Woman talking over the phone

Telmed model

Telmed model is one of the health models covered by the compulsory basic insurance policy. The holders of this policy are required to call a free hotline which is available 24/7 if they experience any health problems or need to consult a medical expert. In other words, consultation by phone must be made before seeing a doctor, going to hospital, or pharmacy. If the medical professional determines that seeing a doctor or further treatment is necessary, they will refer the patient to a doctor or hospital immediately.

Advantages of the Telmed model

The fact that you need to consult a medical professional via phone before actually seeing a doctor leads to the first advantage of this health insurance model: lower prices and premiums. Price comparison and analyses show that the premiums are from 15 to 20% lower compared to basic health insurance premiums.

There is a high number of insurance companies which provide Telmed policies, with the exception of several major health insurance providers.

Phone consultations are not required in case of an emergency, annual gynecological check-up, ophthalmologist examination, and other services depend on the insurance company.

Drawbacks of the Telmed model

Limitations for individuals who require frequent medical attention

The very fact that you need to call a hotline before seeing a medical professional or going to a pharmacy or hospital may present a huge drawback, especially for individuals who require more frequent medical attention.

Inability to choose medical professionals or institutions

The following disadvantage is that Telmed usually does not allow the policyholder to choose their doctor or hospital and limits their choice. However, there are some insurance providers that do not have such limitations, but the policies with fewer limitations usually come with higher premiums.

No direct access to the medical professional

If the policyholder breaches the Telmed policy and seeks medical attention directly from a doctor or hospital before consulting the hotline first, some penalties like reimbursement rejection or switching the client’s policy to a standard and more expensive one may occur. That happens if the person holding the policy fails to comply with the insurance policy conditions on several occasions after receiving a warning for the first contract breach.

The accuracy of the diagnosis

Finally, it is quite difficult to give an accurate diagnosis over the phone, even for the top medical professions. If call centers are operated by the insurers, they might be required to suggest the most cost-efficient option over the most effective or more expensive medical solution.

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