LAMal lets every insured person choose the way they access care. Basic benefits are strictly identical across all models — only freedom to choose your provider varies, in exchange for a premium discount. Information applicable to 2026, source FOPH (bag.admin.ch).
1. What is an insurance model?
LAMal allows each insured person, on top of the basic benefits that are identical for everyone, to choose the form under which they want to access care. Several models exist — also known as special forms of insurance: standard insurance and alternative models (family doctor, HMO, Telmed), plus bonus insurance.
Alternative models grant premium discounts in exchange for a voluntary restriction on the choice of care providers. Basic benefits remain strictly identical across all models — LAMal guarantees it. Premium subsidies are available regardless of the model chosen.
2. Overview of models
The five forms of insurance permitted by LAMal differ in how much freedom the insured has in choosing the first care provider, and in the discount granted in return.
| Model | Freedom of choice | Possible discount | Suited to |
|---|---|---|---|
| Standard | Full | None | Those who want to freely choose any doctor or hospital |
| Family doctor | Restricted to the designated first-contact doctor | Up to 20% | Those with a trusted doctor |
| HMO | Restricted to the designated HMO medical centre | Up to 20% | Those living near an HMO centre |
| Telmed | First contact required by phone / app | Variable | Those comfortable with remote consultations |
| Bonus | Full (standard deductible only) | Up to 50% after 4 claim-free years | Those in excellent health, young adults |
3. Standard model
Standard insurance is the reference form. The insured person can consult any doctor or hospital listed in the cantonal admission register, with no prior step or mandatory referral.
It is the most expensive model in terms of premiums, but also the most flexible. It corresponds to the reference premium on which all discounts for the other models are calculated.
Full freedom to choose any doctor or hospital.
No obligation to go through a designated first-contact provider.
Compatible with all optional deductibles (from CHF 300 to CHF 2,500 for adults).
Highest premium among all models offered by your insurer.
4. Family doctor model
In this model, the insured person commits to consulting their family doctor first for any non-urgent health issue. The family doctor then decides whether to refer the patient to a specialist or a hospital if necessary.
Emergencies: you can go directly to an emergency department without going through your family doctor.
The family doctor must be on the approved list of your health fund.
The discount granted can reach 20% of the standard premium.
If you change family doctor, notify your health fund within the deadlines set in your contract.
Combinable with an optional deductible, within the limits of the legal minimum premium (50% of the standard premium).
5. HMO model (Health Maintenance Organization)
In this model, the insured person commits to first consulting a doctor or medical centre belonging to the HMO network of their insurer.
HMO doctors often work in a group practice or fixed-purpose health centre.
The HMO doctor manages the entire follow-up and refers the insured to an external specialist if needed.
Even in an emergency, the insured must in principle contact their HMO centre first. If unavailable, the on-call doctor can be consulted.
The discount can reach 20% of the standard premium.
HMO centres are not available in every region — their presence is more common in large urban areas.
6. Telmed model
In this model, before any non-urgent medical consultation, the insured must contact a medical telephone hotline or mobile app approved by their insurer. The medical tele-adviser then directs the insured to the appropriate care provider (doctor, emergency service, pharmacist, etc.).
This model is particularly suited to people comfortable with digital tools and whose physical consultations are infrequent.
It can be offered on its own or combined with a network of partner doctors.
Discounts vary by insurer and canton.
In case of a confirmed emergency, prior triage is not required.
7. Bonus insurance
Bonus insurance is a particular model that rewards claim-free years with a progressive premium reduction.
Year 1: the insured pays 10% more than the standard premium (starting premium).
Each subsequent claim-free year, the premium drops one tier.
After 4 claim-free years, the maximum discount of 45% of the starting premium is reached (equivalent to roughly 50% off the standard premium).
If the insured submits claims in a given year, the discount drops one tier the following year.
Only compatible with the standard deductible of CHF 300 — cannot be combined with an optional deductible.
Incompatible with restricted-choice models (family doctor, HMO, Telmed).
Minimum contract duration longer than 1 year.
Not all insurers offer this model.
8. Common rules for alternative models
Whichever model is chosen, some rules apply uniformly — this is a fundamental guarantee of LAMal.
Basic benefits covered are strictly identical across all models.
Cantonal subsidies (premium reductions) remain available regardless of the model chosen.
The maximum legal discount is 50% of the standard premium with a CHF 300 deductible and accident coverage. This minimum premium can never be breached.
Combining an alternative model with an optional deductible is possible, but the legal minimum premium floor may limit the effective discount.
9. Deadlines and switching model
Switching insurance model generally follows the same deadlines as switching health fund.
| Situation | Deadline |
|---|---|
| Model switch on 1 January | Termination letter to be sent before 30 November |
| Switch on 1 July (standard model, CHF 300 deductible) | Termination possible by 31 March |
| Bonus insurance | Minimum duration longer than 1 year — check the specific terms of your contract |
| Premium increase during the year | Right of extraordinary termination with one month's notice |
Always check the specific terms of your contract, in particular for minimum commitment (as with bonus insurance). Termination must be sent by registered mail and all premiums must be up to date for the change to be validated.
Source: Federal Office of Public Health (FOPH) — bag.admin.ch. Information applicable to calendar year 2026. This guide is for informational purposes only. For any specific personal situation, consult the competent cantonal authority or the FOPH directly. References: Insurance involving restricted choice of care providers (FOPH); Bonus insurance (FOPH); 4.3 Special forms of insurance — Practical guide to health insurance; Premiums and cost-sharing (FOPH).