Groupe Mutuel OptiMed

  • Family doctor model

  • Primary care: family doctor

General

General information:

Health insurance model «OptiMed» of the insurance company Groupe Mutuel.

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 Groupe Mutuel.
Medical partner:
Argomed, Ärztenetz Nordwest, Beodocs, Grisomed, Hapmed, HARESO, HAV Schwyz, HAV-SH, Igomed, iNetz, Medbase, MedNet Biel-Bienne, mednetbern, Monvia, Réseau de Soins Neuchâtelois, Réseau Delta, RhyMed, Sanacare, Seelandnet, xundart, zimdoc, zmed, Zolamed.
Pharmacy choice:
You get free choice of pharmacy
Payment methods:
8.7% of payments are made using the tiers garant payment method, in which you pay and claim reimbursement.
90.9% of payments are tiers payant, meaning the bills are paid directly by the insurance (Groupe Mutuel).
Reimbursement:
The average waiting period before tiers garant reimbursement from Groupe Mutuel is 10.8 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 Groupe Mutuel is 97% (according to FOPH data). The minimum ratio required by the FOPH is 100%.
Number of policyholders:
A total of 296,991 people hold compulsory health insurance policies from Groupe Mutuel.
Additional child-discount:
Not specified.
Administrative costs:
4.6% (ratio of adminstrative costs to risk-adjusted premiums as per BAG data).
Administrative costs per policyholder:
CHF 230 (as per the most recent BAG data).

Customer satisfaction

General satisfaction    7.6/10 (Good)
Helpfulness    7.7/10 (Good)
Billing: flexibility    7.3/10 (Satisfactory)
Reimbursement: time frame    7.6/10 (Good)
Product information    7.5/10 (Good)

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