Changes to the special terms and conditions of the insurance models OptiMed (RS) and PrimaCare (RF)

Under basic insurance, the special terms and conditions are a document that sets out the specific rules for the alternative insurance models. It was necessary to update these special terms and conditions to enable us to offer a better customer experience to persons covered by one of these alternative models.

The way your basic health insurance works, as well as the benefits to which you are entitled, will not change:

• The way your insurance model works will not change.
• Your premium will not be impacted by the changes.
• The medical benefits covered by your insurance will remain the same. The benefits of basic health insurance are defined by the Law on Health Insurance (LAMal/KVG) and are therefore identical, regardless of the insurance company and the basic health insurance model chosen.
• If your residence canton pays part of your health insurance premium, the subsidies to which you are entitled will not be affected by the changes.
• Your deductible will not be impacted by the changes.
• The data shared with our partners will remain the same.
• Your family doctor will remain the same.
• Your supplemental insurance policies will not be affected by these changes, which only apply to basic health insurance.
   

The main changes have been made to Article 10 to provide a better customer experience for insured persons:
1)    who move to a region where their insurance model is no longer available;
2)    who can no longer be followed by their family doctor (e.g. when the doctor retires). 

Currently, these people can already opt for a new insurance model. People in “situation 2” can also choose a new family doctor.

In future, in “situation 2”, if the insured person fails to respond, Groupe Mutuel will be able to choose a new family doctor without the person's consent, based on the doctor most frequently consulted by this person. If this is not possible, as in “situation 1”, the insured person will be transferred to a similar model in order to continue to benefit from an lower premium (until now, the insured was transferred to the standard model, which resulted in a significant premium increase).

No, because the changes to the special terms and conditions take effect on 1 January 2024. The notice period is therefore the same as for other policyholders wishing to change their basic insurance model or insurer (i.e. the notice of termination must be received by the current insurer by 30 November 2023).

You can download your new special terms and conditions below:

• OptiMed 
• PrimaCare 

You can also ask to receive them by calling us free of charge on 0800 808 088 or by visiting one of our agencies.

If you require further information about the changes, please do not hesitate to contact us:

• Using the contact form
• By telephone on 058 0800 808 088, Monday to Friday from 8 am to 6 pm
• In one of our agencies