GP model and HMO: the practice first
In the GP model you first go to the GP you have chosen when you have a complaint; in the HMO model you first go to a specific health centre. From there you are referred to specialists or to hospital if needed. In return the premium is lower than in the standard model. In Zurich in 2027, the median monthly premium for adults with a CHF 300 deductible in the GP/HMO model was CHF 598.42, and CHF 677.00 in the standard model (median, FOPH data).
How the GP and HMO model works
Both models are insurance with restricted choice of service provider (Art. 41 para. 4 and Art. 62 para. 1 KVG). In the GP model you choose a GP practice from your insurer’s list. In the HMO model your first point of contact is a health centre or group practice the insurer works with.
If you need a specialist, therapy or hospital treatment, the practice gives you a referral. Without a referral the insurer does not have to pay for the treatment, except in an emergency or where the insurance conditions provide an exception.
The model is only open to you if you live in the area where the insurer offers it (Art. 100 KVV). From 2027 the FOPH groups GP and HMO tariffs under the tariff type “PRAXIS”; up to 2026 it lists them separately.
What you pay compared with the standard model
Compared with the standard model of the same insurer, a GP or HMO tariff is 11.0 to 13.5% cheaper on median (depending on city and deductible, premiums 2027).
| City | Standard (free choice of physicians) | GP/HMO | Telemedicine/digital | Flex |
|---|---|---|---|---|
| Zurich (ZH) | CHF 677.00 | CHF 598.42−11.6 % | CHF 597.05−11.8 % | CHF 597.00−11.8 % |
| Bern (BE) | CHF 699.75 | CHF 617.95−11.7 % | CHF 622.95−11.0 % | CHF 603.30−13.8 % |
| Lausanne (VD) | CHF 720.80 | CHF 637.60−11.5 % | CHF 639.00−11.3 % | CHF 624.30−13.4 % |
| Lugano (TI) | CHF 764.00 | CHF 684.40−10.4 % | CHF 689.55−9.7 % | CHF 687.45−10.0 % |
| City | Standard (free choice of physicians) | GP/HMO | Telemedicine/digital | Flex |
|---|---|---|---|---|
| Zurich (ZH) | CHF 549.75 | CHF 470.45−14.4 % | CHF 471.50−14.2 % | CHF 472.20−14.1 % |
| Bern (BE) | CHF 571.45 | CHF 490.10−14.2 % | CHF 494.60−13.4 % | CHF 475.00−16.9 % |
| Lausanne (VD) | CHF 592.50 | CHF 512.00−13.6 % | CHF 511.00−13.8 % | CHF 496.00−16.3 % |
| Lugano (TI) | CHF 635.70 | CHF 556.10−12.5 % | CHF 561.40−11.7 % | CHF 562.50−11.5 % |
Our own calculation: median of all tariffs per model in the city municipality (premium region 1), percentage compared with the median of the standard model. “Telemedicine and other models” is the FOPH tariff type “DIV” up to 2026; besides telemedicine it also includes other models. Source: FOPH, health insurance premiums 2027, as at 15.10.2026, opendata.swiss. Methodology: How we calculate.
What do I need to do before seeing a doctor?
Most insured people are in a model like this: in 2024, according to the FOPH, 79.8% of adults and 83.1% of children. If you do not know the rules, you risk your insurer not paying for a treatment.
GP/HMO · Emergency
In an emergency you go straight to the nearest emergency department or call 144, without a referral and without calling first. Many tariffs require you to inform your GP practice or HMO centre afterwards within a deadline. How long that deadline is depends on the insurance conditions.
Important: The insurance conditions of your tariff are binding. You will find them in your policy or on your insurer’s website. The rule above describes what many tariffs provide, not your contract.
Legal basis: Art. 41 para. 4 KVG
Suits you if …
- you have a GP who is on the insurer’s list
- you are in regular treatment and want a practice that coordinates everything
- you are insuring children with a paediatric practice
Watch out for
- Before signing up, check whether your practice is on the list (the insurer’s list of doctors).
- You need a referral for every specialist; note the exceptions in the insurance conditions.
- After an emergency you often have to inform the practice within a deadline.
More in the glossary
Frequently asked questions
How does the GP model work?
When you have a complaint, you always go first to the GP practice you chose. It treats you itself or refers you to a specialist or to hospital. In return the insurer gives you a discount on your basic health insurance premium.
What is the difference between the GP model and the HMO model?
In the GP model you choose a single GP practice from a list. In the HMO model the first point of contact is a health centre or group practice where several doctors work. The rule is the same: go there first, then on with a referral.
What happens if I see a specialist without a referral in the GP model?
If you see a doctor without following the required route, the insurer does not have to pay for that treatment (Art. 41 para. 4 KVG). Many insurance conditions also provide for exclusion from the model after repeated breaches. Emergencies are always exempt.
How do I leave the GP model?
You can switch from the standard model to a model with restricted choice at any time. Returning to the standard model or switching to another model is only possible at the end of a calendar year; your notice must reach the insurer one month in advance, i.e. by 30 November (Art. 100 KVV, Art. 7 KVG).
Are the benefits worse in a savings model?
No. The statutory benefits of basic health insurance are the same in every model. Only the route to treatment is restricted: the insurer only has to pay for what the chosen service providers carry out or arrange (Art. 41 para. 4 KVG).
Sources
- Federal Health Insurance Act (KVG), Art. 41Art. 41 KVGfedlex.admin.ch
- Federal Health Insurance Act (KVG), Art. 62Art. 62 KVGfedlex.admin.ch
- Health Insurance Ordinance (KVV), Art. 99–101aArt. 99–101a KVVfedlex.admin.ch
- Health Insurance Ordinance (KVV), Art. 36Art. 36 KVVfedlex.admin.ch
- FOPH: Health insurance, special types of insurancebag.admin.ch
- FOPH: health insurance premiums, opendata.swissopendata.swiss
- FOPH: Statistics on compulsory health insurance 2024, tables T 7.08 and T 7.09 (as at 22.05.2025)bag.admin.ch
Calculation based on the 2027 premiums approved by the FOPH, as at 15.10.2026, source: FOPH, health insurance premiums, opendata.swiss. Only the insurer’s quote or policy is binding. The model descriptions and rules are general information, not individual advice; your insurer’s insurance conditions are binding. Methodology: How we calculate.