With a general practitioner model, your first point of contact with any health-related questions or in case of illness is your GP.
If you are insured under the general practitioner model, you pay significantly lower premiums than in the standard model with a free choice of doctor. Depending on your place of residence, deductible and age group, premiums can be up to 15 percent lower.
As your general practitioner is always your first point of contact for any health-related questions, they will be aware of your medical history and be able to quickly prescribe the relevant treatment. This will save you having to go from one doctor to another and help avoid any medical errors resulting from a doctor treating you who is not aware of your medical history. In complex cases and in consultation with your general practitioner, you can at any time request a second opinion or ask to be treated by a specialist.
And not least, by opting for a general practitioner insurance model, you are demonstrating social responsibility: with “alternative” insurance models, which include general practitioner models, you are helping keep healthcare costs as low as possible – even if you have to visit a doctor from time to time. This is because your general practitioner will coordinate all the relevant benefits and therefore bear some responsibility for costs.
Under a general practitioner model, your choice of doctor is limited. If you wish to visit a doctor other than your general practitioner, you will need a referral issued in advance. You must bear any costs arising in connection with treatments or operations that are carried out without a referral. If you contact doctors other than those specified under the general practitioner model, you can switch to an ÖKK variant with a free choice of doctor.
Under the general practitioner model, you specify a general practitioner when you take out the policy. This is a requirement for concluding a general practitioner model.
The main principle behind the general practitioner model is that by having a single point of contact for patients, it is more convenient for them and it also helps keep healthcare costs as low as possible. That is why you are contractually obliged to decide on a general practitioner.
General practitioners have an obligation to offer a deputy when they are absent. So if you are ill, you do not have to wait until your general practitioner is back from their holidays, but instead you can get treatment from their deputy. In this case, your health insurance will cover the costs in the same way as if you had received treatment from your general practitioner.
In case of an emergency where your life is not in danger, you should first of all contact your general practitioner by phone. If you cannot reach the practice, you can contact an emergency doctor or hospital. You should then notify your general practitioner of any such emergency treatment as quickly as possible.
In extremely urgent situations, you should call the emergency services and have them take you to the nearest hospital. You must then notify your general practitioner within 20 days. They can then pass on any important information to the doctor treating you and possibly also help care for you during your stay in hospital.
At ÖKK, you can choose from a list of hundreds of general practitioners from all regions of Switzerland. You can consult our List of general practitioners to check whether your preferred doctor is listed.
In principle, a general practitioner is free to decide which patients they wish to treat. It is often the case that if a general practitioner refuses to treat you, this is because they already have too many patients on their books and therefore cannot accept any new patients. This is not the case in emergencies: Then all doctors have an obligation to help you.
In principle, you need a referral from your general practitioner for an appointment with a specialist. Exceptions to this rule include gynaecologists, opticians and paediatricians. If you do not have a referral, you can contact your gynaecologist directly for preventative examinations and check-ups during pregnancy. Equally, you do not need a referral, for example, if you need to make an appointment with an optician to have your glasses adjusted or for an eye test Children and young people under the age of 16 who are insured under the general practitioner model can consult their paediatricians directly.
It is important that you stick to the rules of the general practitioner model. If you do not do so, then ÖKK can transfer you to the basic model with a free choice of doctor without consulting you and you will then lose your premium discount. In addition, ÖKK will not pay your doctor’s bill if you have not contacted your general practitioner in advance. There are exceptions to this in cases of emergency.
You can of course change your general practitioner at any time, if you move house, for example, or even if you no longer have a trusting relationship with them. You do not need to provide your insurer with a reason for wishing to do so. As an ÖKK customer, you simply have to use this form.
It is always possible to change from the general practitioner model to the basic insurance model with a free choice of doctor as of 1 January of the following year. To do so, you must give one month’s written notice, i.e. your health insurer needs to have received notice by 30 November of a given year. This means that if you want to be insured under a model with a free choice of doctor from 1 January 2024, you need to submit an application by 30 November 2023.
If you wish to change from ÖKK CASAMED GENERAL PRACTITIONER to a different CASAMED model, this is possible as of the first day of the following month.