You live in Italy and work in Switzerland: LAMal or the Italian system?

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 Italy, 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 Italy while keeping your job in Switzerland, the canton of Ticino counts the 3 months from the departure from Switzerland, and the joint institution 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 Italy; the joint institution, in Olten, can give you information.

If you opt for the Italian system

You stay in the national health service (SSN). The 2024 budget law (law 213/2023, art. 1 paras 237-238) provides for a contribution to the region of residence of 3 to 6 % of the net salary earned in Switzerland. It is at least 30 € and at most 200 € for each month worked (these limits can be doubled in case of non-payment or non-communication), from 2024; the region adjusts the rate according to net income and family responsibilities. The contribution applies to the “old cross-border workers” (people who lived in a border municipality, in principle returned home every day and worked in Ticino, Graubünden or Valais between 31 December 2018 and 17 July 2023) who chose the Italian system, to residents who work and stay in Switzerland and use the SSN, and to their dependent family members. Letter b covers only the cases where the right of option was exercised: old cross-border workers who chose LAMal are not named there, nor are the new cross-border workers. Law 213/2023, in Italian

Where things stand. The decree of the Minister of Health of 14 November 2025 (Gazzetta Ufficiale no. 293, 18 December 2025) leaves each region to set its rate by its own act; payment is made once a year through the payment instruments of art. 5 of the digital administration code, and the decree sets no date. Lombardy announced the minimum of 3 % on 2025 income and aimed to implement it by September; at the end of June 2026 it told Ticino that it had asked the Ministry of Economy to postpone the entry into force to 2027. Piedmont does not plan to apply it. In early July 2026, nothing had yet been requested. The canton of Ticino has provisionally withheld 50.2 million francs of border compensation payments (ristorni) intended for Lombardy, because, according to its legal opinion, the levy is a tax contrary to art. 9 of the tax agreement (the unions also dispute it). According to the news agency ATS, the Federal Council replied on 15 June 2026 that the analysis of its State Secretariat and an external expert opinion conclude that the contribution complies with the agreement, and that a unilateral withholding of the payments would breach it. According to a union and a party, implementing acts were still missing on 24 September and 1 October 2026 (without saying which); the interministerial table on cross-border work is due to meet again on 9 November. We found neither a regional act nor a payment request. The situation as of 5 October 2026 is not established: this page presents the contribution as a scenario, not as an amount due.

Where to send the request

In Ticino, to the Ufficio dei contributi (contributions office, Settore obbligo assicurativo) of the Istituto delle assicurazioni sociali (social insurance institute), Via Ghiringhelli 15a, 6501 Bellinzona. Elsewhere, to the authority of the canton of employment. Canton of Ticino, in Italian

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 Italy. Per month, depending on the insurer: 330.00.- to 534.80.- for an adult with accident cover (median 466.85.-), 306.90.- to 509.40.- without it, 75.90.- to 219.00.- for a child (14 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.

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).

• According to the FOPH and the canton of Ticino, if only one parent works, the whole family follows that parent’s choice, and with LAMal everyone is with the same Swiss insurer; if the other parent works in Italy or draws a pension there, the children stay insured in Italy; if both spouses work in Switzerland, each exercises their own option and all the children follow the same one.
• 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.

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.