Alternative models
With our four alternative models, you can significantly reduce your premiums compared with the standard model. Before any medical consultation, you must call upon a preferred first point of contact. The model that is best for you depends on your preferred first points of contact.
Flexibility of choice
PrimaFlex
Save up to 27% on your premiums.
Condition: you must first consult one of four possible first points of contact: a partner pharmacy, our telemedicine partner, the Ada symptom checker or your family doctor.
Health networks
OptiMed
Save up to 26% on your premiums.
Condition: you must choose a doctor from one of the OptiMed lists as your first point of contact. You call on this doctor first, who then refers you to a specialist if necessary.
Telemedicine and
symptom checker
SanaTel
Save up to 23% on your premiums.
Condition: you must first consult our telemedicine partner or use the Ada symptom checker(1).
Family doctor
PrimaCare
Save up to 16% on your premiums.
Condition: you must notify us of your family doctor beforehand. You call on this doctor first, who then refers you to a specialist if necessary.
Standard model
Free choice of doctor
Standard
With the standard model, you are entirely free and can see the doctor of your choice, without any preconditions.
DiscoverCompare: your first point of contact depending on the alternative model
(1) From January 2025, Ada will be added to the list of first points of contact available under the SanaTel alternative model.
(2) From January 2025, it will be possible to choose a remote family doctor with our telemedicine partner Medgate.
Ask for advice
Do you have any questions about our basic insurance models?
Our insurance advisers will be happy to answer any questions you may have about your insurance coverage.
How may I optimise my basic health insurance?
Groupe Mutuel suggests three ways to save on your insurance.
1.
By choosing an alternative model
(with savings of up to 27 %).
Calculate your 2025 premium
2.
If your medical expenses are lower than CHF 2,000 a year, you can increase your deductible to receive a premium reduction.
Optimise now
3.
Depending on your situation, you can save money by switching insurers within Groupe Mutuel, as at 1 January or 1 July of each year depending on your coverage. We bring together six independent health insurance companies that offer the same high-quality service: Philos, Avenir, Easy Sana, Mutuel, Supra and AMB.
Contact us
Good to know
The Swiss health insurance system
In Switzerland, basic insurance is compulsory and is legally regulated under the Swiss Federal Law on Health Insurance (LAMal/KVG). Compulsory health insurance covers basic healthcare in the event of illness, accident and pregnancy.
For more comprehensive coverage and a higher level of comfort, you can take out one or more
supplemental insurance policies. These are optional and are subject to the Federal Law on Insurance Contracts (LCA/VVG).
What is the LAMal/KVG?
The Federal Law on Health Insurance (LAMal/KVG) is based on the principle of solidarity. The premiums paid by the insured persons depend only on their region of residence and age group: children (0–18), young adults (19–25) or adults (26+). Within these groups, the premium is the same.
The benefits covered by the LAMal/KVG are defined by law and apply to all health insurance funds.
Benefits covered under the LAMal/KVG
- In Switzerland: throughout Switzerland, the costs of a hospital stay in the general ward of a listed hospital are covered up to the amount of the tariff in the insured person’s canton of residence.
- Outside Switzerland: in the event of an emergency in the EU/EFTA/UK on presentation of the insurance card: the costs of hospitalisation are covered up to the amount that the visited country would have paid for its residents. Outside of the EU/EFTA/UK, the costs of hospitalisation are covered up to 90% of what the treatment would have cost in the canton of residence in Switzerland.
The costs of medications prescribed by a doctor and listed in the List of Medicines with Tariff (LMT/ALT) and the Specialties List (LS/SL) are covered.
Alternative medical treatments practiced by a recognised doctor (acupuncture, homeopathy, phytotherapy, traditional Chinese medicine, anthroposophic medicine) are covered.
Medically prescribed spa treatments in Switzerland are reimbursed at CHF 10/day for a maximum of 21 days per calendar year.
For children up to the age of 18, the costs of glasses or lenses are reimbursed up to CHF 180/calendar year. For adults, between CHF 180 and CHF 630 per eye is covered for certain conditions only (as per the List of Medical Aids and Appliances LiMA/ MiGeL).
External and removable devices (e.g., crutches, wigs, hearing aids, etc.) are covered as per the List of Aids and Objects MiGeL).
Standard pregnancy: seven check-ups and two ultrasounds during pregnancy; delivery at home, in a birthing center or hospital and one check-up after the birth are covered.
High-risk pregnancy (as determined by a doctor): all necessary check-ups and ultrasounds are covered.
Lump sum of CHF 150 for antenatal classes offered by a hospital or midwife.
The following are covered:
- Investigations for the early detection of diseases (e.g., breast cancer screening) in certain risk groups or through cantonal screening programs in accordance with the LAMal/KVG.
- Recommended vaccinations and vaccinations administered to groups at increased risk of complications or exposure to certain diseases.
- Nutritional advice and courses as per the special cases under the LAMal/KVG.
- Gynecological check-ups: one examination/calendar year in the first two years, then one examination every three years.
Costs are covered for conditions of the masticatory system and dental accidents that are treated by a dentist.
Transportation costs are covered at 50% up to a maximum of CHF 500/calendar year.
Rescue costs are covered at 50% up to a maximum of CHF 5,000/calendar year (in Switzerland only).
Services provided by recognised psychologists/psychotherapists are covered when medically prescribed.
Outpatient treatment is covered as per the KVG/LAMal (e.g., doctor’s visits):
- In Switzerland: 100%
- Outside Switzerland: in the event of an emergency in the EU/EFTA/UK and on presentation of the insurance card, the costs are covered up to the amount that the country in which the person is located would have paid for its residents. Outside the EU/EFTA/UK, the costs are covered up to twice the treatment cost in the canton of residence in Switzerland.
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