GP model

What is the GP model?

The GP model (Hausarztmodell) is a variant of compulsory basic health insurance. You commit to going first to the GP practice you have chosen whenever you have a health issue. Your doctor either treats you or refers you to a specialist, a hospital or a therapy. This role is called “gatekeeper” or gatekeeping: one point of contact coordinates your treatment so that duplicate tests and unnecessary specialist visits are avoided.

The law does not speak of a “GP model” but of insurance with a restricted choice of service provider. The Federal Office of Public Health (FOPH, in German BAG) counts three forms under this heading: the GP model, the HMO and telemedical advice, in other words the Telmed model. All three belong to the special types of insurance that insurers may offer alongside the standard model.

It is important to distinguish it from supplementary insurance: the GP model is not supplementary insurance and not a contract under the Insurance Contract Act (ICA). It remains basic insurance under the Federal Health Insurance Act (KVG). The insured benefits are therefore exactly the same as in the standard model. The only things that change are the route to those benefits and the premium. The deductible (Franchise) and the retention fee (Selbstbehalt) also apply as usual, unless the insurer waives them fully or partly in its plan, which the ordinance expressly allows.

Anyone who lives in the area in which the insurer offers the model can take out the GP model. This applies to adults, young adults and children. For children, the GP practice is often a paediatric practice. According to the FOPH, people who live in an EU or EFTA state or in the United Kingdom, for example cross-border commuters, cannot choose special types of insurance.

How it works

When you sign up, you choose a GP practice from your insurer’s list. The list depends on the plan: some insurers accept almost all GP practices in a region, others only practices from certain doctors’ networks. That is why insurers do not offer the model everywhere. Together with the premium data, the FOPH publishes a list of catchment areas, i.e. the municipalities in which a particular GP or HMO plan is available.

If you need medical help, you go to this practice first. If you need a specialist, the practice issues a referral, which it usually reports directly to the insurer. Without a referral, you risk the insurer not paying the bill or paying only part of it. How strictly the insurer applies this is set out in the insurance conditions of your plan, not in the law.

Most plans have exceptions for which you do not need a referral, for example emergencies. Exactly which exceptions apply varies from insurer to insurer. Read the conditions before you sign up and, if anything is unclear, ask before you book an appointment with a specialist.

The reward for this restriction is a lower premium. However, the insurer cannot set the discount freely. It must be based on genuine cost differences that result from the restricted choice, not on the fact that the model mainly insures healthy people. As long as an insurer does not have claims data from five accounting years, the premium may be at most 20% below the premium of its standard insurance. How big the difference really is at your insurer is shown by the premium calculator for your municipality, deductible and all models.

Switching: in at any time, out at the end of the year

You can switch from the standard model to a GP model at any time, even in the middle of the year. The other way round is stricter: you can only go back to the standard model, to another model or to another insurer at the end of the calendar year. After you have been notified of the new premium, your notice must reach the insurer by 30 November. You will find an overview of the dates under deadlines.

Legal basis

Art. 41 para. 4 KVG allows insured persons, in agreement with their insurer, to limit their choice to service providers that the insurer selects with a view to more cost-effective care. The insurer then only has to cover the cost of benefits that these service providers provide or arrange. The last sentence is key for you: “The benefits required by law are covered in every case.”

Art. 62 para. 1 KVG allows the insurer to reduce the premium for this kind of insurance. The details are set out in the Health Insurance Ordinance (KVV):

• Art. 99 KVV: Insurers may operate models with a restricted choice alongside standard insurance. Under para. 2, they may fully or partly waive the deductible and the retention fee.
• Art. 100 KVV: The model is open to everyone living in the area of operation (para. 1). You can join at any time (para. 2), but leave only at the end of the calendar year with the notice periods under Art. 7 KVG (para. 3).
• Art. 101 KVV: Discounts are only permitted for cost differences that result from the restricted choice or the special remuneration of doctors, backed by claims data from at least five accounting years (para. 2). Without such data, the 20% limit applies (para. 3).

The law does not say what happens if you break the rules of the model. That is set out in the insurance conditions of the plan.

Example: premiums 2026 in the city of Bern

Lea is 36, lives in the city of Bern and compares the models. The table shows the median monthly premium of all offers for each model type. Basis: premiums 2026, municipality of Bern (region 1), adults, year of birth 1990, with accident cover; source FOPH. GP and HMO plans are grouped together in this analysis because both work via a fixed first point of contact.

The median compares offers from different insurers. What counts for your decision is the difference at the insurer you actually choose, and whether the practice you want is on its list. In the premium calculator, you can see every model of every insurer side by side for your municipality; the profiles under health insurers show which models an insurer offers.

What this means for you

The GP model is worthwhile above all if you already have a GP you trust and that practice is on an insurer’s list. Then you change little in your day-to-day life and pay a lower premium. Ask yourself four questions before you switch:

1. Is my practice on the list? Ask the insurer or your practice which networks and plans it belongs to.
2. How often do I go straight to specialists? If you are regularly treated by several specialists, you need a referral for each new course of treatment. That is doable, but it takes organisation.
3. Which exceptions apply? Check in the conditions what you do not need a referral for and what happens if you break the rules.
4. Am I often away? If you live somewhere else during the week, an initial consultation by phone may be more practical than a fixed practice.

Because you can switch into the GP model at any time, you do not have to wait until the end of November. However, you can only return to the standard model on 1 January. So do not try the model out “for a while” if you already know that you want to see different specialists freely in the current year. If you want to change insurer at the same time, the overview under switching insurer will help you. The model finder works out which model suits your daily life with a few questions.

Common mistakes

• Going to a specialist without a referral. This can mean that the insurer does not pay the bill. Get the referral before the appointment.
• Not checking the GP practice. If you take out a model in which your own practice is not on the list, you have to change doctor or leave the model again at the end of the year.
• Giving notice of the switch back too late. You can only return to the standard model on 1 January, and your notice must reach the insurer by 30 November after the premium notification.
• Confusing the GP model with supplementary insurance. The model rules only apply to basic insurance. Your supplementary insurance continues independently.
• Looking only at the discount. A large discount is of little use if you keep running up against the limits of the model. First check whether the process fits your daily life.

We explain how we analyse premiums and calculate medians under how we calculate.