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Groupe Mutuel PrimaFlex

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Groupe Mutuel PrimaFlex

Multiple: Telemedicine/pharmacy/family doctor
Primary care: Telemedicine/pharmacy/family doctor

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General

General information:

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

Health insurance model:

Pharmacy model: Holders of pharmacy-model policies are required to visit pre-specified pharmacies as a first stop. From there they are referred to doctors, specialists, therapists, or hospitals.

Choice of doctor:

Your choice of doctors is limited by Groupe Mutuel PrimaFlex requirements.

Medical partner:

Medgate.

Telmed consultation:

Recommendations made during telemedicine consultation are not binding.

Pharmacy choice:

Choice of pharmacies is limited to those on the Groupe Mutuel PrimaFlex pharmacy list.

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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