Cross-border commuters from Austria: compulsory insurance and choice

Cross-border commuters from Austria: compulsory in Switzerland, a choice in favour of Austria

If you live in Vorarlberg or Tyrol and work in the St. Gallen Rhine Valley, in Graubünden or elsewhere in Switzerland, you are a cross-border commuter. Under the Agreement on the Free Movement of Persons, Switzerland is in principle responsible for your health insurance, from your first working day (Art. 1 para. 2 let. d of the Health Insurance Ordinance, KVV).

Together with Germany, France and Italy, Austria is one of the countries with a right of option. You can have yourself exempted from Swiss compulsory insurance and take out insurance in Austria. For this, Switzerland requires proof that you are covered for illness in your country of residence, during stays in other EU states and in Switzerland (Art. 2 para. 6 KVV).

The Austrian Health Insurance Fund (ÖGK) names two ways for cross-border commuters to take out insurance in Austria:

A one-way rule is important: according to the ÖGK, once you have private health insurance as a cross-border commuter, you can no longer switch to ÖGK self-insurance. The ÖGK page on cross-border commuters does not state contributions; ask the ÖGK directly. The general rules on the choice are set out in the article Right of option for cross-border commuters.

Step by step: exemption or joining an insurer

1. Note your first working day. From this day, you have 3 months, both for joining a Swiss insurer and for the application for exemption.
2. Get a quote from the ÖGK. Ask about self-insurance for cross-border commuters and the contribution. With private insurance, get written confirmation of which benefits are covered in Austria, in the EU and in Switzerland.
3. Compare Swiss premiums for residence in Austria. In 2027, 13 insurers have an approved offer (table below).
4. Clarify your family’s situation. If your spouse works in Austria, they and the children are insured there. If your spouse does not work, they and the children follow your choice.
5. Submit the application. For Austria: application for exemption to the responsible office of the canton where you work, with the notification form, proof of cover in Austria and in Switzerland, and your G permit. For Switzerland: application to an insurer.
6. Hand in form S1. If you are insured in Switzerland, your insurer issues form S1. You submit it to the health insurance institution at your place of residence; you are then treated in Austria like a person insured there.

The rules in detail

Deadline. Persons resident in the EU who are subject to compulsory insurance must take out insurance within 3 months of the requirement to take out insurance arising (Art. 7 para. 8 KVV). According to the FOPH, the same deadline applies to the application for exemption. If you join a Swiss insurer in time, you are covered retroactively from the start of work; if you join later, only from the date you join.

Responsible office. The authority designated by the canton where you work decides on the application; it also assigns people who do not take out insurance in time to an insurer (Art. 6a para. 3 of the Federal Health Insurance Act, KVG). The FOPH publishes the list of cantonal offices.

An application, not silence. According to a Federal Supreme Court ruling of 10.03.2015, exercising the right of option tacitly is not valid. If you simply remain insured in Austria without submitting an application, you are still subject to compulsory insurance in Switzerland.

Duration of the choice. According to the Common Institution under the Federal Health Insurance Act (Gemeinsame Einrichtung KVG), the choice applies for as long as your work as a cross-border commuter continues without interruption, and it is irrevocable. A new employer, a different canton of work or higher premiums change nothing. After a documented interruption, such as unemployment with insurance in Austria, you get a new right to choose when you take up a new job in Switzerland.

New family members. For Austria, as for Germany and Italy: if you are insured under the KVG, you can apply for an exemption for new family members within 3 months of a marriage or birth, retroactively from the event. If you have already exercised the right of option in favour of Austria, new family members cannot join Swiss insurance.

Cash benefits. According to the ÖGK, sickness benefit and maternity benefit are paid exclusively by the institution in the country of employment. For cross-border commuters working in Switzerland, loss of earnings due to illness is therefore governed by Swiss rules and your employment contract, regardless of your choice of health insurance for medical care.

Swiss premiums for residence in Austria in 2027

If you are insured in Switzerland, you pay the premium the insurer has set for insured persons resident in Austria, not the premium for Buchs or Chur. Monthly premiums 2027, standard deductible (children CHF 0, from age 19 CHF 300); lowest premium, median and highest premium across all insurers with an offer. Source: FOPH, approved premiums EU/EFTA/UK 2027 (file “Prämien_EU.csv” on opendata.swiss), retrieved on 15.10.2026, own analysis:

In 2027, 13 insurers have an offer for Austria, including CONCORDIA, ÖKK, Sanitas, SWICA and Sympany. The FOPH publishes the 2028 premiums in autumn 2027; until then, the 2027 figures apply.

For Swiss basic health insurance with residence in Austria:

• Standard deductible only. Higher deductibles, bonus insurance and GP, HMO or telemedicine models are not available to you (Art. 101a KVV). In Switzerland, you pay a CHF 300 deductible and a 10 % retention fee up to CHF 700 a year, children up to CHF 350 (Art. 103 KVV). For treatment in Austria, according to the FOPH, the rules of the country of residence apply.
• Accident cover through your employer. If you work at least 8 hours a week for the same employer, you are also insured against non-work-related accidents under the Accident Insurance Act (UVG) (Art. 13 para. 1 of the Accident Insurance Ordinance, UVV). Accident cover in basic health insurance can then be excluded (Art. 8 KVG); see Excluding accident cover.
• Premium subsidy. On modest incomes, the canton where you work is responsible (Art. 65a KVG).

Example: from Feldkirch to Buchs

Example with fictitious persons. Lukas, 29, lives in Feldkirch and starts a job in Buchs SG on 01.05.2027, working 42 hours a week. He is single.

In your comparison, also include the co-payment: in Swiss basic health insurance, you pay up to CHF 1,000 a year yourself for treatment in Switzerland (CHF 300 deductible plus a retention fee of up to CHF 700).

Special cases

Posting is something different. If an Austrian employer sends you to Switzerland temporarily, you are not a cross-border commuter within the meaning of these rules. Posting rules then apply, and you remain in the Austrian system with the A1 certificate.

Family. The exemption includes non-working family members in the same country. There is no separate right of choice for the family for Austria as there is for Germany. Details and examples are in the article Families of cross-border commuters.

Travel. As a person insured in Switzerland, you receive the European Health Insurance Card from your insurer for temporary stays in other EU/EFTA states and in the United Kingdom.

Other neighbouring countries. France has its own form procedure, see Cross-border commuters from France; for Germany, the separate right of option applies, see Cross-border commuters from Germany.

Common mistakes

• Taking out private insurance first and thinking of the ÖGK later. Once you have private insurance as a cross-border commuter, you can no longer join ÖGK self-insurance.
• Not having equivalence reviewed. A private policy without sufficient cover for treatment in Switzerland is not enough for the exemption.
• Counting the deadline from the contract start instead of the start of work. What counts is your first working day.
• Calculating with Swiss regional premiums. For cross-border commuters, the premium for residence in Austria applies, without a cost-saving model.
• Remaining insured twice. If you act too late, you may end up paying in both countries; see Insured twice.

If you are insured in Switzerland and want to switch insurer, the deadline calculator shows the dates; you can compare places of residence in Switzerland in the premium calculator. All articles for commuters are in the topic area Cross-border commuters.