Groupe Mutuel OptiMed

Family doctor model
Primary care: family doctor

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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).