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Assura medical network

Family doctor model
Primary care: family doctor

General

General information:

Health insurance model «Medical network» of the Swiss insurance company Assura.

Health insurance model:

Family doctor model: When you use a family doctor policy, you are required to visit your relevant family doctor first. Your doctor may then refer you to specialists, therapists or hospitals. A primary consultation from your doctor is not necessary in the event of medical emergencies, gynecological examinations and treatments by eye doctors.

Choice of doctor:

Your choice of family doctor is limited to just one doctor from the Assura doctor list.

Medical partner:

Réseau Delta.

Pharmacy choice:

Choice of pharmacies is limited to those on the Assura medical network pharmacy list.

Payment methods:

64% of payments are made using the tiers garant payment method, in which you pay and claim reimbursement.
36% of payments are tiers payant, meaning the bills are paid directly by the insurance (Assura).

Reimbursement:

The average waiting period before tiers garant reimbursement from Assura is 14 days.

Financial reserves:

The solvency ratio shows how available financial reserves compare to Federal Office of Public Health (FOPH) minimum reserve requirements. The solvency ratio of Assura is 88% (according to FOPH data). The minimum ratio required by the FOPH is 100%.

Number of policyholders:

A total of 804,064 people hold compulsory health insurance policies from Assura.

Additional child-discount:

Assura provides additional premium reductions from the second child onwards.

Administrative costs:

6.9% (ratio of adminstrative costs to risk-adjusted premiums as per BAG data).

Administrative costs per policyholder:

CHF 218 (as per the most recent BAG data).

Customer satisfaction

General satisfaction 7.1/10 (Satisfactory)

Helpfulness 7.2/10 (Satisfactory)

Billing: flexibility 6.9/10 (Acceptable)

Reimbursement: time frame 6.8/10 (Acceptable)

Product information 7.3/10 (Satisfactory)

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