HMO model casamed hmo
A whole team to look after you
Take the easy way with HMO group practice: Sympany’s casamed hmo basic insurance offers several specialists to take care of you when you’re ill. casamed hmo is extremely simple and you save a lot on premiums:
Brief overview of the casamed hmo HMO model
HMO stands for health maintenance organisation, in other words an organisation that’s designed to keep you healthy. The idea behind the HMO concept is that doctors and medical staff take a more proactive interest in your health, instead of just treating you when you’re sick.
Accordingly, the HMO model indicates an insurance savings scheme whereby you always contact your chosen HMO centre in the event of health complaints. The HMO centre will then coordinate your treatment in a process known as Managed Care. More information about the topic of Managed Care >
In Switzerland, HMO centres are usually group practices where there is (at least) one family doctor in addition to medical staff from other specialist fields. This gives you access to the widest possible range of medical benefits from a single provider.
Advantages:
- You get a discount on your premiums. Find out more about the premium discount here >
- You will usually be treated by the same doctor. If they aren’t available, you will be seen by another doctor.
- Doctors from various specialist fields frequently work together in the same HMO centre and, where necessary, collaborate in the interest of your well-being.
Disadvantages:
- You don’t get a free choice of doctor and will have to abide by the rules of the HMO model. You will need a referral for the majority of specialist medical practices.
- HMO centres often have longer opening hours than family doctor practices but, unlike telemedicine models (callmed 24, casamed pharm, flexhelp24), you will not receive 24/7 medical advice.
- Not all medical practices can be registered with under the HMO model. There are also many medical practices that have suspended admissions and are not accepting new patients. Before opting for the HMO model, please make sure that the centre you want to register with is on our list of centres and will accept you. Search for a centre >
As with the family doctor model, you will usually be treated by the same doctor at the HMO centre. However, as there are usually doctors from other specialist fields at an HMO centre, many different complaints can be treated at a single centre. The close collaboration means that you will benefit from optimal and efficient treatment with a minimum of hurdles.
We had thought that a HMO practice would be a bit impersonal. Despite this, we decided four years ago to go with a HMO practice to save on premiums and we are now extremely satisfied with it. It’s as if we have several doctors on standby for us at once.
Luzia and Andreas Schwegler, 65 and 68, retired
Useful links about the HMO model
Has your desired practice suspended admissions? If so, please let us know. Many thanks for your support!
How the casamed hmo HMO model works
- If you have any health complaints, your chosen HMO centre (group practice) is always your first point of contact for health complaints.
- The centre coordinates your treatment and, if necessary, refers you to a specialist or the hospital. You can visit an ophthalmologist, gynaecologist, paediatrician or emergency department directly – no need for a referral. (But: medical emergencies must subsequently be reported to your chosen HMO centre.)
- In the HMO model, you pay between 12 and 16% less in premiums than for a model with a free choice of doctor.*
What does it mean if I choose the casamed hmo HMO model as my basic insurance?
Would you like comprehensive medical care? A point of contact for all health questions where family doctors and specialists work hand in hand? Then casamed hmo is just right for you! Details can be found here – and in our casamed hmo product leaflet.
For every new treatment, the first thing to do is contact your HMO group practice where a number of doctors will be there to help you. The HMO group practice coordinates your treatment and, if necessary, refers you to other specialists or the hospital. casamed hmo facilitates cost-conscious processes. This is why the premiums are lower than those for traditional basic insurance.
There are a number of HMO centres to choose from in Switzerland. Use our HMO centre search to find your nearest centre right away. Please clarify whether they are accepting new patients. When you take out the policy, you inform Sympany of your chosen centre by completing a paper or online form.
You always have a contact person – even for urgent problems – and receive comprehensive medical care. Depending on the centre, several specialists will be on hand should the unexpected happen.
Yes, some centres also offer specialised services alongside basic medical care. If you’re ill, please always contact your HMO centre administration first, which will coordinate scheduling your appointment at the centre. If necessary – and if possible – a specialist from the same centre will be called in.
Yes, that’s not a problem. It’s important for you to inform your practice so that it’s aware of all your treatments in advance and can coordinate any further treatments that may be required.
Yes, please follow your treatment plan. Someone will check whether there are any referrals for follow-up treatment.
Sympany monitors compliance with the rules – both by law and out of fairness towards other policyholders. Anyone who disregards the rules will face financial consequences (e.g. because they need to be moved to a traditional basic insurance plan and no switch is possible for a year or because they have to cover treatment costs if they repeatedly disregard the rules).
Special cases and exceptions
Your practice is also there for you if you experience urgent problems and need emergency treatment. In an acute, very serious or life-threatening emergency, immediate treatment is the priority. If you were unable to contact your practice for this reason, please do so as soon as possible after the emergency situation, ideally by presenting the emergency treatment certificate that you received from the emergency doctor.
In this case too, please contact your HMO centre as your first port of call.
Exception: the accident is an acute, (life-) threatening emergency, meaning immediate treatment is the priority. In this case, please inform your practice/centre afterwards and ideally provide them with the emergency treatment certificate that you received from the emergency care centre.
You can contact your gynaecologist directly for any treatments relating to your pregnancy.
For non-pregnancy-related medical issues, please get in touch with your HMO centre as usual.
Yes, there are exceptions. You can contact ophthalmologists, gynaecologists and emergency doctors directly. And paediatricians for children under 16 years old can also be chosen freely.
If longer treatment is on the horizon, ask your practice for a longer-term referral. It’s useful to keep your practice up to date on unplanned follow-up treatments so that your treatments are coordinated in the best possible way.
No. As long there is a referral for follow-up treatment, no additional notification is required for these kinds of services. You therefore don’t have to notify anyone about laboratory analyses.
Please inform your HMO centre of this in advance, to allow them to coordinate your treatment.
Even in this case, your HMO centre is your first point of contact to discuss the best course of action over the phone. If, in urgent cases, you can’t reach anyone outside of business hours, inform the centre of the steps taken after you’ve been treated elsewhere.
It’s best to seek a second opinion from your group practice. Or maybe you’d like to involve another expert? You can do this with a referral. If you’ve been dissatisfied for a long time, it might make sense to change your centre. Important: following through with referrals by the HMO centre is always mandatory.
Switch HMO centre or insurance model
You can find a new centre using our online search. You can switch at any time from the beginning of the following month. Don’t forget to inform us of your chosen practice here in advance. Find out whether the centre is accepting new patients.
Find out what you need to know when switching to another Sympany basic insurance here: Switch insurance models. Please bear in mind that the rules of the current model remain valid until the switch, as you will still benefit from the discount of your old model until then.
Downloads
Terms and Conditions of Insurance casamed hmo (2024)
A comparison of all Sympany’s basic insurance policies
Your advantages at Sympany
* Examples of the premium discounts
Depending on the alternative insurance model, insured persons can have one or a number of available first points of contact (Medgate, family doctor’s practice/HMO centre, pharmacy) for reporting health complaints.
Some models make it possible to coordinate treatment to a greater extent than others, which results in varying levels of cost savings. Sympany passes these cost savings on to its customers in the form of a premium discount – which is always calculated precisely for the respective model, age group, franchise and premium region.
Discount of 12%:
adult premium in Bern BE, CHF 2’500.– deductible, without accident cover, Vivao Sympany AG
Discount of 16%:
adult premium in Solothurn SO, CHF 2’500.– deductible, without accident cover, Vivao Sympany AG