FAQ – Most frequently asked questions
Our answers to the most frequently asked questions
You can find here the answers to our insured members’ most frequently asked questions.
Simply click on your subject of interest.
Basic health insurance (LAMal/KVG)
In accordance with Article 3 of the Swiss Federal Health Insurance Law (LAMal/KVG), any person residing in Switzerland is obliged to take out health insurance within three months of birth or taking up residence in Switzerland. If a person does not sign up for insurance, the cantonal or communal authorities will register that person automatically.
You can suspend your basic health insurance as soon as you receive marching orders or confirmation of civilian service for more than 60 days. Send a copy of the document in question by mail or email to firstname.lastname@example.org. Once we have received the document, we will send you a confirmation of suspension. At the end of your service, send us the certificate of incorporation or a copy of the service booklet in order to confirm the suspension. We will then cancel any invoices that will have been suspended during the service period.
When you join a health network, you choose your general practitioner from the list corresponding to the chosen network. You should always consult this doctor first. If necessary, this doctor will refer you to an appropriate specialist.
By opting for a health network system, you benefit from high quality medical attention and help contain health costs. This responsible behaviour will allow you to benefit from a discount on your insurance premium!
You are not required to consult your general practitioner beforehand in certain specific cases (e.g. for consultations with a gynaecologist, eye specialist, etc.).
You will find all the necessary information in your special terms and conditions of insurance.
No, specialists do not need to be on a list of approved doctors. However, the decision to refer you to a specialist must be taken by your general practitioner. If necessary, your GP must issue a referral voucher and forward it to us.
You may change your general practitioner once a year.
Just send us the name of your new doctor by mail or email (email@example.com). The general practitioner must appear on the list of doctors approved by your network (exception: in the PrimaCare model, there is no list of doctors).
You have not complied with the terms and conditions of PrimaCare, PrimaTel, Sanatel, Optimed, Réseau de soins BasicPlus, SUPRAcare. If you feel that our decision is unjustified, please contact our Benefits Department on 0848 803 111.
Most of the gaps in basic insurance can be filled by supplemental insurance. The most significant gaps include the coverage of the costs of dental care, glasses and alternative medicine.
a) Pharmacy costs: your pharmacy costs are covered as before. This means that you pay your invoices directly to the pharmacy and then you are reimbursed by your insurer, after deduction of the co-insurance amounts (“third-party guarantor” system).
b) Costs of other healthcare providers (doctors, laboratories, physiotherapists, etc.): these costs are normally also refunded according to the “third-party guarantor” system. However, if the healthcare provider has entered into a “third-party payer” agreement with Groupe Mutuel, the insurer settles the healthcare provider's invoice and invoices the insured person for his share of the costs.