Health Insurance for Swiss Cross-Border Workers

As a cross-border worker, it is essential to take out health insurance to cover your healthcare expenses, including medical consultations, medications, and hospitalizations. Health insurance is mandatory for cross-border workers, but it is not automatically set up; therefore, you must take care of it from the beginning of your activity in Switzerland.

I Am a New Cross-Border Worker

If you are starting your activity in Switzerland or if you have recently moved from France to Switzerland, you are generally affiliated with the Swiss health insurance system, the LAMal (Health Insurance Law). However, an agreement between France and Switzerland allows you to exercise an option regarding your health coverage.

Available Options

As a cross-border worker, you have the choice between:

• Affiliation to a Swiss insurance fund (LAMal), which offers comprehensive healthcare coverage.
• Affiliation to the French Cross-Border Social Security Scheme (CMU), managed by the CPAM.

Choices and Implications

Your choice must be carefully considered as it has long-term financial consequences. It is crucial to understand the details of each option, including associated costs and benefits offered. LAMal generally covers a wider range of healthcare, while CMU may have limitations based on your personal situation.

Option Period

It is imperative to exercise your option within 3 months of starting your employment. If you do not do so, you will be automatically affiliated with LAMal, which may not meet your needs. Make sure to make your choice promptly to avoid inadequate coverage.

I Am Already an Existing Cross-Border Worker

Once you have chosen your insurance, this choice is generally final. However, certain changes in your situation may allow you to exercise your option again:

• Resumption of work in Switzerland after a period of compensable unemployment in France.
• Change from a cross-border worker status to exclusively Swiss pensioner status.

Choice Consequences

The choice between LAMal and CMU has implications for your coverage and reimbursements. LAMal ensures direct access to healthcare in Switzerland, while CMU may require more complex administrative procedures to access care. Additionally, the reimbursement of healthcare expenses may vary depending on the chosen scheme.

Loss of Earnings Insurance

Loss of earnings insurance is coverage that can indemnify you in case of sick leave. Although it is not mandatory, it is often offered by employers. Inquire with your company to find out if such insurance is included in your employment contract.

Possible Situations

There are two main cases:

• Your employer has taken out insurance: check the extent of the coverage offered.
• Your employer does not have insurance: you will be compensated based on your seniority in the company, with a minimum of 3 weeks' salary during the first year.

Registration Request

To facilitate the process, you can fill out a registration form for CMU if you opt for this coverage. You will need to provide various documents, such as your employment contract and proof of address. Feel free to consult the resources available on the relevant organizations' websites for detailed information.

Right to Healthcare Reimbursement

Cross-border workers have the right to be reimbursed for their healthcare expenses, whether they are affiliated with LAMal or CMU. It is important to keep all healthcare receipts and request reimbursement within the specified deadlines. For LAMal, reimbursements are generally based on Swiss rates, while for CMU, they are aligned with French rates.

Assistance for Cross-Border Workers

Organizations and assistance services are available to help cross-border workers with their insurance procedures. They can assist you in choosing your insurance, managing your reimbursements, and understanding your rights. Do not hesitate to contact them for personalized advice.

Useful Documents

Here are some links to documents and resources that may be helpful to you in your procedures:

• Swiss Cross-Border Worker - ameli.fr
• Health Insurance Guide for Cross-Border Workers (PDF)
• News on Health Insurance and Cross-Border Workers - CPAM
• Rights of Cross-Border Workers - Public Service

Conclusion

Choosing the appropriate health insurance as a cross-border worker is essential to ensure your financial security and that of your family. Take the time to inform yourself well and do not hesitate to consult insurance experts to guide you through this process. Good coverage will allow you to benefit from quality care without worrying about unforeseen expenses.