Swica FAVORIT SANTE

HMO model
Primary care: HMO center

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General

General information:

Health insurance model «FAVORIT SANTE» of the Swiss insurance company Swica.

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 Swica.

Medical partner:

Ärztenetz Nordwest, localmed, Medbase, MediX, mediX limmimed, mediX luzern, mediX säntis, mediX winterthur, MedNet Biel-Bienne, Monvia, PizolCare, Sanacare, Seelandnet.

Pharmacy choice:

You get free choice of pharmacy

Payment methods:

11.6% of payments are made using the tiers garant payment method, in which you pay and claim reimbursement.
88.3% of payments are tiers payant, meaning the bills are paid directly by the insurance (Swica).

Reimbursement:

The average waiting period before tiers garant reimbursement from Swica is 2.3 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 Swica is 106% (according to FOPH data). The minimum ratio required by the FOPH is 100%.

Number of policyholders:

A total of 727,810 people hold compulsory health insurance policies from Swica.

Additional child-discount:

Swica provides additional premium reductions from the third child onwards.

Administrative costs:

5.3% (ratio of adminstrative costs to risk-adjusted premiums as per BAG data).

Administrative costs per policyholder:

CHF 202 (as per the most recent BAG data).