In general, persons resident abroad who work in Switzerland are required to take out Swiss health insurance. Some exceptions apply, depending on the employee’s country of residence and nationality.
Insurance at place of work for EU/EFTA cross-border commuters
In 2002, the coordination of social security systems was regulated under the Swiss-EU Agreement on the free movement of persons and the EFTA Convention. Accordingly, the requirement to obtain health insurance is based on the place-of-work principle. Anyone working in Switzerland, as well as non-working family members, is required to take out Swiss health insurance.
Beginning and end of compulsory health insurance
Cross-border commuters from EU/EFTA countries who hold a G permit are subject to compulsory health insurance from the date their employment contract begins. They have three months in which to register with a Swiss health insurer. If they fail to do so, they can be automatically assigned to a health insurer; if the delay is not justifiable, they will be liable to a premium surcharge for late registration. In this case, they will be required to cover the costs of any medical treatment received prior to enrolment themselves.
The requirement for compulsory health insurance ends when the employment contract ends.
Option of obtaining insurance in country of residence
Switzerland has, however, concluded agreements with its neighbouring countries (Germany, Austria, France and Italy) so that persons living in these countries have the option of taking out health insurance in their country of residence. For more details, see the table below (in German).
Residents of these countries who do not wish to take out Swiss health insurance must submit an application for exemption to the relevant cantonal authority (see list below) within three months after starting work.
In March 2015, the Federal Supreme Court issued a ruling on the exercise of this option in the area of health insurance. According to the ruling, the so-called tacit exercise of this option does not have legal force. Cross-border commuters who have previously been insured abroad rather than in Switzerland and who have not submitted a formal application for exemption from compulsory insurance may take out insurance in Switzerland under the KVG. They must obtain confirmation from the relevant authority in the canton where they work that they have not yet exercised this option with legal force. On presenting this confirmation, they will be enrolled by the Swiss health insurer (see information letter dated 20 April 2015 below).
Procedure for exercising the option for France
Cross-border commuters who are insured in France and have this option available must, within 3 months, complete the “Choice of health insurance system” form (see below) and return it, signed by the French Caisse primaire d’assurance-maladie (CPAM), to the relevant authority in the canton where they work. Persons who are insured, and continue to work, in Switzerland but who move to France and wish to obtain health insurance there must, without delay, send a copy of this form, signed by the CPAM, to the Swiss health insurer, so that their insurance in Switzerland can be terminated.
The procedure for exercising this option for France is governed by the agreement of 7 July 2016 between Switzerland and France (see the agreement below, together with the information letter of 11 July 2016 and the FAQ).
Cross-border commuters from non-EU/EFTA countries
Cross-border commuters (G permit holders) who are third-country (i.e. non-EU/EFTA) nationals, as well as non-working family members, can apply to be subject to Swiss health insurance. The application must be submitted within three months after the G permit becomes valid. If this deadline is missed, insurance cover begins on the date of enrolment.
Cover ends when employment in Switzerland ceases, the G permit is revoked or expires, or if the insured person dies or opts to be no longer subject to Swiss health insurance. In this last case, a new application can only be submitted in special circumstances.
Family members of Italian cross-border commuters
Family members (non-working) of cross-border commuters residing in Italy must be insured either in Switzerland or in Italy, depending on the circumstances (see below the information of the canton of Ticino, in Italian).
Compulsory health-insurance requirement applicable to persons residing in an EU/EFTA member state (in German) (PDF, 210 kB, 13.08.2018)
Cantonal institutions authorised to grant exemption from compulsory health-insurance (in French/German/Italian) (PDF, 162 kB, 26.09.2022)
Choice of health-insurance system - Form for exercising option right for France (in French) (PDF, 141 kB, 10.07.2019)
Information letter dated 20 April 2015 : health-insurance option rights – Federal Supreme Court decision ruling of 10.03.2015 (9C_801/2014) (in French) (PDF, 43 kB, 08.03.2022)
Information letter dated 11 July 2016 for cantons and LAMal health insurers : Agreement on health insurance between the Swiss Confederation and the Republic of France (in French) (PDF, 522 kB, 08.03.2022)
Agreement between the Swiss Confederation and the French Republic on Health Insurance of 7 July 2016 (in French) (PDF, 4 MB, 07.07.2016)
FAQ for frontier workers and Swiss pensioners residing in France on the Franco-Swiss agreement of 7 July 2016 concerning the possibility of exemption from Swiss health insurance (in French) (PDF, 163 kB, 01.07.2017)
Last modification 08.03.2022
Federal Office of Public Health FOPH
Health and Accident Insurance Directorate
Section Legal Supervision of Health Insurance
Tel. +41 58 462 21 11