Telmed model

What is the Telmed model?

The Telmed model is a form of basic health insurance in which your first point of contact is not a practice but a telemedical advice service. If you have symptoms, you first call a hotline or get in touch via an app or a chat. A medically trained professional asks about your symptoms and recommends the right route: wait and treat yourself, make an appointment with your GP, see a specialist, go to a pharmacy or go to the emergency department.

The principle is called gatekeeping: one point of contact decides on the first step before costs arise. In the GP model, a fixed practice takes on this role; in the HMO, a health centre; in the Telmed model, advice at a distance. The Federal Office of Public Health (FOPH, in German BAG) lists all three as compulsory health insurance with a restricted choice of service provider and calls the Telmed variant “telemedical advice”. The entry on telemedicine explains more about the technology behind it.

Telmed is not supplementary insurance. It remains basic insurance under the Federal Health Insurance Act (KVG), with the same benefits required by law, the same choice of deductibles (Franchise) and the same retention fee (Selbstbehalt). You only give up going straight to a doctor of your choice without checking first. Insurers sell the model under their own names; in the FOPH dataset, it belongs to the plans with a restricted choice.

Who is it for? Above all for people who rarely see a doctor, want flexibility in their schedule or do not have a regular GP practice. Because the advice is not tied to a location, many insurers offer Telmed throughout Switzerland, including areas without a GP or HMO network.

How it works

The process is similar in most plans; each insurer sets out the details itself:

1. Contact before seeing a doctor. You contact the advice service before you start any treatment. Many plans offer a phone line around the clock, plus an app or video.
2. Initial assessment. The professional assesses how urgent it is and recommends the next step. They may also set a period within which you should attend the appointment.
3. Treatment. You go to the place that was recommended to you. The advice service usually reports the case directly to your insurer.
4. Follow-up treatment. As a rule, you do not need to call again for the same course of treatment; for a new problem, you do.

If you do not follow these steps, the insurer can reduce or refuse cost coverage in line with its conditions. The law itself only says that, with a restricted choice, the insurer only has to cover benefits that the selected providers provide or arrange. In an emergency, you go straight to the emergency department; how quickly you must inform the advice service afterwards is stated in the plan.

Premium discount with rules

The insurer may reduce the premium, but only within the limits of the ordinance. The discount must be based on cost differences that result from the restricted choice of service providers. A healthier pool of insured persons alone does not justify a discount. If the insurer does not yet have claims data from five accounting years, the premium may be at most 20% below its standard premium. The premium calculator shows the actual differences for each insurer.

Joining and leaving

You can join the Telmed model at any time, even during the year. You can only leave it, i.e. go back to the standard model or to another model, at the end of the calendar year. After the premium notification in the autumn, your notice must reach the insurer by 30 November. If you want to change insurer, you will find all dates under deadlines.

Legal basis

The Telmed model is based on the same provisions as all models with a restricted choice:

• Art. 41 para. 4 KVG: In agreement with the insurer, insured persons can limit their choice to service providers that the insurer selects for more cost-effective care. The insurer then only covers benefits that these providers provide or arrange. The benefits required by law are covered in every case.
• Art. 62 para. 1 KVG: The insurer can reduce the premium for this kind of insurance.
• Art. 99 KVV: Insurers may offer this insurance alongside standard insurance and, under para. 2, fully or partly waive the deductible and the retention fee.
• Art. 100 KVV: Open to everyone in the area of operation (para. 1), joining at any time (para. 2), leaving at the end of the calendar year subject to the notice periods under Art. 7 KVG (para. 3).
• Art. 101 KVV: Discounts only for cost differences proven over at least five accounting years (para. 2), otherwise at most 20% (para. 3).

There is no act on telemedicine in the narrower sense for this model. When you have to call, which exceptions apply and what the consequences of a breach are is stated in the insurance conditions of the plan.

Example: premiums 2026 in the city of Zurich

Noah is 36, lives in Zurich and hardly ever sees a doctor. He compares the standard model with Telmed. The table shows the median monthly premium of all offers for each model type. Basis: premiums 2026, municipality of Zurich (region 1), adults, year of birth 1990, with accident cover; source FOPH. The group “Telmed and others” contains all plans with an initial consultation by phone and other special forms, as grouped by the premium calculator.

The medians compare different insurers. At an individual insurer, the gap between standard and Telmed can be larger or smaller. You can see which insurers offer a Telmed model in your municipality in the premium calculator and in the profiles under health insurers.

What this means for you

Telmed suits you well if you rarely have health issues, do not want a regular GP or travel a lot for work. It suits you less well if you are in ongoing treatment with several specialists and would have to clear every new step. Check before you switch:

1. Availability: Can you reach the advice service around the clock, and is there an app or video as well as the phone?
2. Exceptions: For which treatments do you not need to call, for example emergencies or preventive care?
3. Consequences: What happens if you forget to call once?
4. Combination: Does a higher deductible suit your expected costs? The deductible calculator works it out for you.

Because you can join at any time, you can also switch to Telmed in the middle of the year if you stay with your insurer. The way back is only open on 1 January. If you also want to change insurer, the usual dates apply; the switching insurer page explains the process. The model finder helps you work out which model suits your daily life.

Common mistakes

• Going straight to the doctor. If you start new treatment without contacting the service first, you risk the insurer not paying the bill.
• Missing the recommended period. If the advice service recommends seeing a doctor within a certain time, the recommendation often only applies for that period.
• Mistaking Telmed for supplementary insurance. The model only concerns basic insurance. Supplementary insurance has its own rules.
• Switching back too late. You can only return to the standard model on 1 January; your notice must reach the insurer by 30 November after the premium notification.
• Looking only at the discount. A low rate only pays off if you can stick to the procedures.

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