Help me choose health insurance model

Inspired by the thread about complimentary insurance, I would like to get your opinion on the basic insurance. I am now with Assura Standard Model and pay 280/month. I know that Assura has low ratings, so I was thinking if it would be worth it to switch? For sure it does not seem to make sense to combine the standard model with a high deductible. I can go get treated wherever I want, but I pay for it out of my pocket anyway, so…

Is there any other model you would recommend? I initially did not choose the family doctor, because it seemed very limiting. I was new to Switzerland, didn’t know if I will stick to one place and didn’t know any good doctors. It also feels weak to depend on a single doctor who may be on holidays sometimes?

Any experience with the SWICA Pharmacy model? I really need to go to a pharmacy first? I can’t call a number? And HMO? Are you limited to a selected chain of “praxis”?

I think Telmed model sounds reasonable: you call them, they give you assistance and then you can choose the praxis that you want. Correct? Here the highest rating comes from Agrisano, followed by ÖKK and SWICA. But is Agrisano not only for farmers?
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Regarding complimentary abroad insurance (deliberately not saying “travel”). I wanted to go this year to USA (which didn’t work out, “thank you” corona), so I know what you mean by fine print. I eventually took the insurance from Viseca for 30 CHF, but I’m really considering taking this complimentary insurance and having a peace of mind. To me, traveling is also a big motivator in life, and the more financially independent I get, the more ambitious travels I would like to make. So I would not like to hear at some point that they refuse to insure me!

For the basic insurance they must accept you, don’t worry.

Also: it’s a bit early to discuss about basic insurance. Wait a couple of months when the new offers are available.

Do things change so drastically? I am with Assura since 5 years and they have remained the cheapest all these years. And what time will we know the Prämien for 2021? And when is it not too late to make the switch?

You can have a praxis as your doctor. I don’t think the entire praxis will go on vacation at the same time.

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If so, then what’s the difference between home doctor and home praxis model? Is the HMO a whole chain of praxen? And still, it feels limiting. What if the praxis that I use now is not on the authorized list? Right now I’m using two praxen: one is very close to me, the other one is open 365 days a year.

They might change. You will know when it happens since everyone will talk about it. At that point you have time until the end of the year to change. For complementary is different. I have to do it before the end of the month.

Make sure you use https://www.priminfo.admin.ch/de/praemien when comparing insurances. On Comparis some insurers are not shown because they don’t pay referral fees to them.

I’m personally with Assura CasaMed (family doctor which is 5mins walk away from my place) and happy with it. My wife had bad experiences with the TelMed case, they end up sending you to their “chain” doctors usually outside the place you live. We’re now all with the CasaMed model and we both have the highest deductible but she has accident insurance included due to being a house wife. Including my son we pay 450 CHF/month (184 for me, 200-ish for my wife and ~70 for my son).

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About Assura : have been using them since several years, never had a problem.

About the housedoctor : you can change it with a one days notice inside the (extensive) network they have. I even took the option of the pharmacy network to even reduce insurance costs.

Since I am with the highest deductible and never had big issues, I never got something back anyway from the insurance.

As far as I know, the doctor choice does not apply if you have an emergency/sudden illness during travel in Switzerland/weekends etc. Just for regular/planned treatment you have to get to your declared doctor.

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I always wondered how it work with the pharmacy one. Say your back hurt or something else. You go to the pharmacy, they ask you something and then either try to sell you stuff or tell you to just go home and rest. Is it that way? At least TelMed it (probably) work this way.

I have seen different variations of the TelMed model (even at the same insurance company):

a) You agree to call in and adhere to their recommendation/guidance (and might have to visit the doctors they chose)
b) You agree to call in and get advice - but are then free to proceed and visit a doctor as you choose

The latter of course had a lower rebate but I chose it anyway, as choice of medical practitioner was important to me.

It is just you are supposed to get your drugs at a pharmacy in a certain network. Nothing to do with medical advice.

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Ok so the standard model gives you a free choice of doctors and telmed is limited to “partners” of the Krankenkasse? But then the cheaper models are even more limited, right? (HMO, Pharma and Family Doctor)

Well there you go. What other real problems could you have if not the Krankenkasse refusing to pay? I heard that’s the biggest problem with them. I’m with Assura + Standard Model + 2500 deductible, so I never actually had to deal with Assura. I pay all my bills myself and it’s as if Assura didn’t exist.

From what I could understand, you have a free choice of a specialist from their partner list, which is public. You think it’s possible that you say “I want doctor X from the list” and they say NO?

Check out this SWICA flowchart:
FAVORIT PHARMA:

FAVORIT TELMED:

As you can see, not only do you go to a pharmacy for medical assessment (can also call just like in Telmed), but you’re also limited to a narrower list of partners (only MEDIPHARM, not all).

Ok I elaborate : I had to call few times, some issues between accident/normal health insurance, questions for how stuff actually works, changing from unemployed for my wife to employed and now self-empoyed concerning the accident insurance etc. Always pleasant to deal with it in my experience.
Sure, no experience about actual repayment, but since it is highly regulated by law… not sure what the risk actually is…

This is technically correct because they’re too lazy to do the invoicing proxy function which others do. However I nowadays just scan all the invoices from doctors I get using their App (Either the Assura app or the MediData scanner app) and occasionally get refunds, especially for stuff for my kid.

The Telmed model is really the best. You save a lot of money and it’s so easy! They can send prescriptions directly to the pharmacy. I’m with Swica right now.

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Telmed is so better that now it costs more than the other methods.

I think I’ve seen the possibility to use the pharmacy as first step for a visit.

That’s some valuable input! So you can just call your Swica Telmed, tell them what’s wrong, and based on that they can give you some prescription drugs? And they don’t charge extra for it? (I mean, the medicine costs, but does the prescription cost?)

Example: my gf had a big migraine, so strong she had to throw up. I took her to ER, they gave her some strong painkillers via infusion. Would telmed prescribe some strong painkillers over the phone?

Edit: now I remember we did call the insurance and we did get some prescription, it was just not strong enough. Me & gf both have the standard model, which of course includes phone assistance.

here it is:
https://www.groupemutuel.ch/en/clients-prives/nos-produits/sante/assurance-obligatoire-de-soins/PrimaPharma.html

Oh that is new to me that you can get prescriptions over the phone… That is pretty cool. Will they also give “Krankschreibungen” or you have to go physically to a doctor for that ?

I have sanacall and my one experience was very good. I had an issue and they organized an appointment with a specialist in Zurich without any fuss.

However, I would only recommend these models if you are a healthy person with not too many complications. They all come with fine prints that you should be aware of.

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