Families of cross-border commuters: insuring partners and children

Cross-border commuters with a family: who is insured where?

If you work in Switzerland as a cross-border commuter and live in a neighbouring country with your partner and children, the question of health insurance concerns the whole family. According to the FOPH, the place-of-work principle of the Agreement on the Free Movement of Persons applies not only to you but also to your non-working family members: if you are insured in Switzerland, they in principle also belong in Swiss basic health insurance.

Two circumstances change this. First, the right of option: if you as a cross-border commuter from Germany, France, Italy or Austria choose your country of residence, the exemption includes your non-working family members in the same country. Second, your partner’s employment: if your spouse works in the country of residence, they are insured there, and the children with them.

The table is based on the information sheets of the FOPH and the Common Institution under the Federal Health Insurance Act (Gemeinsame Einrichtung KVG). A separate rule applies to Italy: according to the FOPH, non-working family members of cross-border commuters resident in Italy must take out insurance in Switzerland or in Italy, depending on the circumstances; details are in the article Cross-border commuters from Italy. For family members in other countries, the FOPH and FSIO overview partly differs: if they live in Denmark, Spain, Portugal, Sweden or the United Kingdom, for example, they are insured in the country of residence; in Finland, there is a choice, as for the four neighbouring countries.

Step by step: insuring your family

1. Clarify the employment status of all adults. If your partner works in the country of residence, the question is settled for them and the children: they are insured there.
2. Make your choice within 3 months. The deadline from your first working day applies to you and to the family members insured with you (Art. 7 para. 8 of the Health Insurance Ordinance, KVV).
3. List your family members in the application. In the application for exemption, you name the family members who are exempted with you. For France, they are listed on the “Choice of health insurance system” form (Choix du système d’assurance-maladie). If you choose Switzerland, you register them with your Swiss insurer.
4. Germany: choose separately or not. Only for Germany may family members jointly choose the other system.
5. Apply for S1 for all insured persons. If your partner and children are insured in Switzerland, they also need the S1 certificate from the Swiss insurer for treatment in the country of residence.
6. Report new family members. Depending on the country, marriage or birth triggers a new 3-month deadline (see below).

The rules in detail

Who counts as a family member. Within EU coordination, according to the ÖGK, the law of the country of residence determines who counts as a family member; spouses and minor children usually count as family members everywhere, while the rules for cohabiting partners, parents or children in education vary. For cross-border commuters from countries outside the EU/EFTA/UK, the KVV itself defines family members: spouses, children up to the age of 18 and children in education up to the age of 25 (Art. 3 para. 2 KVV).

Partner working in the country of residence. If a spouse or a parent works in the country of residence, then, according to the Common Institution, the spouse or parent and the children must be insured in the country of residence. Swiss health insurance for the children is then not possible.

Separate right of option for Germany. Under a special agreement, family members of cross-border commuters from Germany can exercise the right of option separately. If you choose Switzerland, they can take out insurance in Germany, but only as a unit: all family members together.

Marriage and birth. For Germany, Austria and Italy: if you are insured under the Federal Health Insurance Act (KVG), you can apply for an exemption within 3 months for new family members through marriage or birth; it applies retroactively from the event. If you have chosen the country of residence, new family members cannot join Swiss insurance. For France, according to CLEISS, marriage, divorce, birth or death do not trigger a new right to choose.

France: recognition by the CPAM. If you are insured under the KVG (LAMal), the French health insurance fund CPAM checks whether your relatives count as family members under French law. If so, they are treated in France without paying their own contributions; if not, according to CLEISS, they may be able to take out insurance on the basis of their residence in France.

Child premiums 2027 for residence abroad

If your children are insured in Switzerland, you pay the child premium the insurer has set for your country of residence. Monthly premiums 2027 for children aged 0 to 18, CHF 0 deductible, with accident cover; 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, young adults aged 19 to 25 with a CHF 300 deductible and accident cover pay a median of CHF 421.60 (Germany), CHF 510.00 (France), CHF 371.00 (Italy) and CHF 452.20 (Austria). The FOPH publishes the 2028 premiums in autumn 2027; until then, the 2027 figures apply.

These rules apply to children resident abroad:

• No optional deductible. The higher child deductibles of up to CHF 600 (Art. 93 para. 1 KVV) and the cost-saving models are not available to insured persons resident in the EU (Art. 101a KVV). Children pay no deductible (Art. 64 para. 4 KVG).
• Half the retention fee. For treatment in Switzerland, children pay a 10 % retention fee up to a maximum of CHF 350 a year (Art. 103 para. 2 KVV).
• Cap for several children. If several children of one family are insured with the same insurer, together they pay at most the deductible and retention fee of one adult (Art. 64 para. 4 KVG).
• Premium subsidy. For cross-border commuters and their family members on modest incomes, the canton where the commuter works is responsible (Art. 65a let. a KVG).

Whether an insurer grants a family discount to families resident abroad is set out in its approved tariff; ask about it when you request a quote. You can find the insurers with an offer for the neighbouring countries under Health insurers, for example CSS, Helsana and SWICA.

Example: three families, three solutions

Example with fictitious persons. All three cross-border commuters start work in Switzerland on 01.03.2027.

If Paolo and his wife have a second child in 2028, Paolo can apply for an exemption for the newborn within 3 months of the birth, because he commutes from Austria. How to register a baby with Swiss basic health insurance is shown in Insuring your baby.

Special cases

Children in education. Whether an adult child in education is co-insured as a family member is governed, within the EU, by the law of the country of residence. Ask the insurer and the institution in the country of residence before the child turns 18.

Partner takes up work. If your partner takes a job in the country of residence, they and the children must be insured in the country of residence from then on. Report the change to your Swiss insurer so that no double insurance arises; see Insured twice.

Both parents are cross-border commuters. If both parents work in Switzerland, each of them has their own right to choose as a cross-border commuter. For the children, clarify with the canton where you work which choice they follow.

Supplementary insurance. Some insurers offer supplementary insurance for children in Swiss basic health insurance; it is governed by the Insurance Contract Act (ICA), and the general terms and conditions and the insurer’s information are decisive. More on this in the article Supplementary insurance for your child.

Common mistakes

• Forgetting family members on the form. For France, according to CLEISS, the choice applies to the family members you list on the form. Name all non-working family members, for the other countries too.
• Insuring the children in Switzerland although the partner works in the country of residence. This is not possible; the children then belong in the country of residence.
• Assuming a separate right of option for other countries. Only for Germany may family members choose differently from the cross-border commuter.
• Letting the 3 months after the birth pass. For Germany, Austria and Italy, this is the only opportunity to have a new child exempted.
• Calculating with Swiss child premiums. What counts is the premium for the country of residence, without a child deductible and without a cost-saving model.

The basic rules of the choice are explained in Right of option for cross-border commuters, the special features for Vorarlberg and Tyrol in Cross-border commuters from Austria. You can compare Swiss child premiums in the premium calculator. All articles for commuters are in the topic area Cross-border commuters.