You live in France and work in Switzerland: LAMal or French health insurance?

Your 3-month deadline

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The choice, in plain terms

Switzerland insures the people who work there. For those who live in France, the free movement agreement between Switzerland and the EU lets them ask to be exempted from Swiss insurance and to stay in the health system of their country of residence, or to join it. This is the “right of option” (droit d’option in French, Optionsrecht in German, diritto d’opzione in Italian). The Swiss legal basis is art. 2 para. 6 of the health insurance ordinance (OAMal in French, KVV in German). The exemption is granted on request, if you prove that you are covered in your country of residence, during a stay in another EU state and in Switzerland. FOPH, in German · Joint institution (Institution commune LAMal / Gemeinsame Einrichtung KVG), leaflet in German

If nothing is done: once the deadline has passed, the authority assigns you to a Swiss insurer (affiliation d’office in French). The FOPH adds that, for a late affiliation without a valid excuse, a premium surcharge is due (art. 5 para. 2 LAMal).

The 3-month deadline

The request for exemption must be filed with the authority of the canton of employment within 3 months. Eight cantons (AG, AR, BL, BS, GL, OW, SO, UR) and three municipalities in the canton of Zug (Risch Rotkreuz, Steinhausen, the city of Zug) have entrusted this task to the joint institution, in Olten; the other cantons handle it themselves or through their municipalities. FOPH list · Joint institution, in German

Starting point. The free movement agreement (annex II, with annex XI of Regulation 883/2004) speaks of 3 months “after the obligation to be insured in Switzerland arises”, and art. 7 para. 8 OAMal says the same. The FOPH, the joint institution and the canton of Ticino count the 3 months from the start of the work or of the employment contract. For the request for exemption, the canton of Bern’s information sheet counts from the date the G permit (the cross-border worker permit) was issued. These dates can differ: the date used by the authority of your canton of employment is the one that counts.

If you move. If you move to France while keeping your job in Switzerland, the 3 months run from the date of your move, according to the Assurance Maladie (the French national health insurance), CLEISS (the French centre for European and international social security liaison) and the canton of Geneva (the 2016 Franco-Swiss agreement speaks of “taking up residence in France”). The joint institution also counts from the move to the other state.

If you live in France and retire with only a Swiss pension, the 3-month period runs from the date the pension is granted (according to the FOPH, or from the move to the state concerned).

If you opt for the French system

You are affiliated to the French Assurance Maladie and you pay a contribution to the Urssaf instead of a Swiss premium, for as long as you are affiliated.

The contribution is 8 % × (A − 25 % of the annual social security ceiling, PASS), where A is the income of the year before last (2025 for the 2027 contribution), as declared to the Urssaf. If A does not exceed this quarter of the PASS, the formula gives nothing to pay (our reading of the formula, to be confirmed with the Urssaf). For part of a year, the contribution is calculated pro rata: number of days ÷ 365. The 8 % rate is the 2026 one, according to the Urssaf; it states none for 2027. In 2026, the PASS is 48’060 € (order of 22 December 2025), so the allowance is 12’015 €. The PASS is set every year by ministerial order, and the Urssaf had not published the 2027 one as of 5 October 2026. Urssaf, calculation of the contribution, in French · Urssaf, declaration, in French

When and how. The 2027 contribution is calculated on 2025 income, declared on urssaf.fr (the declaration was open until 14 October 2026). Without a declaration, the Urssaf applies a flat base of 5 PASS (240’300 € for 2026); if you declare later, the contribution is recalculated with a 10 % surcharge on the base. The contribution is paid to the Urssaf each quarter; monthly payment is possible with automatic direct debit, otherwise by télépaiement (online payment) or bank transfer. Urssaf, paying the contribution, in FrenchThe base. According to the Urssaf, it is the sum of “net salaries, pensions and annuities” and “other income received” (investment income, net rental income, capital gains, etc.); the reference tax income (revenu fiscal de référence) serves only as a basis for verification. According to the Assurance Maladie, the contribution is calculated “on the basis of the reference tax income”, after a flat annual allowance: both wordings exist.

Care. With the French system, according to CLEISS, the European Health Insurance Card (EHIC) gives access to medically necessary care in Switzerland on the same terms as for Swiss insured persons. According to the Assurance Maladie, it covers urgent care, and non-urgent care without a full hospital stay is reimbursed by the French fund on the basis of French rates. Heavy planned care (at least one night in an institution, or highly specialised and costly equipment) needs prior authorisation from the Assurance Maladie, which issues form S2. Accidents at work, occupational diseases, disability and loss of earnings stay in the Swiss system. Assurance Maladie, in French · CLEISS, in French

Taxes. For income tax in France, if you are a tax resident of France: the LAMal premium is deducted from the Swiss salary before conversion into euros. The contribution paid to the Urssaf is deducted from total income and entered on line 6DD of form 2042-C. Contributions to supplementary health insurance (complémentaire santé, a “mutuelle”) are never deductible. impots.gouv.fr, in French

Rough figures. According to the Urssaf, 234’000 people living in France worked in Switzerland as cross-border workers in 2024 (retirees excluded). Of these, 64 % had chosen French social security.

If you stay in LAMal

The Swiss insurer issues form S1. You hand it to your CPAM, which registers you. Your care in France is then covered by the CPAM on behalf of the Swiss system, under French law.

What each route costs

The two amounts side by side, with the assumptions and each step of the calculation. This is a calculation, not advice: it does not count the costs you still pay yourself, or differences in benefits.

The Swiss premium for 2027 for a person who lives in France. Per month, depending on the insurer: 225.00.- to 885.00.- for an adult with accident cover (median 515.00.-), 209.30.- to 823.10.- without it, 51.70.- to 265.00.- for a child (13 insurers). There is only one deductible (“franchise”): 300.- a year for an adult and 0.- for a child; the optional deductibles and the other models are closed to people who live abroad (art. 101a OAMal). Source: the FOPH’s overview of EU/EFTA/UK premiums.

What can reopen the choice

The choice holds for as long as the cross-border work continues without interruption. According to the joint institution, a new right of option arises when the work in Switzerland ends and the person then has to be insured in their country of residence (for example because of unemployment in that country), and later starts working in Switzerland again; the interruption must be proved in writing. For France, the Franco-Swiss agreement of 7 July 2016 (art. 2 para. 2), the Assurance Maladie and CLEISS say that these cases reopen the choice, and only these:

• starting work in Switzerland, or resuming it after a period of unemployment;
• taking up residence in France;
• moving from worker status to that of a pensioner with only a Swiss pension.

The Federal Supreme Court describes the right as “relatively irrevocable”: it can be revisited only if something new happens.

According to the joint institution, a change of employer or of canton of employment, a change of income or of premium, or the move from an apprenticeship or an internship to a job does not reopen the choice. The canton of Bern’s information sheet says the same of a change of employer or workplace without interruption of the work in Switzerland.

Your family

Family members without paid work who live in the same state as you generally follow your choice: the exemption includes them. The joint institution names one exception: if the spouse or one of the parents works in the state of residence, that person and the children must be insured in that state (no Swiss insurance for the children).

• They cannot exercise their own right of option (CLEISS), and a change in the family situation gives no new right of option.

With LAMal, each person has their own premium: the spouse and each child count.

The steps, one by one

1. Note your start date of work in Switzerland and work out the end of the 3 months (the tool above does this, from the starting point the FOPH uses).
2. Get proof of cover from your country of residence or, for LAMal, a certificate from your Swiss insurer.
3. Fill in the form “Choix du système d’assurance maladie” (“Choice of health insurance system”, January 2024 version), to be stamped by the CPAM (Caisse primaire d’assurance maladie, the local office of the French health insurance) of your department of residence. Form for France, in French
4. Send it to the authority of the canton of employment within the 3 months (some cantons ask for an online submission). In Geneva: the Service de l’assurance-maladie (SAM), the canton’s health insurance office. In Ticino: the Ufficio dei contributi (contributions office, Settore obbligo assicurativo) of the Istituto delle assicurazioni sociali (social insurance institute), in Bellinzona. SAM, Geneva, in French · Ticino, in Italian
5. Keep a copy and check with the authority that your exemption is registered: without an exemption granted, you remain subject to Swiss insurance.

For LAMal, you do not request an exemption; you join a Swiss insurer within the same 3 months. Otherwise the authority assigns you to one, with a possible surcharge (FOPH). In France, the form is also used to state this choice, and it is accompanied by the Swiss insurer’s certificate. The exact documents vary by canton and country: the full list is on the authority’s page.

What this page does not do

• It gives no advice on which insurance to take and does not rank the systems.
• It does not replace the cantonal authority, your health insurer or fund, or legal advice.
• It does not deal with a country’s private insurance, supplementary cover, tax rules (except for France, where they are summarised) or the case of cross-border workers who live in other countries.
• It does not present 2027 amounts that are not yet published.