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CSS Insurance

HMO – Consult your network doctor

HMO stands for Health Maintenance Organisation and is an alternative insurance model for mandatory basic insurance. Similar to the family doctor model, if you have any health problems you first go to the practice that you have reported to us. This forms part of a doctors' network or is a group practice, and coordinates all aspects of your medical advice and treatment. To qualify for the HMO model, insured persons must live within the defined catchment area.

Our product for you: Health Maintenance Organisation (HMO) Insurance

Benefits of the HMO model

  • The doctor you trust provides initial treatment and coordinates the next steps
  • You benefit from the knowledge and experience of all the doctors in the network
  • Where possible, your doctor will prescribe less expensive generic medicines
  • In an emergency, you can contact the CSS telemedicine centre 24/7
  • You can consult an ophthalmologist or gynaecologist without a referral from your family doctor

Premiums & discounts

Premiums depend on where you live, your age, and what deductible you choose. The HMO model lets you enjoy a premium discount on mandatory basic insurance of up to 16%. In return, you agree to always make the stipulated doctor your first point of contact. If you fail to adhere to the rules it will not be possible to reimburse the cost of treatment.


Further details of the HMO model

Follow the tips under "Save on health insurance premiums" to choose the insurance product that is best for you.

Do you have any questions?

We're on hand to help! Find a CSS agency near you. Our client advisors will be happy to take time to discuss your personal needs.