sana24 Managed Care

Multiple: Family doctor/hmo
Primary care: Family doctor/hmo

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General

General information:

Health insurance model «Managed Care» of the insurance company sana24.

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 sana24.

Medical partner:

Ärztenetz Nordwest, localmed, Medbase, MediX, mediX limmimed, mediX luzern, mediX säntis, mediX winterthur, PizolCare, Réseau de Soins Neuchâtelois, RhyMed, Seelandnet, xundart.

Pharmacy choice:

You get free choice of pharmacy

Payment methods:

20% of payments are made using the tiers garant payment method, in which you pay and claim reimbursement.
80% of payments are tiers payant, meaning the bills are paid directly by the insurance (sana24).

Reimbursement:

The average waiting period before tiers garant reimbursement from sana24 is 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 sana24 is 135% (according to FOPH data). The minimum ratio required by the FOPH is 100%.

Number of policyholders:

A total of 76,696 people hold compulsory health insurance policies from sana24.

Additional child-discount:

sana24 provides additional premium reductions from the third child onwards.

Administrative costs:

6% (ratio of adminstrative costs to risk-adjusted premiums as per BAG data).

Administrative costs per policyholder:

CHF 197 (as per the most recent BAG data).