Changes to the CGA LAMal/KVG and the CP LAMal/KVG for alternative models

The CGA LAMal/KVG conditions set out the administrative aspects of the relationship between the insurer and the insured person (e.g. data processing and communication channels). These general terms and conditions were updated in order to specify how your personal data is processed and to provide you with an additional official communication channel.

The CP LAMal/KVG conditions set out the specific rules for the different alternative insurance models. These special terms and conditions were updated in order to improve your understanding of the models and to enable us to offer you a better customer experience, whether through innovations or new benefits.

The way your basic health insurance works and the benefits to which you are entitled will not change:

• The way your insurance model works will remain unchanged.
• The medical benefits covered by your insurance will remain the same. The benefits provided under basic health insurance are defined by the Law on Health Insurance (LAMal/KVG) and are identical, regardless of the insurance provider and basic health insurance model chosen.
• If your residence canton pays part of your health insurance premium, the subsidies to which you are entitled will not change.
• Your deductible amount will not change.
• If you were insured under the family doctor model, your family doctor will remain the same.
• Your supplemental insurance policies will not change. Changes only concern basic health insurance.

Changes apply mainly to the following:

• Art. 7, para. 5: inclusion of our Customer Area as an additional and legally recognised communication channel if you choose to activate it;
• Art. 9: details of how your personal data is processed in accordance with the Swiss Law on Data Protection (LPD/DSG).

Changes to the CP LAMal/KVG for PrimaFlex apply mainly to the following:

• Art. 4, para. 2(b): inclusion of the possibility to use a partner digital health solution (e.g. online symptom checker) as one of the first points of contact in case of a health problem;
• Art. 5, para. 3: if you have not specified a family doctor, the possibility for Groupe Mutuel to choose one for you unilaterally based on the doctor you have visited the most;
• Art. 6: inclusion of accident cases as a derogation (situation in which you are released from the obligation to follow the rules of your model);
• Art. 7: details of how often failure to comply with the rules of the model is taken into account;
• Art. 8, para. 3: inclusion of the possibility of exempting certain benefits from the co-insurance;
• Art. 9: details of how your personal data is processed in accordance with the Swiss Law on Data Protection (LPD/DSG).

The wording of the CP LAMal/KVG for SanaTel has been completely standardised with that of the other models. Changes apply mainly to the following:

• Art. 4: inclusion of the possibility to use a partner digital health solution (e.g. online symptom checker) as one of the first points of contact in case of a health problem;
• Art. 6: inclusion of accident cases as a derogation (situation in which you are released from the obligation to follow the rules of your model);
• Art. 7: details of how often failure to comply with the rules of the model is taken into account;
• Art. 8: details of how your personal data is processed in accordance with the Swiss Law on Data Protection (LPD/DSG).

Changes to the CP LAMal/KVG for PrimaCare apply mainly to the following:

• Art. 6: inclusion of accident cases as a derogation (situation in which you are released from the obligation to follow the rules of your model);
• Art. 7: details of how often failure to comply with the rules of the model is taken into account;
• Art. 8: details of how your personal data is processed in accordance with the Swiss Law on Data Protection (LPD/DSG).

Changes to the CP LAMal/KVG for OptiMed apply mainly to the following:

• Art. 4: inclusion of the possibility to choose a telemedicine centre as your family doctor from the OptiMed lists;
• Art. 6: inclusion of accident cases as a derogation (situation in which you are released from the obligation to follow the rules of your model);
• Art. 7: details of how often failure to comply with the rules of the model is taken into account;
• Art. 8, para. 1- 2: inclusion of the possibility for your family doctor or third parties mandated by him/her to recommend care pathways;
• Art. 8, para. 3: inclusion of the possibility of exempting certain benefits from the deductible or co-insurance;
• Art. 9: details of how your personal data is processed in compliance with the Swiss Law on Data Protection (LPD/DSG), inclusion of the possibility for the insurer to share your data with the healthcare network of which your family doctor is a member and inclusion of your telephone number and email address in the data that Groupe Mutuel shares with your family doctor, the healthcare network of which he/she is a member or any third parties appointed by the family doctor.

No, because changes to the CGA LAMal/KVG and CP LAMal/KVG will take effect on 1 January 2025. The notice period for terminating the insurance is therefore the same as for other policyholders who wish to change their basic insurance model or insurance provider (the notice of termination must be received by your insurer by 29 November 2024 at the latest).

You can download your new terms and conditions of insurance below:

• Supplemental Executory Provisions for Compulsory Health Insurance under LAMal/KVG - Mutuel, Philos, Avenir, Easy Sana and SUPRA (CGA LAMal/KVG)
• Supplemental Executory Provisions for Compulsory Health Insurance under LAMal/KVG - AMB (CGA LAMal/KVG)
• Supplemental Executory Provisions for Compulsory Health Insurance under LAMal/KVG - CMVEO (CGA LAMal/KVG)

If you have opted for an alternative model, you can also download your new LAMal CP below:

• Special conditions of health insurance PrimaFlex – Mutuel, Philos, Avenir, Easy Sana, SUPRA (CP LAMal/KVG)

• Special conditions of health insurance SanaTel – Mutuel, Philos, Avenir, Easy Sana (CP LAMal/KVG)

• Special conditions of health insurance SanaTel – AMB (CP LAMal/KVG)

• Special conditions of health insurance SanaTel – CMVEO (CP LAMal/KVG)

• Special conditions of health insurance PrimaCare – Mutuel, Philos, Avenir, Easy Sana, SUPRA (CP LAMal/KVG)

• Special conditions of health insurance PrimaCare – AMB (CP LAMal/KVG)

• Special conditions of health insurance OptiMed – Mutuel, Philos, Avenir, Easy Sana (CP LAMal/KVG)

You can also receive them by calling us on 0848 803 111 (8cts/min.) or by visiting one of our agencies open from Monday to Friday from 8.00 to 12.00 and from 13.30 to 17.00

Should you need further information about this amendment, we are available:

• via the contact form

• by telephone by requesting a call back at a time that suits you (free of charge)

• by phone on 0848 803 111 Monday to Friday from 8.00 to 18.00 (8cts/min.)
• in our agencies open from Monday to Friday, 8.00 to 12.00 and from 13.30 to 17.00.