You live in Germany and work in Switzerland: LAMal or statutory 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 Germany, 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 settle in Germany while keeping your job in Switzerland, the joint institution counts the 3 months from the move to the other state.

If you retire with only a Swiss pension, the FOPH table (August 2023) also provides for the right of option for retirees who live in Germany; the joint institution, in Olten, can give you information.

If you stay in German statutory insurance

A Swiss employer pays no employer share, according to one fund (SECURVITA): you pay the whole contribution. In 2026, the general rate is 14.6 %. To this is added the additional contribution specific to your Krankenkasse (2.9 %, the official average; according to the ministry, the funds were charging 3.13 % on average at the end of June 2026), plus long-term care insurance at 3.6 % (0.6 percentage points more if you have no children, from age 23), on an income capped at 5’812.50 € a month. A reduced rate of 14.0 % also exists; your Krankenkasse tells you which one applies to your case. The conditions for joining statutory insurance, for someone who was not already affiliated, are not dealt with here: the Krankenkasse can tell you. Your spouse and children can be co-insured at no extra contribution, subject to conditions (Familienversicherung). GKV-Spitzenverband (national association of the statutory funds), in German · Federal Ministry of Health, in German

2027. The 2027 average additional contribution is due to be published by the ministry by 1 November 2026 at the latest; as of 5 October 2026, it had not been. A law published on 29 July 2026 adds 300 € a month to the annual rise of the contribution ceiling (the exact figure is in a draft ordinance). The long-term care surcharge for members without children would rise to 0.9 percentage points, according to a draft law adopted by the government on 30 September 2026 and not yet passed. These values are not used in the calculation on this page. From 1 January 2028, a member whose spouse is co-insured in principle pays 2.5 percentage points more (the law provides exceptions, for example a child under 12 in the household); children stay co-insured free of charge.

If you opt for German private insurance

The exemption requires proof of cover for illness in Germany, during a stay in another EU state and in Switzerland. The amounts of private insurance are not dealt with here.

If you stay in LAMal

The Swiss insurer issues you form S1. You take it to a German statutory fund, which covers your care as for a person insured in Germany and is reimbursed by the Swiss insurer. Techniker Krankenkasse, in German

German long-term care insurance. According to the GKV-Spitzenverband (joint circular of 13 February 2018) and the DVKA (leaflet of 1 March 2023, written for pensioners insured abroad), a person insured in Switzerland who lives in Germany receives, through the fund where they are registered with form S1, the benefits in kind of German long-term care insurance, but not the care allowance (Pflegegeld): cash benefits come from the Swiss insurer. We found no official text saying whether additional German long-term care insurance is compulsory; the fund that receives your S1 can tell you.

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 Germany. Per month, depending on the insurer: 262.00.- to 1'224.00.- for an adult with accident cover (median 526.90.-), 243.70.- to 1'165.70.- without it, 67.80.- to 343.00.- 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.

The Federal Supreme Court describes the right as “relatively irrevocable”: it can be revisited only if something new happens. For a person living in Germany, it has accepted a new choice when their cover in the other country ended through no fault of their own (ATF 147 V 387, judgment of 14 June 2021: a German private insurance product that was discontinued), and it held that, for Germany, the FOPH’s list of cases is not exhaustive.

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).

• The family can exercise the option separately from the person who works, but as one block.
• If you are already insured in Switzerland, you can request the exemption for a new family member within 3 months of a marriage or a birth; it applies from that event. Someone who has already exercised their option cannot, on that occasion, take out LAMal insurance.

With LAMal, each person has their own premium: the spouse and each child count. In the German Familienversicherung (family cover), the spouse and children can be co-insured at no extra contribution, subject to conditions. From 2028, a co-insured spouse in principle adds 2.5 percentage points to the member’s contribution rate.

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: the Meldeformular (notification form) of the joint institution, on which you tick the request for exemption (art. 2 para. 6 OAMal), or the online request on its website. Form for Germany, Italy, Austria, in German
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). 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.