Cross-border commuters: KVG or home country? The right of option explained

Health insurance for cross-border commuters: Switzerland as the rule, country of residence as the exception

As a cross-border commuter, you live abroad and work in Switzerland. Which country is responsible for your health insurance is governed by the Agreement on the Free Movement of Persons (AFMP) with the EU, through its Annex II and Regulation (EC) No 883/2004. The principle is the place-of-work rule: the state where you work is responsible. If you are employed in Basel, Geneva or St. Gallen and live in the EU, you therefore belong in Swiss basic health insurance, together with your family members who are not in employment.

There is an exception for four neighbouring states. Cross-border commuters resident in Germany, France, Italy and Austria may choose whether they want to be insured in Switzerland or in their country of residence. This right to choose is called the right of option. It does not take effect by itself: if you want your country of residence, you submit an application for exemption from compulsory health insurance in Switzerland.

The table follows the overview by the Federal Office of Public Health (FOPH) and the Federal Social Insurance Office (FSIO) on the subjection of persons resident in the EU/EFTA/UK (as of August 2023). There are separate articles on the details for your country of residence: Cross-border commuters from Germany, from France, from Austria and from Italy.

Step by step: exercising the right of option

1. Note your first working day. Compulsory insurance in Switzerland begins when you start work in Switzerland. From that day, you have 3 months, both for joining a Swiss health insurer and for the exemption application.
2. Compare both systems. The Swiss insurers’ premiums for your country of residence, contributions and benefits in your country of residence, treatment in both countries, family. The offices there can tell you the contributions in your country of residence.
3. Decide, and do so for the whole family. The exemption includes family members who are not in employment in the same state. For Germany, there is a separate right of option for the family (see below).
4. Country of residence chosen: submit the application. The application goes to the competent office of the canton where you work within 3 months. According to the Common Institution under the Federal Health Insurance Act (Gemeinsame Einrichtung KVG), it must include a signed registration form, proof of insurance cover in your country of residence and in Switzerland, and proof of your cross-border activity, such as your G permit.
5. France: have the form stamped. If you live in France, you fill in the “Choix du système d'assurance-maladie” form, have it stamped by the French health insurance fund (CPAM) and send it within 3 months to the office of the canton where you work.
6. Switzerland chosen: choose an insurer and join. Not every insurer covers people resident in the EU. If you join in time, cover starts retroactively from the date you became subject to compulsory insurance (Art. 7 para. 8 KVV).
7. Keep the confirmation. You will need the canton’s decision or the insurer’s policy every time you change job and if questions arise.

The legal rules in detail

Requirement to take out insurance. Under Art. 1 para. 2 let. d of the Health Insurance Ordinance (KVV), people who live in an EU state and are subject to Swiss insurance under the Agreement on the Free Movement of Persons and its Annex II are required to take out insurance. Art. 95a of the Federal Health Insurance Act (KVG) declares Regulations (EC) No 883/2004 and No 987/2009 applicable for this purpose. The requirement to take out insurance ends when the employment ends.

Deadline and start. Art. 7 para. 8 KVV requires you to join within 3 months of becoming subject to compulsory insurance. Cover then starts from the date of subjection; if you join later, only from the date you join. You then bear any costs before the joining date yourself. If the delay is inexcusable, you also owe a premium surcharge (Art. 5 para. 2 KVG).

Exemption. Art. 2 para. 6 KVV exempts, on application, people resident in an EU state who can be exempted under the Agreement and who prove that they are covered for illness in their state of residence, during a stay in another EU state and in Switzerland.

Responsibility. The authority designated by the canton decides on applications for exemption and assigns people who do not take out insurance in time to a health insurer (Art. 6a para. 3 KVG).

No tacit choice. On 10.03.2015, the Federal Supreme Court ruled (9C_801/2014) that tacitly exercising the right of option has no legal force. According to the FOPH, if you were insured abroad without a formal application, you can take out insurance under the KVG if the canton where you work confirms that the right of option has not yet been validly exercised.

Irrevocable. According to the Common Institution under the Federal Health Insurance Act, the choice applies for the duration of uninterrupted cross-border activity. The following do not give you a new right to choose: changed financial circumstances, higher premiums, a new employer or canton of work, or moving from training or an internship into employment. A new right to choose only arises when your activity in Switzerland ends, for example if you are insured in your country of residence because of unemployment, and you then take up a job in Switzerland again. You must document the interruption in writing.

What Swiss basic health insurance costs cross-border commuters in 2027

If you take out insurance in Switzerland as a cross-border commuter, you do not pay the premium for your place of work, but the premium the insurer has calculated for your country of residence. The FOPH approves these premiums separately. According to the FOPH, around a third of Swiss health insurers offer cover for people resident in the EU/EFTA/UK. In the 2027 premium data, there are 13 insurers each for Germany, France and Austria, and 14 for Italy.

Monthly premiums 2027, adults aged 26 and over, standard deductible CHF 300, with accident cover; lowest premium, median and highest premium across all insurers offering cover. Source: FOPH, approved premiums EU/EFTA/UK 2027 (file “Prämien_EU.csv” on opendata.swiss), retrieved on 15.10.2026, own analysis:

The range is wide: for residence in Germany, there is CHF 962.00 per month between the lowest and the highest premium, for the same statutory benefits. According to the FOPH’s 2027 data, insurers offering cover for these four states include CSS, Helsana, Sanitas, SWICA and Visana. The FOPH will publish the 2028 premiums in autumn 2027; until then, the 2027 values apply.

Three rules distinguish insurance for cross-border commuters from insurance for people resident in Switzerland:

• No optional deductible, no lower-cost models. The special types of insurance under Art. 93–101 KVV, i.e. higher deductibles, bonus insurance and GP, HMO or telemedicine models, are not available to insured persons resident in the EU/EFTA/UK (Art. 101a KVV). The standard deductible of CHF 300 and a 10 % retention fee up to CHF 700 per year apply (Art. 64 para. 2 KVG, Art. 103 KVV).
• Premium in francs or euros. If you live abroad, the insurer charges the premium in Swiss francs or in euros and may charge it quarterly (Art. 92a KVV).
• Premium subsidies from the canton of work. Cross-border commuters in modest financial circumstances receive premium subsidies from the canton where they work (Art. 65a KVG); the FOPH links to the offices. General information on subsidies is available under Premium subsidies.

The premium calculator uses Swiss premium regions. You will find the premiums for residence abroad on Priminfo under “EU/EFTA/UK” or directly from the insurer.

Example: three months to decide

Example with fictitious people. Sara, 34, lives in Konstanz and starts a job in Kreuzlingen (canton of Thurgau) on 01.03.2027. She has a G permit; Sara’s partner works in Germany.

Because Sara’s partner is in employment in Germany, he would be insured there in his own right anyway. How the rules for partners and children work in detail is explained in the article Families of cross-border commuters. Suspending accident cover is explained under Suspending accident cover.

Special cases

Family. The exemption includes family members living in the same state who are not in employment. If the spouse or a parent works in the country of residence, they and the children must be insured there; Swiss insurance for the children is then not possible.

Germany: separate right of option. If the cross-border commuter chooses Switzerland, their family members can still take out insurance in Germany. However, the family members may only choose together.

New family members. For Germany, Austria and Italy: if you are insured under the KVG, you can apply for exemption within 3 months of a marriage or birth, retroactively from the event. For France, a change in family circumstances does not give a new right of option.

Cross-border commuters from third countries. If you commute from a state outside the EU/EFTA/UK, you are only made subject to Swiss insurance on your own application, also within 3 months of your G permit becoming valid (Art. 3 and Art. 7 para. 4 KVV). If you waive this, you cannot submit a new application without a specific reason.

Treatment in two countries. If you are insured in Switzerland, you can receive treatment in Switzerland and in your country of residence. For your country of residence, the insurer issues form S1; the rules and co-payment of the country of residence apply there. More on this in the article Treatment abroad.

Common mistakes

• Missing the deadline. After 3 months, the right to choose is gone. The canton can assign you to a health insurer, and if the delay is inexcusable, a premium surcharge is added.
• Thinking that doing nothing is a choice. Tacitly exercising the option is not valid. Without an application, you remain subject to compulsory insurance in Switzerland.
• Paying premiums twice. If you stay insured in your country of residence and do not submit the application in time, you risk being insured in both states. How to resolve this is shown in Insured twice.
• Counting on Swiss regional premiums and lower-cost models. Cross-border commuters pay the premium for their country of residence, without an optional deductible and without a GP or telemedicine discount.
• Hoping to switch later. Higher premiums or a new employer do not reopen the right to choose.

If cross-border commuters are insured in Switzerland, the normal dates of basic health insurance apply to switching health insurer; the deadline calculator shows them. You will find all articles for commuters in the section Cross-border commuters. How we prepare premium data is explained under How we calculate.