Vater mit Tochter im Park

HMO model – all the benefits of a medical network

The HMO model is a version of mandatory basic insurance. Your doctor’s practice from the medical network is your first point of contact in health-related matters.

Calculate premium

The advantages for you

  • The chosen doctor’s practice from the medical network or the group practice is your first point of contact.
  • You get a discount of at least 13% on the premium for your basic insurance.
  • No matter which basic insurance model you choose – you always receive the same benefits for illness, accident and maternity.
  • Medical advice is available 24/7 on 058 277 77 77.
  • CSS clients can find fantastic offers in the enjoy365 Health Shop and use the active365 app for free.

The HMO model at a glance

Medical treatment

You choose a doctor’s practice from the medical network and always go there first.

Go directly to a specialist

You can see an eye doctor, gynaecologist or midwife directly.

Health Maintenance Organisation Insurance

That’s the full name of CSS’s HMO model. You'll find it mentioned under this name on the policy.

Low-cost generics

Ask for a generic if available and possible. That’s how you save on costs.

How the HMO model works

Would you like to benefit from the experience of all the doctors in the network? And are you looking for the cheapest possible premium? Then the HMO model is perfect for you.

What should you do in the event of illness?

Under the HMO model, you always turn to your doctor’s practice from the medical network first. You decide which will be your HMO doctor’s practice when taking out the insurance.

How much will the premium cost each month?

Premiums depend on where you live, your age and what deductible you choose.

Your premium at a glance

Calculate premium

What you need to know about the HMO model

A group practice consists of several doctors working together in the same place. A medical network is made up of doctors in different locations.

Special treatment

Your doctor's practice will refer you directly to a specialist, for therapy or to a hospital if necessary. You can continue to go to your gynaecologist without a referral for screenings and routine consultations during pregnancy. Because basic insurance pays important maternity benefits.

What to do in an emergency

The phone number of your medical network is also your emergency number. If you can’t reach anyone there, follow the instructions given in the practice’s answering machine message.

What are the rules?

The rules include informing your doctor’s practice about all treatments and referrals, and obtaining its approval. That way, you pay lower premiums.

Anyone not following the rules will face financial consequences. You will have to pay up to CHF 500 per doctor’s bill from your own pocket.

What does HMO mean?

HMO stands for health maintenance organisation. You benefit from the knowledge and experience of the medical network. The exchange between its members enables a high quality of treatment.

Basic insurance benefits

Overview of benefits

Outpatient treatment / classical medicine

Cost coverage according to the tariff, throughout Switzerland, for treatment by recognised doctors, chiropractors, dieticians, midwives, speech therapists, physiotherapists, ergotherapists, nurses and nursing auxiliaries

Outpatient treatment / alternative medicine

Acupuncture, anthroposophic medicine, Chinese medicine, homeopathy and phytotherapy: Cost coverage according to the tariff, throughout Switzerland, for treatment by recognised doctors with an FMH qualification in the respective field of complementary medicine

Hospitalisation

Cost coverage without limit to sum or duration in the general ward (hospital/acute-care hospital) in accordance with the current cantonal hospital list

Health promotion / prevention

As stipulated in article 12 of the Health Insurance Benefits Ordinance

Frequently asked questions

You can go to any ophthalmologist you choose for a prescription for glasses or contact lenses. CSS pays towards glasses under supplementary insurance and not basic insurance. However, please consult your doctor’s practice if you're experiencing a new problem, or if you're planning to have an operation, such as cataract removal.

You require a referral from your chosen doctor’s practice for physiotherapy and chiropractic treatment.

The easiest way to find recognised doctors near you is to use premium calculator or the HMO doctor search function. You can change your doctor at any time.

Save the number 058 277 77 77 to obtain free medical advice. If you contact other telemedicine service providers or use apps other than Well or myCSS, you will be billed for their services.

How to save on premiums

Premiums depend on where you live, your age and what deductible you choose.

Higher deductible

The higher the deductible, the lower the premium. How to make the right choice.
Change deductible

Switch model

Change your medical point of contact and pay less.
Switch model

Exclude accident cover

If you work at least 8 hours a week, you can save on premiums.
Change accident cover