You can change your health insurance until the end of November. This could potentially save premiums. Anyone who also opts for a telemedicine model for their basic insurance can also significantly save on premium costs – up to 1700 francs per year.
However, caution is advised here. Clear conditions apply to such Telmed offers: the request must be submitted and discussed via the app or phone prior to treatment, except in emergencies. The procedure is then negotiated through a call center and a doctor’s appointment is activated.
Anyone who skips this process and goes straight to the doctor is violating the telemedicine model. And that can quickly get expensive: Analyzing the Telmed models of the ten largest health insurance companies, consumer protection found that some punish the first offense without warning.
Costly omissions
These rule violations are usually penalized by transferring them to the standard model, i.e. by exclusion from the Telmed model, which requires higher premium costs. Some health insurance companies also sometimes refuse to provide reimbursement without warning. In other words, insurance companies refuse to cover the costs of treatment, examination or medication even if they are insured according to the statutory basic insurance benefits catalogue.
The health insurance fairness check of consumer protection shows that in Assura, Concordia, Helsana, KPT, Swica and Visana there is a risk of extremely expensive sanctions even for the first violation without warning. It does not take into account whether the violation was accidental or not. The 2023 insurance regulation is valid.
The enforcement rule for Visana’s “Tel Care” offer is particularly strict: it obliges the sanctioned policyholder to pay the premium difference retroactively from the beginning of the year. This means that if you stick to the rules all year but forget to call the call center twice before seeing a doctor, for example during the stress of Christmas, the entire difference must be paid in premium (over CHF 1,000). region).
Only CSS, Mutuel, Philos, and Sanitas are completely free from sanctions without warning for Telmed models. Most health insurance companies only impose sanctions after the second or third violation.
Consumer protection demands more justice
“It is unacceptable for insured persons to be charged thousands of francs in treatment costs or additional premiums without warning,” says Sara Stalder, 56, director of consumer protection. “We urge health insurance companies to make enforcement rules fairer and communicate them more transparently.”