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Old 16.08.2010, 21:17
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Health insurance - GP model - do we have to choose a doctor?

Hi,

I was wondering if anyone could please help us understand exactly what a "GP" model health insurance plan means? Details follow...

We've just done a health insurance comparison (basic only) on comparis.ch. The cheapest premium is on a "GP (WINDOC)" model which comparis says requires a "Primary consultation by phone". But we don't want to have to ring before seeing a doctor, so we don't want to choose this one. The second cheapest is on the "GP" model with Kolping insurance (details here).

If we choose this "GP" model, will we have to specify a particular GP, write our name down on his/her list, and possibly be restricted to seeing this GP only, and not be able to change GP's if they turn out unsuitable? i.e. Will be potentially be stuck with a bad GP if we choose badly the first time?

Thanks,
Roy
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Old 16.08.2010, 21:20
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Re: Health insurance - GP model - do we have to choose a doctor?

I suggest that you contact Forum member Jenny who has helped many members with their health insurance.
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Old 16.08.2010, 21:23
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Re: Health insurance - GP model - do we have to choose a doctor?

From my understanding you pick one and then you have to see that one, yes. But I was told by my company (CSS) that you can change it later, if you want to.
When I signed up, they had a whole list of GPs to choose from and I had no idea, but I just went with the one my boyfriend's family go to.
So far, havent needed it....Touch wood.
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Old 16.08.2010, 21:50
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Re: Health insurance - GP model - do we have to choose a doctor?

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We've just done a health insurance comparison (basic only) on comparis.ch. The cheapest premium is on a "GP (WINDOC)" model which comparis says requires a "Primary consultation by phone". But we don't want to have to ring before seeing a doctor, so we don't want to choose this one.
Pity...calling up beforehand is really no big deal. I use a similar scheme with SWICA. We call up and say "I have this and that problem and I have made an appointment at such and such". They say "That sounds fine. I will just make a note on your file" and I am done and for that short call I save over 10% on a family of 4. Another benefit is that these people can also get you appointments when whoever you have been trying to see has been fobbing you off.
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Old 16.08.2010, 21:56
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Re: Health insurance - GP model - do we have to choose a doctor?

You can change your doctor if you are not happy, as long as that doctor is on the list that the company provides, just be aware some lists are bigger than others......
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Old 17.08.2010, 09:00
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Re: Health insurance - GP model - do we have to choose a doctor?

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You can change your doctor if you are not happy, as long as that doctor is on the list that the company provides, just be aware some lists are bigger than others......
Do you know how I can find Kolping's list? I couldn't find it on their website (no English unfortunately, but Google translating the French version works for me).

Specifically, we're in Martigny (so we want to make sure we can see someone in Martigny), and of course we'd need an English-speaking doctor...
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Old 17.08.2010, 09:06
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Re: Health insurance - GP model - do we have to choose a doctor?

Hmm...Kolping's description of their "Système médécin de famille (SMF)" plan - which I believe is what comparis.ch calls their "GP" plan - says "Aucune liste de médecins de famille limitative".

This seems to translated to "No limited list of family doctors". I'm a bit confused...
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Old 17.08.2010, 09:17
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Re: Health insurance - GP model - do we have to choose a doctor?

We use Intras and the policy is called Minima (I think)....we are free to choose any doctor. For example, I had a problem with my foot. I called up a local GP and spoke to him on the phone, told him the problem and he gave me the name of an orthapeadic to go and see. Was all done quickly with no problems.

Hope that helps.

Cheers

Sean
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Old 17.08.2010, 10:08
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Re: Health insurance - GP model - do we have to choose a doctor?

You can always change the doctor, just agree with the insurer beforehand.

I have had a quick look at Kolping and your nearest agent is at Versoix,
near the station at Versoix, near Geneva

http://map.search.ch/versoix/rampe-de-la-gare-3

Caisse maladie Kolping SA
Agence Versoix / 1088
Name Sandrine Castellano
Rampe de la Gare 3
Post Box CP 507
1290 Versoix
Téléphone 022 / 779 13 13
info-versoix@mykolping.ch

They run the standard general doctor system (SML: Système médécin de famille). You agree to normally go to the named doctor of your choice first (As you do in Britain) He will if necessary send you to a (More expensive) specialist. If you have a GP group practise in Martigny, you might want to choose them, as you can usually get a better service when there are 4 or 5 doctors working together, as often they are better equipped and can do more things themselves.

For emergencies, eye doctors, gynaecologists, and temporary locums, you can choose to go to another doctor.

So why not take a list of your local preferred doctors to the agent and sign up, you will need to take your Swiss ID permits.

You can change your health insurance in October every year, ask the agent for the date when the cancellation has to arrive on their desk, I think it is the last working day in October 2011)

Personally I would choose a bigger insurer for your first year (Visana, Helsana, Swica) because the cheaper ones can be very frustrating: they keep staff to a minimum, and as you can see your nearest agent is in Geneva. You can change next October when you have asked around at work for their opinions. Most insurers offer cheaper premiums if you go to a GP first, some ask you to call a hot line for a diagnosis first.

Last edited by Ittigen; 17.08.2010 at 10:35.
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Old 17.08.2010, 17:29
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Re: Health insurance - GP model - do we have to choose a doctor?

As a general rule, there are 2 types of GP model insurance :

i) GP model

You have to name a GP on your insurance application form and agree to see him/her first before seeing a specialist.
You have total free choice of GP.
You can change your GP in the future if you need to but you should let your insurance company know before visiting the new one

ii) Other GP models

Some companies offer both the GP model described above as well as a different method (different names with every company...) whereby you have to name a GP from a list provided.

---

So, some companies have lists, some don't. Some offer both systems, some don't.
As a general rule, for those companies offering both methods, it works out slightly cheaper with the "naming a GP from their list" method.
e.g. The Groupe Mutuel have PrimaCare (GP method) and BasicPlus (GP method but must choose one from their list). The BasicPlus is less expensive than PrimaCare.

It sounds like the method you've chosen is a general GP method so you have complete free choice of doctor.

I usually suggest talking to friends/colleagues about local doctors as people are always happy to recommend a good GP.

Otherwise, you can try this website where you can search by postcode and speciality :

http://www.doctorswiss.ch/
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Old 17.08.2010, 18:37
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Re: Health insurance - GP model - do we have to choose a doctor?

Thanks everyone for your help!! I now understand the GP model, and I think it will suit us.

As Ittigen suggested, though, instead of Kolping I decided to look for a company that was 1) big and 2) had an agency closer to Martigny.

Visana (Med Direct) is almost as cheap as Kolping for us, and Visana appears to have an agency in Sion. Has anyone had experience with them? Specifically, I wonder if their "list" of doctors has a good English-speaking doctor in Martigny... I suppose I may have to contact them to find out...?
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Old 17.08.2010, 18:42
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Re: Health insurance - GP model - do we have to choose a doctor?

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Visana (Med Direct) is almost as cheap as Kolping for us, and Visana appears to have an agency in Sion. Has anyone had experience with them? Specifically, I wonder if their "list" of doctors has a good English-speaking doctor in Martigny... I suppose I may have to contact them to find out...?
There is no list with the Visana Med Direct option - you can choose whoever you like.
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Old 17.08.2010, 19:06
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Re: Health insurance - GP model - do we have to choose a doctor?

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If you have a GP group practise in Martigny, you might want to choose them, as you can usually get a better service when there are 4 or 5 doctors working together, as often they are better equipped and can do more things themselves.
Also, I was wondering if anyone could help me find out if there is such a "GP group practise" in Martigny? (not sure of how that would translate into French...)
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Old 17.08.2010, 20:07
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Re: Health insurance - GP model - do we have to choose a doctor?

Hi Waldo - I think the translation would be "groupe medicale". I've just done a Google search on Martigny - there is a wealth of information there which may be of a general interest to you. If the page comes up in French or German, it is usually possible to get a version in English too. Welcome to Valais!
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Old 29.03.2016, 00:03
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Re: Health insurance - GP model - do we have to choose a doctor?

Hello,
We just moved to Sion with young children. Would you advise getting a GP and a Pediatrician or just a GP? Back home we just had a GP and it worked great for us, but not sure if the categories are different here.

We are with Assura. How much does a typical check-up cost? Just curious as the kids will be needing vaccines throughout the years.

Any advice would be greatly appreciated. Thanks
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Old 29.03.2016, 00:09
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Re: Health insurance - GP model - do we have to choose a doctor?

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Hello,
We just moved to Sion with young children. Would you advise getting a GP and a Pediatrician or just a GP? Back home we just had a GP and it worked great for us, but not sure if the categories are different here.

We are with Assura. How much does a typical check-up cost? Just curious as the kids will be needing vaccines throughout the years.

Any advice would be greatly appreciated. Thanks
The cost of an appointment depends on different factors - there's no "one size fits all".
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Old 29.03.2016, 09:00
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Re: Health insurance - GP model - do we have to choose a doctor?

As GJ says, it just depends- it is partly costed on time it takes in 5 mins chunks, I think. You do not need a peadiatrician really- unless difficulties arise. Personally I'd talk to neighbours and see what their say. It's so important to link up with a doctor early- just in case- so that s/he knows of you and your family, and vice-versa- even if it costs you for a consultation. Then (and touch wood and all that) should you be faced with one of the children getting poorly- it will be much easier. I'd say an initial consultation BEFORE anything goes wrong- is really worthwhile.
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Old 29.03.2016, 17:59
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Re: Health insurance - GP model - do we have to choose a doctor?

As GJ and Odile have said, the cost of an appointment depends on many factors.
Doctors bill using the "TarMed" method and so you're charged depending on their TarMed tariff and also the length of the appointment.

Your choice of insurance company doesn't affect the cost of the doctor.

This website is useful for finding doctors : http://www.doctorfmh.ch/index_en.cfm
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Old 29.03.2016, 18:09
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Re: Health insurance - GP model - do we have to choose a doctor?

A pediatrician is just a GP for kids. The level of training here is not that great and most GPs and pediatricians are fine for the basics. Anything more serious and you find yourself wondering just how they qualified.

If you are willing to trust your GP/pediatrician 100% in all decisions then go for the family Dr model (where you have to name your GP/pediatrician). If you want more flexibility (and slightly higher premiums) to choose when to go to a specialist then don't...
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Old 29.03.2016, 18:23
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Re: Health insurance - GP model - do we have to choose a doctor?

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A pediatrician is just a GP for kids. The level of training here is not that great and most GPs and pediatricians are fine for the basics. Anything more serious and you find yourself wondering just how they qualified.

If you are willing to trust your GP/pediatrician 100% in all decisions then go for the family Dr model (where you have to name your GP/pediatrician). If you want more flexibility (and slightly higher premiums) to choose when to go to a specialist then don't...
Depending on the company and model of insurance, pediatricians may be an exception to the rule so you can still benefit from a reduced premium if you take the GP model but then visit a pediatrician in the first instance for the children.
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