Cross-border commuters from Germany: Swiss KVG or statutory fund?

Cross-border commuters from Germany: two systems, one deadline

If you live in Germany and work in Switzerland, two health insurance systems meet. Which one applies is governed by the Agreement on the Free Movement of Persons between Switzerland and the EU, through Regulation (EC) No 883/2004. The basic principle: the country in which you work is responsible. As a cross-border commuter with a G permit, you are therefore subject to compulsory Swiss basic health insurance from your first working day (Art. 1 para. 2 let. d of the Health Insurance Ordinance, KVV).

Germany, however, is one of the four neighbouring countries with a choice, the right of option. You can have yourself exempted from Swiss compulsory insurance and remain insured in Germany, or take out insurance there. According to the German Liaison Agency Health Insurance – International (DVKA), the exemption is possible if you have cover comparable to Swiss basic health insurance, for example as a voluntary member of a statutory health insurance fund in Germany.

Which contributions are due in Germany, and whether a statutory fund accepts you as a voluntary member, is governed by German law. Your German health insurer and the DVKA answer these questions; we do not give figures for them. The general rules on the choice are set out in the article Right of option for cross-border commuters.

Step by step to your decision

1. Note the key date. The 3 months run from your first working day in Switzerland, not from the date you sign the contract.
2. Ask your German health insurer. Clarify in writing whether, and on what conditions, you can stay in statutory health insurance or join it voluntarily, and how high your contribution would be.
3. Get Swiss premiums for residence in Germany. Only 13 Swiss insurers have an approved offer for Germany in 2027 (see the table below).
4. Think about your family. If your spouse works in Germany, they are insured there themselves, and so are the children. If your spouse does not work, the family decides via the separate right of option.
5. Submit the application or join before the deadline. For Germany: application for exemption to the responsible office of the canton where you work, with the notification form, proof of insurance in Germany and in Switzerland, and your G permit. Some cantons accept it via the web portal of the Common Institution under the Federal Health Insurance Act (Gemeinsame Einrichtung KVG). For Switzerland: application to an insurer.
6. Register with form S1. If you are insured in Switzerland, your insurer sends you form S1. You hand it in to a health insurer at your place of residence and can then get treatment in Germany.

The rules for Germany in detail

Exemption on application. Art. 2 para. 6 KVV exempts persons resident in an EU state from compulsory insurance if they can be exempted under the Agreement on the Free Movement of Persons and prove that they are covered for illness in their country of residence, during a stay in another EU state and in Switzerland. The authority designated by the canton where you work decides on the application (Art. 6a para. 3 of the Federal Health Insurance Act, KVG).

Deadline. You 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. There is no tacit choice: according to a Federal Supreme Court ruling of 10.03.2015, a formal application is required.

Irrevocable. The choice applies for as long as your work as a cross-border commuter continues without interruption. A new employer or a different canton of work does not change this. Only after a documented interruption, for example unemployment with insurance in Germany, do you get a new right to choose when you take up a new job in Switzerland.

Separate right of option. For cross-border commuters from Germany, a special agreement provides a separate right of choice for the family. If you choose Switzerland, your family members can take out insurance in Germany. They may only do so as a unit, however: the cross-border commuter on one side, all family members together on the other.

New family members. If you are insured under the KVG and a family member joins through marriage or birth, you can apply for an exemption within 3 months of the event; it applies retroactively from the marriage or birth. If, on the other hand, you have already exercised the right of option in favour of Germany, new family members cannot join Swiss insurance, according to the information sheet of the Common Institution; the exemption cannot be revoked.

Swiss premiums for residence in Germany in 2027

If you are insured in Switzerland, you do not pay the premium for your place of work, but the premium the insurer has calculated for insured persons resident in Germany. 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:

These 13 insurers have an offer for Germany in 2027: Agrisano, Aquilana, Assura, CONCORDIA, CSS, Helsana, KPT, Mutuel, ÖKK, Sanitas, SWICA, Sympany and Visana. The list is not a ranking. They are the same 13 insurers as in 2026. The FOPH publishes the 2028 premiums in autumn 2027; until then, the 2027 figures apply.

For insured persons resident in Germany, these restrictions apply: no optional deductible, no bonus insurance, no GP, HMO or telemedicine model (Art. 101a KVV). The co-payment for treatment in Switzerland follows Swiss law: a CHF 300 deductible and a 10 % retention fee up to CHF 700 a year for adults and up to CHF 350 for children (Art. 103 KVV). For treatment in Germany, according to the FOPH, the co-payment rules of the country of residence apply.

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) and can exclude accident cover from basic health insurance (Art. 8 KVG); this is what the “without” accident row shows. On a low income, the canton where you work helps with a premium subsidy (Art. 65a KVG).

Example: family in Lörrach, job in Basel

Example with fictitious persons. Jan, 38, lives in Lörrach with his wife Katrin, 36, and two children. He starts a job in Basel on 01.02.2027. Katrin does not work.

The Swiss flat premium is due for each person; the German contribution is governed by German law. This is exactly why a written comparison before the deadline is worthwhile for families. How partners and children are insured in detail is explained in the article Families of cross-border commuters.

Special cases

Travel to other countries. As a person insured in Switzerland and resident in Germany, you receive the European Health Insurance Card from your insurer. It applies to medically necessary treatment during a temporary stay in other EU/EFTA states and in the United Kingdom.

Returning to Swiss insurance. If you were previously insured in Germany without a formal application, ask the canton where you work to confirm that you have not yet validly exercised the right of option. With this confirmation, a Swiss insurer will accept you, according to the FOPH.

Double insurance. If you stay insured in Germany and submit the application for exemption too late, you may be insured in both countries. What to do then is shown in Insured twice.

Cross-border commuters from Italy and France. Separate procedures apply to Italy and France; see Cross-border commuters from Italy and Cross-border commuters from France.

Common mistakes

• Deciding only after the probationary period. The deadline starts on your first working day. After 3 months, the choice is gone.
• Simply keeping your German insurance running. Without a formal application for exemption to the canton where you work, you remain subject to compulsory insurance in Switzerland.
• Overlooking the separate right of option. Only for Germany may family members choose differently from the cross-border commuter, and only jointly.
• Calculating with Basel or Zurich premiums. What counts is the premium for residence in Germany, without a cost-saving model and without an optional deductible.
• Not reporting a birth or marriage. A 3-month deadline applies again to the exemption of new family members.

If you are insured in Switzerland and want to switch insurer, the normal dates for basic health insurance apply; the deadline calculator shows them. For a comparison with places of residence in Switzerland, use the premium calculator, which calculates with Swiss premium regions. All articles for commuters are in the topic area Cross-border commuters.