Consumer Protection warns about Telmed’s model
These health insurance companies face severe penalties without warning
In order to save on insurance premiums, many Swiss consumers have opted for Telmed’s basic health insurance model. But be warned: anyone who doesn’t comply with the requirements can expect huge and potentially expensive penalties.
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With the Telmed model, a teleconsultation before visiting a doctor is mandatory. Anyone who fails to comply should expect severe penalties at best.
You can change your health insurance until the end of November. This can save insurance premiums. Anyone who also chooses the telemedicine model of their basic insurance can also save significantly on premium costs – up to CHF1,700 per year.
However, caution is advised here. Clear terms apply to Telmed’s offers: the request must be made and discussed via the app or over the phone before treatment – except in emergency cases. Then the procedure is discussed via the call center and the doctor’s appointment is activated.
Anyone who bypasses this process and goes directly to a doctor is violating the telemedicine paradigm. And that can get expensive quickly: In analyzing Telmed’s forms for the top ten health insurers, Consumer Protection found that some are penalized on the first offense and without warning.
Costly omissions
Such violations of the rules are usually punished by transferring them to the standard model, that is, excluding them from Telmed’s model, which entails higher premium costs. Some health insurance companies also refuse to provide reimbursement, sometimes without notice. In other words, insurance companies refuse to cover the costs of treatment, examinations, or medications, even though they are insured according to the statutory catalog of essential insurance benefits.
affiliate Verify the fairness of health insurance From consumer protection offerings: In Assura, Concordia, Helsana, Swica and Visana, there is a risk of expensive penalties even for the first violation – without warning. It is not considered if the breach was accidental. Insurance Regulations 2023 apply.
The penalty rule for Visana’s “Tel Care” offer is particularly strict: it requires the sanctioned policyholder to pay the difference in premiums backdated to the beginning of the year. This means that if you adhere to the rules all year round, but forget to call the call center twice before visiting the doctor, for example during Christmas stress, then you have to pay the entire difference in premiums (more than 1000 CHF depending on the region).
Only CSS, Mutuel, Philos and Sanitas completely dispense with penalties without notice for Telmed models. Most health insurance companies do not impose penalties until after the second or third violation.
Consumer protection requires more fairness
“It is unacceptable for the insured to be charged with thousands of francs in treatment costs or additional premiums without warning,” says Sarah Stalder (56), director of consumer protection. “We call on health insurers to make the penalty rules fairer and to communicate them with more transparency.”
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