Basic health insurance

pursuant to the Federal Law on Health Insurance (LAMal/KVG)

Compulsory basic health insurance covers the benefits provided by LAMal/KVG in case of illness, accident and maternity. Opt for the standard model to have the freedom to choose your doctor and consult a specialist directly, or choose an alternative model to benefit from a premium reduction.

Our basic insurance models

Need medical advice on a Sunday night? At these times, it’s great to be able to call a telemedicine center. Do you appreciate personal care based on a relationship of trust that goes back many years? Then contact your family doctor. Decide for yourself how you want to contact medical professionals. We offer various models for basic insurance. Choose the model that best suits your needs.

Calculate your 2024 premium
Standard model

Standard model

There are no restrictions. You are free to choose your doctor and can consult a specialist directly.

  • Your first point of contact: You choose your first point of contact with no restrictions.
Discover the standard model
Alternative model – Flexible

Alternative model – Flexible

- PrimaFlex -

You remain flexible and choose your first point of contact as needed if a health issue arises. PrimaFlex offers exclusive preventive services and some benefits without a deductible.

  • Your first point of contact: You choose the first point of contact that works best for you: Partner pharmacy, telemedicine, or your family doctor.
  • Save up to 24% on your premiums!
Discover PrimaFlex
Alternative model - Family Doctor

Alternative model - Family Doctor

- PrimaCare -

You specify your family doctor when you join. This allows for a long-lasting and trusting relationship with your healthcare partner.

  • Your first point of contact: You always consult your family doctor first.
  • Save up to 23% on your premiums!
Discover PrimaCare
Alternative model - Telemedicine

Alternative model - Telemedicine

- SanaTel -

Get professional medical advice by phone 24/7. After the consultation, you are free to decide which treatment you choose.

  • Your first point of contact: You first call our partner for telemedicine: Medi24.
  • Save up to 20% on your premiums!
Discover SanaTel
Alternative model - Health network

Alternative model - Health network

- OptiMed -

You enjoy the benefits of a network of doctors: For quality assurance, the doctors in the network exchange information regularly.

  • Your first point of contact: You choose your family doctor within the OptiMed network of doctors.
  • Save up to 26% on your premiums!
Discover OptiMed

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.

The Swiss health insurance system

In Switzerland, basic insurance is compulsory and is legally regulated under the Swiss Federal Health Insurance Act (KVG/LAMal). 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 of more
supplemental insurance policies. These are voluntary and are subject to the Federal Insurance Contract Act (VVG/LCA).

What is the KVG/LAMal?

The Federal Health Insurance Act (KVG/LAMal) 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 KVG/LAMal are defined by law and apply to all health insurance funds.

How can you optimize your health insurance in 2024?

Choose an alternative model or increase your deductible: So you can benefit from reduced premiums. Learn more about your savings options.

Optimize now

Six health insurance funds for excellent service

Did you know that Groupe Mutuel includes six independent health insurance providers? The health insurance companies Philos, Avenir, Easy Sana, Mutuel, Supra and AMB are all part of Groupe Mutuel. Their premiums differ – but their high standards of quality and service are identical. Depending on your personal situation, you can save money by switching providers within Groupe Mutuel, from 1st January or 1st July each year, depending on your cover. Contact us to find out more.

Benefits covered under the KVG/LAMal

  • 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 hospitalization 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 hospitalization 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 (ALT/LMT) and the Specialties List (SL/LS) are covered.

Complementary medical treatments practiced by a recognized 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 Products and Items 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: 7 check-ups and 2 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 KVG/LAMal.
  • 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 KVG/LAMal.
  • Gynecological check-ups: one examination/calendar year in the first two years, then one examination every 3 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 recognized 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.
Groupe Mutuel

Rue des Cèdres 5 Case postale, 1919 Martigny    |    +41 0848.803.111