GP, HMO, telemedicine, pharmacy: which insurance model suits you?

Same benefits, different first point of contact

In basic health insurance, you choose an insurance model as well as a deductible. In the standard model, for outpatient treatment you go directly to any licensed physician who is suitable for your illness (Art. 41 para. 1 of the Federal Health Insurance Act, KVG). In the special types of insurance, you agree with the insurer to restrict this choice to service providers that it selects for more cost-effective care. The insurer then only has to pay for services that these providers deliver or arrange; however, the statutory compulsory benefits are insured in every case (Art. 41 para. 4 KVG). In return, the insurer may lower the premium (Art. 62 para. 1 KVG).

The models are the norm: according to the Office of the health insurance ombudsperson, around 80 % of all insured persons were in a model with a restricted choice of service provider in 2025.

The FOPH is introducing the new categories because the previous models could no longer be clearly separated; in particular, it says, the difference between GP and HMO is no longer significant. In the 2026 premium data, pharmacy tariffs are still listed under “GP/HMO”.

The models at a glance

GP model

In the GP model, you choose a GP practice from the insurer’s list. It treats you itself or refers you to a specialist, a therapist or a hospital. This suits you if you already have a GP who is on the list. What applies if you go straight to a specialist without a referral is explained in the article GP model and specialists.

HMO model

In the HMO model, your first point of contact is a health centre where several physicians and often therapists work together. The model is only open to insured persons who live in the area where the insurer operates it (Art. 100 para. 1 of the Health Insurance Ordinance, KVV). It requires such a centre to be within easy reach.

Telemedicine model

In the telemedicine model, you call a telemedicine centre or use its app before every visit to a physician. The professionals recommend the next step: treating yourself, going to a GP, a specialist or a hospital. You do not need a regular practice. How the call works is described in the article Telemedicine model.

Pharmacy model

In the pharmacy model, you go to a partner pharmacy first. It advises you, treats simple cases or refers you on. In the Zurich premium data for 2026, three tariffs have “pharm” in their name. Which routes are allowed after that is set out in the rules of the insurer concerned.

Standard model and bonus insurance

The standard model has no restrictions, but has the highest premium. There is also bonus insurance, whose premium falls after years without claiming benefits; it may not be combined with an optional deductible (Art. 96 para. 4 KVV).

What the models cost in 2026

The premium depends more on the insurer than on the model. Premiums 2026, municipality of Zurich (region 1), adults (born in 1992), with accident cover; source FOPH. The categories are those used by the FOPH for 2026.

Model and deductible	Offers	cheapest	median	most expensive
Standard, CHF 300	27	CHF 605.20	CHF 639.80	CHF 724.00
GP/HMO, CHF 300	62	CHF 517.70	CHF 565.80	CHF 656.80
Telemedicine and others, CHF 300	39	CHF 527.90	CHF 575.00	CHF 701.20
Standard, CHF 2,500	27	CHF 476.90	CHF 511.50	CHF 595.70
GP/HMO, CHF 2,500	62	CHF 389.40	CHF 437.50	CHF 528.50
Telemedicine and others, CHF 2,500	39	CHF 399.60	CHF 449.80	CHF 572.90

A comparison within the same insurer is more meaningful, because only the model changes there. For each insurer, we compared its cheapest model offer with its own standard model:

The ranges show: with one insurer, the model brings 5 %, with another over 20 %. An insurer may only give more than 20 % if it proves the savings with figures from at least five financial years; it may not give a discount just because the insured persons are healthier (Art. 101 paras 2 and 3 KVV). The most expensive GP premium in Zurich is higher than the cheapest standard premium. Which models an insurer offers is shown in its profile under Health insurers; you can compare the offers for your municipality in the premium calculator.

Sample calculation: three models with one insurer

Example with fictitious people. Nadia is 34, lives in Zurich, has a CHF 2,500 deductible and is insured with Sanitas in the standard model. She compares her insurer’s models. Premiums 2026, municipality of Zurich (region 1), adults, with accident cover; source FOPH.

In a model, the insurer may also waive the deductible and retention fee wholly or partly (Art. 99 para. 2 KVV). Whether a tariff does so is set out in its conditions.

Which model suits you? Five questions

We cannot give a recommendation for your situation. But these questions show you what matters when choosing:

1. Do you have a GP, and are they on the list? Then the GP model is often a small step. Ask at the practice or check the insurer’s list before you switch.
2. Is there an HMO centre near you? The HMO model requires you to live in its catchment area and to be willing to go there first.
3. Are you happy with a phone call or an app as the first step? Then telemedicine is an option, even without a regular practice and if you are often on the move.
4. Are you regularly being treated by specialists? Then you need referrals in every model and must observe deadlines. How this works and where the pitfalls are is explained in the article Rules of cost-saving models.
5. How big is the discount with your insurer? Compare the model with the standard model of the same insurer and with other insurers. Depending on the insurer, the difference is between around 5 % and over 20 %.

The model finder asks you these questions and shows which models fit your answers. The rules of the individual models are described on the pages on the GP and HMO model, the telemedicine model and the pharmacy model.

Switching into a model and out again

So you can join at any time, but only leave once a year. Ask your insurer from which date it will implement your switch into a model. From bonus insurance, you can only move into a model at the end of the year (Art. 97 para. 2 KVV). If you live in the EU, Iceland, Norway or the United Kingdom and are insured in Switzerland, you cannot choose special types of insurance (Art. 101a KVV). You change your deductible for 1 January regardless of the model; the deadlines are in the article Changing your deductible.

Common mistakes

• Believing the model cuts benefits. The compulsory benefits are insured in every model. You save through the route, not through the list of benefits.
• Only comparing the model, not the insurer. In Zurich, the most expensive GP offer costs more than the cheapest standard offer.
• Not reading the rules. Which cases are allowed without a referral, which deadlines apply and what a breach costs is set by each insurer itself. The ombudsperson observes that these rules are becoming increasingly complex in some models.
• Wanting to leave the model too late in the autumn. You can only return to the standard model if your notice arrives by 30 November.
• Changing model and insurer at the same time without sending a notice of cancellation. If you want to move to another insurer on 1 January, cancel with your current one, even if only the model is different with the new provider.

How we evaluate premiums is explained under How we calculate. You can find all topics on saving money in Saving money.