CSS HMO

HMO model
Primary care: HMO center
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General

General information:

Health insurance model HMO of the insurance company CSS.

Health insurance model:

HMO model: As an HMO policy holder, you are required to get medical consultation from a doctor at an eligible HMO center before receiving further treatment. Your HMO center may then refer you to specialists, therapists or hospitals. A primary consultation from an HMO center is not necessary in the event of medical emergencies, gynecological examinations and treatments by eye doctors.

Choice of doctor:

Your choice of general practitioners is limited to doctors at HMO health centers which partner with CSS.

Medical partner:

Ärztenetz Nordwest, Ärztenetzwerk Thurgau, Grisomed, Hapmed, localmed, Medbase, MediX, mediX limmimed, mediX luzern, mediX säntis, mediX winterthur, Monvia, PizolCare, Réseau Delta, RhyMed, Sanacare, xundart, zimdoc, zmed, Zolamed.

Pharmacy choice:

You get free choice of pharmacy

Payment methods:

10% of payments are made using the tiers garant payment method, in which you pay and claim reimbursement.
90% of payments are tiers payant, meaning the bills are paid directly by the insurance (CSS).

Reimbursement:

The average waiting period before tiers garant reimbursement from CSS is 7.7 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 CSS is 84% (according to FOPH data). The minimum ratio required by the FOPH is 100%.

Number of policyholders:

A total of 1,501,294 people hold compulsory health insurance policies from CSS.

Additional child-discount:

CSS does not offer additional premium reductions for more than one child.

Administrative costs:

4% (ratio of adminstrative costs to risk-adjusted premiums as per BAG data).

Administrative costs per policyholder:

CHF 152 (as per the most recent BAG data).