Cross-border commuters and health insurance in Switzerland
Do you work in Switzerland but live in another country? If so, you may be subject to Swiss health insurance obligations as a cross-border commuter. Find out more here.
28.11.2023
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1. Working in Switzerland: compulsory health insurance for cross-border commuters
All people from abroad working in Switzerland are required to take out insurance with a Swiss health insurer. However, exceptions are possible depending on your country of residence and nationality – neighbouring countries and EU/EFTA countries are exempt, for example.
2. “Place-of-employment principle” for cross-border commuters: what does this mean?
The place-of-employment principle means that all cross-border commuters must take out health insurance in their country of employment. Exceptions apply to people from other countries near the border. You have what is known as the “right to choose”. This includes employees from:
Germany
France
Italy
Austria
This means they can choose whether they take out insurance in Switzerland or in their country of residence.
Those affected by the right to choose must decide within three months of the commencement of employment whether they wish to take out insurance in Switzerland or in their country of residence.
To do this, you must either choose a Swiss health insurer or apply for exemption from mandatory health insurance with the competent authority in your canton of employment. Important: once exempted from compulsory health insurance in Switzerland, you can’t change your mind afterwards.
Do you live in France, work in Switzerland and have the right to choose? Then within three months you must have the form Choix du système d 'assurance-maladie approved by the Caisse primaire d'assurance-maladie française (CPAM).
If you want to get insurance in Switzerland, send it back to the competent authority in the canton you work in. If you want to take out French health insurance, send the form to your health insurance company in France.
Are you a cross-border commuter with citizenship outside the EU/EFTA countries? Then you have to apply to be insured with a Swiss health insurance company. You must submit the application within three months of receiving your category G residence card.
You can change your mind later and subsequently do without Swiss insurance. However, it is no longer possible to apply again without a special reason. If you no longer work in Switzerland, you will no longer be able to be insured by a Swiss health insurance provider.
3. Is there mandatory health insurance for unemployed family members?
In Switzerland, unemployed family members of cross-border commuters are subject to mandatory insurance. However, there is no family insurance for cross-border commuters in Switzerland.
The following exceptions are possible:
Possible exemption from the obligation to obtain insurance in the home country: Germany, France, Italy, Austria and Finland.
No Swiss insurance obligation: Denmark, Liechtenstein, Portugal, the UK, Sweden, Spain and Hungary.
Special provisions apply to unemployed family members of pensioners in Spain.
Good to know: do you have children and you and your spouse work in different countries? Then your children must be insured in the country of residence.
4. What do I need to know about Swiss health insurance?
Swiss health insurance differs from other countries in many ways.
This means you pay a separate premium for each family member. The cost of your health insurance premiums is not related to your salary.
The premiums are not deducted directly from your wages. Nor does your employer pay for a part of the premiums, as is customary in Germany, for example. You pay the health insurance premiums either monthly or annually by invoice. Some insurance companies allow you to pay half-yearly or quarterly.
Those in a difficult financial situation can claim a premium discount. For cross-border commuters, the corresponding office in the canton where you work is responsible for this.
People residing in Switzerland can change their basic insurance provider every year. You must cancel your current policy by 30 November.
You can also change health insurance as a cross-border commuter – but only within Switzerland. Basic insurance may not refuse your application.
If you are treated in Switzerland, you pay out-of-pocket expenses.
The benefits of basic insurance are legally defined. Regardless of how much the premiums cost, the benefits are the same for all providers.
For benefits not covered by basic insurance, you can take out supplemental insurance. You can take out basic insurance and supplemental insurance with different providers.
In contrast to basic insurance, Swiss supplemental insurance usually requires you to answer a health questionnaire as part of your application. The insurance company then decides whether to accept or reject your application for supplemental insurance based on this.
No right to choose for supplemental insurance
You do not have any right to choose for supplemental insurance. This means: if you live in Germany, France, Austria or Italy, you must take out supplemental insurance in your country of residence.
If you work more than eight hours per week for the same employer, you are insured against accidents. For unemployed family members, you must include accident cover in your health insurance policy.
Health insurance for cross-border commuters: costs in the EU/EFTA area
Some Swiss health insurers have special offers for those living in an EU or EFTA country. The cost of the premiums depends on the country and provider. Here you can find an overview.
The premiums for health insurance for cross-border commuters are usually higher than the premiums for people residing in Switzerland. This is because cross-border commuters may seek medical treatment both in Switzerland and in their country of residence.
5. Cross-border commuters and visits to the doctor: what conditions apply to treatment?
Cross-border commuters may choose to undergo treatment either in their country of residence or in Switzerland . The same applies to co-insured, non-working family members.
Treatment administered in Switzerland is subject to out-of-pocket expenses (deductible and coinsurance) as well as the Swiss catalogue of service fees for basic insurance. In the policyholder’s country of residence, the out-of-pocket expenses and statutory benefits of that country apply.
Form S1 for benefits in your country of residence
Do you have Swiss insurance and want to receive benefits in your country of residence? If so, you must submit Form S1 (formerly Form E106) and submit it to a health insurer in your country of residence.
Regardless of your residence status, you will continue to receive your salary once you have beenemployed for more than three months even in the event of illness or accident. How much you receive, and for how long you get your salary depends on a variety of factors. One of these is whether your employer company has daily sickness benefit insurance.
You can read more about this in our article on daily sick pay.
6. Is health insurance tax-deductible for cross-border commuters?
Whether you can deduct your health insurance premiums for tax purposes depends on your country of residence.
This article was first published on 01.09.2022
