Telemedicine model: how the call before a doctor’s visit works

Telemedicine model: call first, then see the doctor

The telemedicine model (Telmed) is a form of basic health insurance in which your first point of contact is not a practice but advice given at a distance. If you have a new health problem, you first contact a telemedicine advice centre by phone, app or video. A medically trained specialist asks about your symptoms and tells you what to do next. The FOPH calls this form “telemedicine advice” and counts it among the types of insurance with a restricted choice of service provider.

The same statutory benefits are insured as in the standard model. You only give up going directly to a doctor of your choice without contacting the centre first. In return, the insurer may lower the premium. This is how the four basic forms differ at the first step:

The advice is provided by centres the insurer works with. Well-known providers include Medgate or Santé24, SWICA’s telemedicine centre. Which centre is responsible for you is shown on your health insurance card or in your policy. How telemedicine works in general and what basic health insurance pays for it is explained in the glossary entry.

Step by step: how the call works

1. Get in touch before treatment. Before you go to a practice, a therapy or a hospital because of a new problem, you contact the advice centre. The number is usually on your health insurance card; save it on your phone.
2. Have your details ready. The specialist asks for your insurance number, symptoms, how long you have had them, previous illnesses and medicines.
3. Receive a recommendation. You find out whether you can treat yourself or should go to the pharmacy, your GP, a specialist or hospital. The advice often also names a period within which you should attend the appointment.
4. Note the case number. Many centres assign a case or reference number and report the case directly to your insurer. Note the date and number in case a bill is disputed later.
5. Follow the recommendation. You go where you were referred, within the stated period. The practice bills your insurer as usual.
6. Clarify follow-up treatment. As a rule, you do not have to call again for check-ups for the same treatment. For a new problem you do. How long a case stays “open” is set out in the conditions.

Exceptions: emergency, gynaecologist, ophthalmologist

In a real emergency, you go straight to the emergency department or dial 144. Depending on the tariff, you must inform the advice centre afterwards within a certain deadline. Some tariffs also exempt individual services from the call, such as gynaecological check-ups or eye examinations. No law sets out these exceptions: the insurance conditions of your tariff apply. Read them before you take out the policy, not after the first bill.

The legal rules in the telemedicine model

There is no separate Telmed law. The model is based on the provisions for all types of insurance with a restricted choice of service provider:

• Restricted choice: In agreement with the insurer, you can limit your choice to service providers it selects for more cost-effective care. The insurer then only has to cover services provided or arranged by these providers (Art. 41 para. 4 of the Federal Health Insurance Act, KVG).
• Lower premium: For such types of insurance, the insurer may lower the premium (Art. 62 para. 1 KVG). It may also waive the deductible and retention fee in full or in part (Art. 99 para. 2 of the Health Insurance Ordinance, KVV); in practice, the same deductibles usually apply as in the standard model.
• Limits on the discount: The discount must be based on cost differences resulting from the restricted choice, not on healthier insured persons, and must be supported by empirical data from at least five accounting years (Art. 101 para. 2 KVV). Without this data, the premium may be at most 20 % below the same insurer’s standard premium (Art. 101 para. 3 KVV).
• Open to everyone: The model is open to all insured persons resident in the area where the insurer offers it (Art. 100 para. 1 KVV). There are no health questions.
• Join at any time: You can switch from the standard model into the telemedicine model at any time, including during the year (Art. 100 para. 2 KVV).
• Leave only at the end of the year: You can only return to the standard model, move to another model or switch to another insurer at the end of the calendar year, with the notice periods under Art. 7 para. 1 and 2 KVG (Art. 100 para. 3 KVV). After the premium notification, this means your notice must reach your insurer by 30 November.

What happens if you do not follow the procedure is governed not by law but by the tariff. Depending on the tariff, possible consequences are a warning, a reduction in payment for the bill concerned or, after repeated breaches, being moved back to the standard model. Which consequence applies with your insurer is set out in the insurance conditions. The article Rules of managed care models explains more about the rules of all special types of insurance.

What Telmed saves in 2026: premiums compared

The table shows the middle monthly premium (median) of all offers per model group. Premiums 2026, municipality of Bern (region 1), adults born in 1996, with accident cover; source FOPH. The group “Telmed and others” contains all tariffs with initial advice by phone or digitally and other special forms, as grouped by the premium calculator.

With a CHF 300 deductible, the Telmed median is CHF 72.30 per month below the standard model, which is CHF 867.60 a year. With a CHF 2,500 deductible, the difference is CHF 71.10 per month or CHF 853.20 a year.

Medians compare different insurers. More meaningful for a switch within your own insurer is the discount that the same insurer gives on its standard model. For this, we analysed all 18 tariffs in Bern that have “Tel” in their name and whose insurer also offers a standard model there (CHF 300 deductible, same group of persons as above). The discount compared with the same insurer’s standard model was between 6.0 % and 14.5 %, with a median of 10.0 %. None of these tariffs reached the statutory ceiling of 20 % for insurers without five years of empirical data. You will find the figures for each insurer in the premium calculator and in the health insurer profiles.

Sample calculation: standard, Telmed or both with a high deductible?

Example with fictitious people. Selina is 30, lives in Bern and has so far had the standard model with a CHF 300 deductible. She compares the median offers from the table above.

The calculation shows two separate decisions. The model concerns the procedure before a doctor’s visit, the deductible your financial risk. The deductible calculator works out which deductible is cheaper for your costs; the example is not a recommendation for your situation.

Special cases: children, cross-border commuters, supplementary insurance

• Children: Many insurers also offer Telmed for children. The parents make the call. For children with regular check-ups, it is worth checking which appointments are allowed without a call.
• Residence abroad: The special types of insurance are not open to insured persons resident in the EU, Iceland, Norway or the United Kingdom (Art. 101a KVV). Cross-border commuters with Swiss basic health insurance therefore cannot choose Telmed.
• Supplementary insurance: Telmed only concerns basic health insurance. Your supplementary insurance policies continue independently, with their own conditions; the general terms and conditions and the information from your insurer apply.
• Ongoing treatments: If you regularly see several specialists, you need to coordinate every new step with the advice centre. Before switching, clarify whether ongoing treatments may continue.

Common mistakes

• Going straight to the doctor. If you start a new treatment without contacting the centre first, you risk a reduction in payment.
• Missing the recommended period. If the advice recommends an appointment within a certain time, the recommendation often only applies for that period.
• Not reporting the emergency afterwards. After an emergency, many tariffs require you to notify the advice centre within a deadline.
• Switching back too late. You can only return to the standard model on 1 January; after the premium notification, your notice must reach the insurer by 30 November. The deadline calculator shows all dates.
• Only looking at the discount. A lower tariff is only worthwhile if you can follow the procedure in everyday life.

How Telmed differs from the GP, HMO and pharmacy models is shown in the article Insurance models compared, and what happens in the GP model if you go straight to a specialist in the article GP model and specialists. The rules of all models are set out side by side under Insurance models. You will find further ways to a lower premium in the Saving money section. We explain how we analyse premiums and calculate medians under How we calculate.