What is the difference between standard, family-doctor and HMO models?
Answered with official sources — LAMal and health insurance
Updated 11 August 2026
Answer
LAMal allows alternative insurance models (art. 62) at reduced premiums source: Fedlex LAMal RS 832.10. The standard model («free doctor choice») charges the full premium. The «family-doctor» model requires a gatekeeper visit first (5-15% discount). The HMO model provides access only through a contracted health centre (15-20% discount). «Telmed» requires calling a medical hotline before visiting (15% off). «Generic» forces generic drug use (<5%). The worker chooses at underwriting and can switch each year by 30 November. All models cover the same KLV basic catalogue, only access differs.
Official sources
Other questions on this topic
- Must cross-border workers mandatorily take out LAMal insurance?
In principle yes: LAMal art. 3 para. 1 and KVV art. 1 para. 2 lit. d establish mandatory insurance for those working in Switzerland, including cross-border workers.
- What are the average 2026 LAMal premiums in Ticino?
UFSP published 2026 premiums on 24 September 2025. The average adult premium (CHF 300 deductible, with accident cover) in Ticino is about CHF 404/month (+3.1% vs 2025). Young adults 19-25 pay on average CHF 285, children CHF 107.
- Is a cross-border worker under LAMal entitled to premium subsidies?
Yes but conditionally: premium subsidies (individual premium reduction, RIP) are ruled by LAMal art. 65 and delegated to the Cantons. In Ticino the Cantonal LAMal application law art. 33 extends entitlement to withholding-taxed cross-border workers.
- How do I change LAMal insurer and when?
LAMal guarantees free choice of insurer (art. 7). You can cancel by 31 December (registered letter by 30 November) or by 30 June (notice by 31 March) — the latter only with the CHF 300 minimum deductible.
- Does LAMal cover dental care?
Generally no. LAMal art. 31 covers dental care only if caused by serious unavoidable illness (e.g. leukaemia, AIDS) or by accident (without LAINF). Fillings, cleaning, orthodontics and prostheses are not reimbursed by basic insurance.
- How is the option right for the Italian SSN exercised?
The option right lets Italian-resident cross-border workers stay in the SSN and waive LAMal. It is exercised within 3 months of starting work by sending the «Opzione» form to the LAMal Joint Institution (Bern) with S1/E106 issued by the local ASL.
- Which LAMal deductible is most convenient for a cross-border worker?
LAMal art. 64 and KLV set ordinary deductibles from CHF 300 (standard) up to CHF 2,500 (max voluntary). A healthy worker with <1 visit/year saves around 40% on the premium with the CHF 2,500 deductible if annual care stays under ~CHF 2,700…
- Should I include accident cover in LAMal?
If you work at least 8 hours/week for a Swiss employer you are automatically covered by LAINF (Accident Insurance Law, RS 832.20) for work and leisure accidents. You can then suspend accident cover in LAMal, saving about CHF 8-15/month.
The information on this page is for guidance only and does not replace personal advice from an accountant, lawyer or union office. Tax, social-security and permit rules change frequently: always verify with the official sources linked in each answer.