurer pays according to the tariff that applies to the chosen doctor. You bear the deductible and a 10% retention fee.

With a GP model

In the GP model, you voluntarily restrict this choice. You choose a GP practice that your model accepts and always go there first when you have a health problem. If you need a specialist, the practice issues a referral. The insurer then only has to cover the costs incurred by this practice or at its instigation. The benefits required by law remain insured in every case.

In return, the insurer may lower the premium. The discount is not freely set: it may only pass on cost differences resulting from the restricted choice or from the way doctors are paid, not from healthier insured persons. If the insurer does not yet have claims data from at least five accounting years, the premium may be at most 20% below the premium of its standard model. The insurer can also fully or partly waive the deductible and retention fee in the model.

Which exceptions apply to the principle of “GP first”, for example in emergencies, and what happens if you do not follow it, is set by each insurer in its insurance conditions.

Billing

GPs bill their services according to a tariff. Since 01.01.2026, the itemised tariff TARDOC together with outpatient flat rates has applied to outpatient medical services; it replaced the previous TARMED tariff. Tariff protection applies to basic health insurance benefits: surcharges above the tariff are not allowed.

Legal basis

Art. 41 para. 1 KVG guarantees you, for outpatient treatment, free choice among the approved service providers who are suitable for your illness. Under Art. 41 para. 4 KVG, you can, in agreement with the insurer, limit this choice to service providers it selects for more cost-effective care; the benefits required by law are still insured. Art. 62 para. 1 KVG allows lower premiums for this.

The Health Insurance Ordinance (KVV) sets out the details. Art. 99 KVV allows insurers to offer such models and to waive the deductible and retention fee. Art. 100 KVV provides that you can switch into a model at any time, but leave it again only at the end of the calendar year. Art. 101 KVV limits the premium reduction. The approval of doctors is governed by Art. 36 and 37 KVG.

Example: standard model or GP model

Jonas is 34 and lives in Zurich. He compares the monthly premiums for 2026 for adults with accident cover. The table shows the median of all offers in the municipality of Zurich (region 1), broken down by model. Source: FOPH, health insurance premiums 2026.

Deductible	Standard model	GP and HMO models	Difference per month	Difference per year
CHF 300	CHF 639.80	CHF 565.80	CHF 74.00	CHF 888.00
CHF 2,500	CHF 511.50	CHF 437.50	CHF 74.00	CHF 888.00

The premium calculator shows the premiums for your municipality, age and deductible, with all the insurers’ models.

What this means for you

Whether a GP model is worthwhile depends less on the premium than on your habits. These questions help:

1. Do you already have a GP you trust? Check whether their practice is approved in your insurer’s model.
2. Do you often go straight to specialists? Then you need a referral each time in the model. That is doable, but it is an extra step.
3. Is the practice taking on new patients? Clarify this before you switch.

You can switch into a GP model at any time. Returning to the standard model or switching to another model is only possible on 1 January, and your notice must reach the insurer by 30 November; all dates are listed under deadlines. You will find the key figures and models of the individual insurers under health insurers.

Common mistakes

• Going straight to a specialist. In the GP model, the insurer can then refuse to pay or apply sanctions under its conditions.
• Looking only at the premium. If the model does not suit your daily life, every referral will annoy you.
• Not reporting a change of practice. If you change GP, inform your insurer beforehand.
• Thinking fewer benefits are insured in the model. The statutory benefits are the same as in the standard model; only the route to them is set.

We explain how we analyse premiums under how we calculate.