Basic health insurance (LAMal/KVG)
Our answers to the most frequently asked questions
You can find here the answers to our insured members’ most frequently asked questions.
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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 your marching order or confirmation of civilian service due to last more than 60 consecutive days. Send us a copy of the document by post or using our notification form. At the end of your service, please send us the certificate of incorporation or a copy of the service booklet in order to confirm the suspension of your insurance. We will then cancel any invoices that will have been stopped during the service period.
It’s an alternative model to the standard basic health insurance model. You receive the same benefits as with a standard basic health insurance model but pay a lower premium. In return, you agree to first see the family doctor you have chosen.
Your family doctor, also known as “general practitioner (GP)”, examines you and refers you to a specialist if necessary. This avoids unnecessary consultations and helps to reduce health care costs.
If your family doctor or another doctor refers you to a specialist, you must ask your GP to draw up a short certificate, i.e. a "referral voucher". Some doctors send it to us electronically. If this is not the case, you can ask your doctor for the referral voucher (a simple signed note is sufficient, mentioning the specialist recommended and the period of validity of the certificate). You can send it to us by post or via your online customer area.
When you join a health network model, you choose your general practitioner from the list corresponding to the chosen model (OptiMed). You will need to consult this doctor first in the event of a medical problem. If necessary, the doctor will refer you to a suitable specialist.
By opting for a health network system, you will benefit from high quality medical care and help to contain rising health costs. This 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, depending on your alternative insurance model, your general practitioner, Medi24 or your partner pharmacy must make the decision to refer you to a specialist. In these cases, a referral voucher must be sent to us.
You are allowed to change general practitioners once a year.
All you have to do is send us the name of your new doctor by post or by email (firstname.lastname@example.org).
- Special condition for SupraCare: the general practitioner can only be changed with the prior consent of the insurer.
- Special condition for BasicPlus, Optimed and Health Network Geneva: your new doctor must be on the list of doctors approved by the network.
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.