7%–19% premium discount
Good support
in a network of physicians
NetMed: HMO model
With the HMO model, you contact your practice or medical specialist in a network of physicians first. This way, you have excellent care while saving money on your premiums.
Key benefits
Who is an HMO model suitable for?
NetMed is ideal for anyone who wants to benefit from the collective knowledge of a network. And for whom it is always possible to contact their group practice or family doctor first. In return, they get an attractive discount on their premium.
How the HMO model works
Step 1
Choose an HMO practice or a family doctor in a network of physicians.
Step 2
For medical treatment or advice, you always contact your HMO practice or family doctor in a network of physicians first.
Step 3
The family doctor responsible for you will provide the initial medical consultation.
Step 4
If necessary, they will transfer you to a suitable specialist. The treatment plan is binding.
In hospital
For a hospital stay, choose the general ward and a recognised clinic on the cantonal hospital list. Cost coverage is then unlimited in terms of amount and duration.
In an emergency
In an emergency, you do not have to go to your family doctor first, but can go directly to an emergency doctor or to the A&E department in a hospital. Your family doctor will take care of any follow-up treatment and check-ups.
Overview of benefits
All the basic insurance models offer the same benefits. We reimburse you for the following benefits from the free choice of doctor model after the statutory cost shares (deductible, copayment, hospital cost contribution) have been deducted.
Basic health insurance | |
|---|---|
| Outpatient treatment | Treatment by doctors and chiropractors as well as medically prescribed therapies provided by other medical professionals |
| EU/EFTA (in emergencies) | Treatment as per bilateral agreements on free movement of persons |
| Other countries (in emergencies) | Up to max. of double the costs paid under the tariff for place of residence or place of work |
If administered by medical doctors: acupuncture, anthroposophical medicine, homoeopathy, phytotherapy, Traditional Chinese Medicine (TCM) in accordance with the statutory provisions | |
Medical aids as per list of aids and equipment (MiGeL) | |
Medicines/drugs as per the Department of Health’s list of pharmaceutical specialities. | |
Preventive measures, e.g. well-child check-ups, gynaecological check-ups (every 3 years), specific vaccinations | |
Check-ups by doctors or midwives, CHF 150 for antenatal course, breastfeeding advice | |
Treatment by medical doctors | |
| Up to age 18 | CHF 180.– |
| Spa treatments in Switzerland | CHF 10 per day, max. 21 days, at accredited spas in Switzerland |
| Transport | 50%, max. CHF 500.– |
| Rescue | 50%, max. CHF 5000.– |
| Switzerland | General ward in hospitals on official list, up to tariff for canton of residence |
| EU/EFTA (in emergencies) | Accommodation, nursing care and treatment as per bilateral agreements on the free movement of persons |
| Other countries (in emergencies) | Up to a maximum of double the costs paid under the tariff for the canton of residence |
The amounts listed are for maximum benefits and, unless specified otherwise, are valid for each calendar year. Benefits are granted only in accordance with the Swiss Federal Health Insurance Act (KVG/LAMal) and the corresponding ordinances, and the general terms of insurance and applicable supplementary terms issued by Sanitas.
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Frequently asked questions
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What does HMO stand for?
The HMO alternative basic insurance model stands for “health maintenance organisation”. This is usually a group practice with family doctors, specialists and therapists working closely together. All the doctors and therapists within this network have access to your medical records. This means that there are no information gaps and you receive the best possible treatment. If you are insured under an HMO model, you always contact your HMO practice first for medical queries.
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Which doctors are included in the health network?
Our doctor locator provides an overview. You can enter the desired location of the practice and the postcode here. Use the “NetMed basic insurance” filter to ensure that only medical specialists recognised by NetMed are shown.
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What is the difference between the HMO model and the family doctor model?
With the family doctor model, one doctor is responsible for your care; in the HMO model you have access to an entire network of physicians.
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What is cheaper: HMO or family doctor model?
The HMO model is usually cheaper: With NetMed, you receive a premium discount of between 7% and 19% compared to the Basic standard model.
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Can I change doctor or group practice?
Yes, that’s possible. Simply choose another HMO practice from the list (see doctor locator)
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Why does the NetMed basic insurance model offer different discounts?
Sanitas offers three discount variants for the NetMed basic insurance model. Sanitas wants its customers to be able to participate more transparently in the cost savings generated by the different networks of physicians. You benefit from a range of discounts depending on your family doctor or practice.
The handy doctor locator shows you quickly and easily which discount variant your medical contact is assigned to.
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Who decides which discount variant my family doctor is affiliated with?
Your family doctor is affiliated with a network of physicians. The network of physicians and Sanitas have concluded contracts with the aim of encouraging the goal of improving medical quality and reducing costs. This cost savings are achieved by optimising treatment paths and coordination. Sanitas calculates these discounts annually based on the cost savings achieved by the respective network of physicians each year. In order to share the cost savings of a specific discount variant, each network of physicians is assigned to the corresponding discount variant based on its cost savings.
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I don’t agree that I have a lower discount. What can I do?
If you would like a higher discount in your NetMed family doctor model, you have the following option: choose a family doctor assigned to a higher discount variant. In our family doctor locator, you can check which discount variant a practice is assigned to. However, if you want to remain with your current family doctor or your current family doctor, the specified discount is final for 2024.
Other basic insurance plans
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