Health insurance: Cross-border commuters working in Switzerland

In principle, persons domiciled abroad who work in Switzerland need to take out Swiss health-insurance cover. Some exceptions may apply depending on the employee’s country of domicile and nationality.

Insurance at place of work for cross-border commuters from EU/EFTA countries

Following the harmonisation of social-security systems introduced in 2002 by the Agreement on the Free Movement of Persons (AFMP) and the EFTA Agreement, the obligation to take out health insurance is based on the place of employment. Anyone working in Switzerland is required to take out compulsory Swiss health insurance, as are all members of their family not in gainful employment.

This rule notably applies to cross-border commuters who are nationals of an EU or EFTA state

Beginning and end of cover

Cross-border commuters who are EU/EFTA nationals and hold a G work permit must have Swiss health insurance from the date their employment contract commences. They have three months in which to enrol with a Swiss health-insurance fund. If they fail to do so, they may be automatically enrolled with a health insurance fund – with a premium surcharge for belated admission in the absence of an excuse for the delay – and are required to pay the costs of any medical treatment received prior to the date of admission themselves.

The obligation to have health-insurance cover ends when the employment contract ends.

Option right

Switzerland has however also concluded agreements with the neighbouring countries (Germany, Austria, France and Italy) granting persons domiciled there the option of taking out health insurance in their country of domicile. See table below “Requirements governing compulsory Swiss health insurance for EU/EFTA residents ”.

Persons domiciled in those four countries who do not wish to take out Swiss health insurance must present an exemption request in the three months following the commencement of their contract to the relevant authority in the canton in which they work (see list below).

In March 2015 the Swiss Federal Supreme Court issued a ruling on the exercising of option rights in health insurance. According to this ruling, the "tacit exercising" of the option right does not have legal force. Cross-border commuters who have hitherto been insured abroad rather than in Switzerland without having submitted a formal request for exemption from the insurance obligation in Switzerland may take out insurance cover in accordance with the Health Insurance Act. They must obtain confirmation from the relevant office in the canton where they work that they have not yet exercised their option right with legal force. By presenting this confirmation, they will then be accepted by the Swiss health insurer (see factsheet dated 10 April 2015 below).

Exercise of option right with France

Cross-border commuters insured in France and enjoying the Swiss health-insurance exemption right must complete the form below “ Choice of health-insurance system ” and return it, signed by the French Caisse primaire d'assurance-maladie (CPAM), to the relevant authority in the canton in which they work within 3 months. Persons insured in Switzerland who move to France and decide to take out health insurance there must rapidly send a copy of this form, signed by the CPAM, to their Swiss health insurer in order to terminate their cover in Switzerland.

The modalities for exercising the option right are set out in the agreement dated 7 July 2016 between Switzerland and France (see wording of the agreement below and the related factsheet dated 11 July 2016 plus FAQ.

Cross-border commuters from other (non-EU/EFTA) countries

Cross-border commuters (G permitholders) who are third-country (i.e. non-EU/EFTA) nationals are subject to Swiss health insurance requirements on request, as are members of their family not in gainful employment. Swiss health-insurance cover must be requested within the first three months of the G permit’s validity. Thereafter, insurance cover commences when the person is accepted by the health insurer.

Cover ends when employment in Switzerland ceases, the G permit is revoked or expires, the insured person dies or elects no longer to be subject to Swiss health-insurance requirements. In this last case, a new request for cover is possible only in special circumstances.

Further information

Health insurance: EU/EFTA premiums and premium reductions

Persons insured in Switzerland pay the EU/EFTA premiums applicable to their country of domicile. Those of limited means are entitled to a premium reduction.

Health insurance: Cost participation for persons insured in Switzerland

The proportion of their treatment costs persons insured in Switzerland will bear depends on the country in which treatment is administered.

Last modification 27.08.2018

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Federal Office of Public Health FOPH
Health and Accident Insurance Directorate
Section Legal Supervision of Health Insurance
Schwarzenburgstrasse 157
3003 Berne
Tel. +41 58 462 21 11

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