Cross-border commuters from France: LAMal or the French system

LAMal for frontaliers: the situation in brief

If you live in France and work in Geneva, Basel, the Jura or Vaud, you are a cross-border commuter (frontalier). Under the Agreement on the Free Movement of Persons and Regulation (EC) No 883/2004, Switzerland is in principle responsible for your health insurance, in other words the LAMal, as the Federal Health Insurance Act (KVG) is called in French. France, however, is one of the four countries with a right of option: you may choose French health insurance instead.

France has its own procedure. It is based on an agreement between Switzerland and France of 07.07.2016. You make your choice with the “Choice of health insurance system” form (Choix du système d’assurance-maladie), which the French health insurance fund CPAM stamps, and send it within 3 months to the responsible office of the canton where you work.

The information on the French system comes from the French liaison body CLEISS and the French national health insurance (ameli.fr). The right to choose only concerns treatment costs. According to CLEISS, work-related accidents, occupational diseases, invalidity and loss of earnings due to illness or maternity remain with the Swiss system; you report a non-work-related accident to your Swiss employer.

Step by step: the “Choix du système” form

1. Work out the deadline. The 3 months start on your first working day in Switzerland, or when you move to France if you already work in Switzerland.
2. Have your documents ready for the CPAM. To register with French social security, CLEISS requires a birth certificate showing parentage and a passport or identity card.
3. Fill in the form. You fill in parts 1, 2 and 4 and tick the chosen system in part 5. You list your non-working family members on the same form.
4. Have it stamped by the CPAM. Part 6 is completed by the CPAM at your place of residence. If you choose the LAMal, you first present the S1 certificate from your Swiss insurer there.
5. Send it to the canton where you work. The completed form goes to the responsible cantonal office within 3 months. The FOPH publishes the list of offices.
6. Keep the confirmation. The choice is permanent; you will need the stamped form if questions arise, when you move and for every new job.

The rules in detail

Requirement to take out insurance and exemption. Persons resident in an EU state who are subject to Swiss insurance under the Agreement on the Free Movement of Persons must take out insurance (Art. 1 para. 2 let. d of the Health Insurance Ordinance, KVV). They are exempted on application under Art. 2 para. 6 KVV if the agreement allows it and they are covered for illness in their country of residence, in other EU states and in Switzerland. The authority of the canton where you work decides on the application (Art. 6a para. 3 KVG).

Deadline and start. If you choose the LAMal and take out insurance within 3 months, you are covered retroactively from the start of the requirement to take out insurance (Art. 7 para. 8 KVV). According to CLEISS, once the 3 months have passed, you and your family members are compulsorily and definitively insured in Switzerland.

No tacit choice. On 10.03.2015, the Federal Supreme Court ruled that exercising the right of option tacitly is not valid. For France, the agreement of 07.07.2016 regulated the transition: anyone who was insured in France without a formal application could still apply for the exemption from 01.10.2016 to 30.09.2017. This transitional period has expired.

Final, with few exceptions. According to CLEISS, a new right to choose only arises on these events:

• your first job in Switzerland;
• resuming work in Switzerland after working in another EU state or after unemployment in France;
• moving to France;
• moving from working life into retirement, if you only draw a Swiss pension.

Marriage, divorce, the birth or the death of a family member do not reopen the choice. Unlike for Germany, Austria and Italy, there is also no application for exemption for new family members for France.

Moving to France with existing LAMal cover. If you are insured in Switzerland, continue working here and move to France, you can choose again within 3 months. If you want to take out insurance in France, according to the FOPH, send a copy of the form stamped by the CPAM to your Swiss insurer straight away, so that your insurance in Switzerland ends.

LAMal premiums 2027 for residence in France

In the LAMal, you do not pay the premium for Geneva or Basel, but the premium the insurer has set for insured persons resident in France. 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, the LAMal for residence in France is offered by the same 13 insurers as for Germany and Austria, including Assura, CSS, Mutuel, Helsana and Visana. The FOPH publishes the 2028 premiums in autumn 2027; until then, the 2027 figures apply.

Further rules for the LAMal with residence in France:

• No cost-saving models. Optional deductibles, bonus insurance and GP, HMO or telemedicine models are not available to you (Art. 101a KVV). For treatment in Switzerland, a CHF 300 deductible and a 10 % retention fee up to CHF 700 a year apply, for children up to CHF 350 (Art. 103 KVV).
• Francs or euros. The insurer charges the premium in francs or euros and may ask for it quarterly (Art. 92a KVV).
• Excluding accident cover. If you are fully insured against accidents through your employer under the Accident Insurance Act (UVG), you can exclude accident cover from the LAMal; this is what the “without” accident row shows. How this works is explained in Excluding accident cover.
• Premium subsidy. On modest incomes, the canton where you work is responsible (Art. 65a KVG).

Example: commuting from Annemasse to Geneva

Example with fictitious persons. Claire, 35, lives in Annemasse and starts a job in Geneva on 01.04.2027. Marc, 37, her partner, does not work; they have a daughter aged 4.

The Urssaf calculator estimates the French contribution; you can find the LAMal premiums of the individual insurers on Priminfo under “EU/EFTA/UK”. Only with both figures can you compare. We do not recommend one system or the other.

Special cases

Family members. The choice also applies to non-working family members who do not draw their own Swiss pension. Who counts as a family member is determined by the CPAM under French law, for example spouses, cohabiting partners or PACS partners, and children up to a certain age. If family members are not recognised, according to CLEISS, they may be able to take out insurance on the basis of their lawful residence in France. More on this in the article Families of cross-border commuters.

Treatment in Switzerland with French insurance. With the European Health Insurance Card from the CPAM, you receive medically necessary treatment in Switzerland. According to CLEISS, non-urgent outpatient treatment is also covered, as is planned treatment with prior authorisation on form S2. The CPAM clarifies the details.

Pensioners. If you only draw a Swiss pension and live in France, you also have a right to choose. According to the FSIO and FOPH, the application for exemption then goes to the Common Institution under the Federal Health Insurance Act (Gemeinsame Einrichtung KVG) instead of the canton where you work.

Other neighbouring countries. Italy and Austria have their own rules; see Cross-border commuters from Italy and Cross-border commuters from Austria.

Common mistakes

• Not having the form stamped. Without the CPAM stamp, the “Choix du système” form is incomplete. Allow time for the CPAM within the 3 months.
• Waiting for a family event as a new occasion. For France, marriage or birth do not reopen the choice.
• Calculating with Geneva premiums. The LAMal for cross-border commuters costs the premium for residence in France, without a cost-saving model.
• Remaining insured twice. If you are insured in both systems, sort it out through the CPAM and the Swiss insurer; see Insured twice.
• Forgetting accidents. The right to choose only concerns medical care. Work-related accidents and daily allowances go through the Swiss system.

The general rules on the choice are explained in Right of option for cross-border commuters. If you are insured under the LAMal 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.