Cross-border commuters from Italy: the new health tax

What the tassa sulla salute is

Since 2024, Italian law has provided for a “quota di compartecipazione al Servizio sanitario nazionale”, usually called the “tassa sulla salute” (health tax) in the border region. It is a contribution to the Italian national health service (SSN) that certain cross-border commuters pay to their region of residence. Switzerland does not levy this charge; it is not part of Swiss health insurance and not a Swiss tax.

The legal bases at a glance:

The money goes into the regions’ budgets. It is mainly intended to increase the salaries of doctors and nursing staff in the border areas, by at most 20 % of the basic salary; the regions may use up to 30 % for social and health services in the border area (Art. 3 DM 14.11.2025).

Who pays the health tax

The law names three groups (Art. 1 comma 237 L. 213/2023):

1. Persons resident in Italy who work and stay in Switzerland and use the Italian national health service.
2. Cross-border commuters under Art. 9 para. 1 of the cross-border commuter agreement who have exercised the right of option for health insurance in Italy.
3. Dependants supported by the persons in groups 1 and 2.

The second group are the so-called “old cross-border commuters” (“vecchi frontalieri”). Under Art. 9 para. 1 of the agreement, these are cross-border commuters resident in Italy who worked for a Swiss employer in the border area in Switzerland on the day the agreement entered into force, 17.07.2023, or between 31.12.2018 and that day. Their salary remains taxable only in Switzerland. The border area comprises the cantons of Graubünden, Ticino and Valais in Switzerland, and Lombardy, Piedmont, the Aosta Valley and the Autonomous Province of Bolzano in Italy (Art. 2 of the agreement). Cross-border commuters within the meaning of the agreement live in a municipality within a 20 km strip along the border and in principle return home every day.

Anyone who started as a new cross-border commuter after 17.07.2023 falls under the agreement’s new tax rule and is not named in the list in comma 237 let. b.

How high the health tax is

Each year, the region sets a rate between 3 and 6 %, graded according to net income and family responsibilities. It applies to the net salary earned in Switzerland, with limits per month worked (comma 238 L. 213/2023, Art. 1 DM 14.11.2025):

How the salary in francs is converted into euros and how salary information is collected is regulated by the regions. According to media reports, Lombardy is planning an online platform with self-declaration of income.

Example with fictitious persons. The amounts are assumed net salaries, already converted into euros, calculated with the 3 % rate announced by Lombardy.

If a region chose the maximum rate of 6 %, Marco would pay 240 euros in the same example, capped at 200 euros. How the region takes family responsibilities into account is set out in its decision.

Status in the regions (25.09.2026)

The tassa sulla salute is a national framework; the regions have to implement it. As of 25.09.2026:

• Lombardy: According to RSI and tvsvizzera (April 2026), the region has announced a rate of 3 %, starting by September 2026. According to both reports, at the end of April 2026 the regional council rejected a motion to abolish it and adopted a motion to negotiate lower rates and deductions.
• Piedmont: According to tvsvizzera (29.04.2026), Piedmont does not apply the charge.
• Aosta Valley and Autonomous Province of Bolzano: We have not found a decision.

As of 25.09.2026, we could not confirm an official decision by Lombardy with the rate, date and payment method in a primary source from the region. Whether contributions will be charged retroactively for 2024 and 2025 is not regulated in the official texts available to us. The notices from your region of residence and your ATS or ASL (local health authority) are binding. We will update this page as soon as an official decision is available.

What this has to do with Swiss health insurance

The basic rule is: if you work in Switzerland, you must take out health insurance in Switzerland, even if you live in Italy (Art. 1 para. 2 let. d of the Health Insurance Ordinance, KVV, Agreement on the Free Movement of Persons with Annex II). Cross-border commuters resident in Italy, however, have a right of option: on application, they can be exempted from Swiss compulsory insurance and take out insurance in Italy instead (Art. 2 para. 6 KVV).

The rules of the right of option according to the FOPH and the Common Institution under the Federal Health Insurance Act (Gemeinsame Einrichtung KVG):

• Deadline: The application goes to the responsible authority of the canton where you work within three months of starting work.
• Explicit: There is no tacit choice; without an application, the Swiss requirement to take out insurance applies.
• Irrevocable: The choice applies for as long as your cross-border work continues without interruption. If you have chosen Italy, you can no longer have the exemption revoked.
• Family: Non-working family members of cross-border commuters from Italy must take out insurance in Switzerland or in Italy, depending on the circumstances.

The tassa sulla salute makes this choice more expensive for old cross-border commuters, but does not change the Swiss rules. If you are insured in Italy today, you cannot switch to Swiss basic health insurance because of the charge, as long as your cross-border work continues without interruption.

Step by step: what old and new cross-border commuters should check

1. Classify yourself: Check whether you fall under Art. 9 para. 1 of the cross-border commuter agreement. What matters is whether you worked as a cross-border commuter in Ticino, Graubünden or Valais on 17.07.2023 or between 31.12.2018 and that day. If in doubt, your employer or the cantonal tax administration can tell you.
2. Clarify your health insurance: Check whether you exercised the right of option in favour of Italy at the time or are insured in Switzerland under the KVG. The confirmation from the canton where you work or your policy shows this.
3. Follow your region’s notices: Your region of residence sets the rate, dates and payment method. Keep your Swiss salary certificates and net payslips.
4. New cross-border commuters: You have three months from the start of work to exercise the right of option. Without an application, you are subject to compulsory insurance in Switzerland and must register with a Swiss insurer.
5. Compare Swiss basic health insurance: If you are insured in Switzerland, you can choose your insurer freely. The premiums for insured persons resident in Italy depend on the country of residence, not on a Swiss premium region. The deadline calculator shows the cancellation dates and deadlines for switching insurer.

Special cases

• Stay in Switzerland: If you are resident in Italy, work and stay in Switzerland, but use the Italian health service, you belong to the first group in comma 237 and must also pay the contribution.
• Dependants: Persons you support are included under comma 237 let. c. How the region takes them into account is regulated in its decision.
• New family members: According to the Common Institution, if you are insured in Switzerland under the KVG, you can apply for an exemption for new family members within three months of a marriage or birth. If you have already exercised the right of option in favour of Italy, you cannot insure new family members in Switzerland.
• Graubünden and Valais: The rule applies to old cross-border commuters in all three cantons of the border area, not only Ticino.
• Unemployment or change of job: According to the Common Institution, a change of employer or canton of work does not trigger a new right of option. Only a documented interruption of your cross-border work, for example due to unemployment in the country of residence, reopens it when you take up a new job. In this case, get advice from the canton where you work before you miss a deadline.

Common mistakes

• Thinking the tassa sulla salute is a Swiss charge. It is an Italian contribution to your region of residence. Swiss insurers and authorities do not levy it.
• Assuming all cross-border commuters are affected. According to the law, it covers old cross-border commuters with health insurance in Italy, persons staying in Switzerland who use the SSN, and their dependants.
• Wanting to switch insurer because of the charge. The right of option is irrevocable for as long as the cross-border work continues without interruption.
• Missing the three-month deadline. New cross-border commuters must exercise the right of option within three months. After that, the requirement to take out insurance in Switzerland applies.
• Confusing media reports with decisions. The rate and date only become binding with the region’s decision.

All topics relating to working in Switzerland while living abroad are in the topic area Cross-border commuters. How exactly the right of option works is explained in the article Right of option for cross-border commuters. The rules for the neighbouring countries are described in the articles Cross-border commuters from Germany and Cross-border commuters from France. You can compare premiums in Switzerland in the premium calculator.