Employment law · Cross-border · health insurance
Health insurance for cross-border workers in Switzerland: choosing between LAMal and the French scheme
If you live in France and work in Switzerland, you fall under Swiss LAMal health insurance by default, but you can ask to be exempted and stay insured in France. This right of option must be used within three months of starting the job, and the choice is final. In France you then join the general scheme (Social Security Code, article L380-3-1) and pay 8 % of your reference taxable income minus a quarter of the annual social security ceiling.
- Official texts cited
- Sources checked on
- Drafted with AI assistance, our method
General legal information with official references and dated checks. It is not personalised advice: for a decision that commits you, have your situation checked by a qualified professional.
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What happens if you miss the three-month deadline?
If no form is sent within three months, the authority of the canton of work enrols the cross-border worker automatically with a LAMal insurer (LAMal article 6a). That enrolment is final and covers non-working family members. Geneva also charges administrative fees. Only a new triggering event, such as returning to a Swiss job after unemployment in France, reopens the choice later.
Read the referencesYou live in France and start a job in Switzerland: I can compare the French contribution with your household's LAMal premiums and check your deadline to choose.
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How long do you have to choose, and can you change your mind later?
You have three months from the start of your work in Switzerland to choose, and the choice is final. Cleiss, the French liaison body for international social security, counts the period from the day you start working in Switzerland (or from your move to France if you move during the job); the canton of Geneva counts it from your hiring date. The exemption requires proof that you have health cover in your country of residence (Swiss health insurance ordinance, article 2 paragraph 6).
If you make no choice within three months, the authority designated by the canton enrols you automatically with a LAMal insurer (automatic enrolment, affiliation d’office; LAMal article 6a). That enrolment is also irrevocable and extends to your family, and Geneva charges administrative fees on top. Work out the deadline before you sign the contract, not after the first payslip.
Cleiss: Je réside en France et je travaille en Suisse (in French)Canton of Geneva: Nouveau travailleur frontalier (pays limitrophes de la Suisse) (in French)Health Insurance Ordinance (OAMal), art. 2 para. 6 (in French)Federal Health Insurance Act (LAMal), art. 6a (in French)
Which events let you choose again?
Only a new triggering event (fait générateur) reopens the right of option: a first job in Switzerland, going back to work in Switzerland after a job in another EU state or a period of unemployment in France, moving your residence to France, or changing from employee to pensioner of a Swiss-only scheme. Each event opens a new three-month period.
The Swiss Common Institution under LAMal (Institution commune LAMal) says the break must be proved in writing, for example with an unemployment benefit certificate. These events never reopen the choice:
- a new employer or a new canton of work;
- a rise in LAMal premiums or a change in income;
- moving from an apprenticeship or internship to an employment contract;
- a marriage, divorce, birth or death in the family.
Cleiss: Je réside en France et je travaille en Suisse (in French)Institution commune LAMal: Droit d’option des frontaliers, October 2018 (in French)
Contribution, family, care, going back: what differs between the two systems?
| Point | LAMal (Switzerland) | French scheme (CNTFS) | Source |
|---|---|---|---|
| Cost | Premium set by the insurer for each insured person | 8 % × (income − 0.25 × PASS), no extra charge per person covered | Social Security Code, art. D380-2; priminfo (FOPH) |
| Other levies | Premiums paid to the LAMal insurer | No CSG or CRDS on that income, no article L380-2 contribution | Social Security Code, art. L380-3-1 IV; art. D380-1 III |
| Non-working family | Follows your choice; the CPAM checks cover in France | Covered with you under the general scheme | Cleiss |
| Spouse working in France | Family stays in France; no LAMal for the children | Family stays in France | Institution commune LAMal |
| Care received in France | Reimbursed by the CPAM for the Swiss insurer, at French rates, with the S1 | Reimbursed by the CPAM under the general scheme | Cleiss |
| No choice within 3 months | Automatic, final enrolment by the canton | Not possible without a request in time | LAMal, art. 6a; ge.ch |
| Going back | No, unless a new triggering event | No, unless a new triggering event | Cleiss; ge.ch |
Triggering events are a first job in Switzerland, a return after unemployment in France or a job in the EU, a change of residence, or retirement.
French Social Security Code (Code de la sécurité sociale): article D380-2Priminfo: health insurance premiums 2027, release of 29 September 2026 (in French)French Social Security Code: article L380-3-1French Social Security Code: article D380-1Cleiss: Je réside en France et je travaille en Suisse (in French)Institution commune LAMal: Droit d’option des frontaliers, October 2018 (in French)Federal Health Insurance Act (LAMal), art. 6a (in French)Canton of Geneva: Nouveau travailleur frontalier (pays limitrophes de la Suisse) (in French)
Which figures matter before you choose?
These benchmarks come from the legal texts and the authorities; your own figures are worked out in the worksheet below.
- Rate of the French contribution, applied to income minus 0.25 PASS
- 8 %
- in force since 1 January 2019 · French Social Security Code, article D380-2
- Provisional base if income is not declared (then a 10 % surcharge for late filing)
- 5 PASS
- in force since 6 May 2017 · French Social Security Code, article R380-5
- Deadline to use the right of option, from hiring
- 3 months
- page dated 17 November 2025 · Canton of Geneva, new cross-border worker page
- Average rise in LAMal premiums in Switzerland
- +5.0 %
- 2027 (announced 29 September 2026) · Federal Office of Public Health (FOPH), priminfo
How is the 8 % French contribution worked out?
The yearly contribution is 8 % of your income for the last known year minus a quarter of the annual social security ceiling (plafond annuel de la sécurité sociale, PASS): 8 % × (income − 0.25 × PASS), under article D380-2 of the French Social Security Code. Income means the reference taxable income (revenu fiscal de référence) as defined in article 1417 of the French Tax Code. According to Service-public.fr, the PASS is 48,060 € in 2026, so the allowance is 12,015 €. With 52,000 € of income, the contribution is 8 % × 39,985 €, which is 3,198.80 € a year.
For a couple filing jointly, shared income not split between the partners on the tax notice counts for half, unless you prove your exact share (article D380-5). The contribution is pro rata when you are covered for only part of the year. In return you pay no CSG or CRDS (French social levies) on that income, and no subsidiary health contribution under article L380-2 (article L380-3-1 IV and article D380-1 III). Payment is quarterly, or monthly by online direct debit on request; if you do not declare your income, a provisional base of five times the PASS applies (article R380-5).
French Social Security Code (Code de la sécurité sociale): article D380-2Service-public.fr: Sécurité sociale, quel sera le plafond annuel en 2027 ? (19 October 2026, in French)French Social Security Code: article D380-5French Social Security Code: article L380-3-1French Social Security Code: article D380-1French Social Security Code: article R380-5
What does article L380-3-1 of the French Social Security Code say?
I.-Les travailleurs frontaliers résidant en France et soumis obligatoirement à la législation suisse de sécurité sociale au titre des dispositions de l'accord du 21 juin 1999 entre la Communauté européenne et ses Etats membres, d'une part, et la Confédération suisse, d'autre part, sur la libre circulation des personnes, mais qui, sur leur demande, sont exemptés d'affiliation obligatoire au régime suisse d'assurance maladie en application des dispositions dérogatoires de cet accord, sont affiliés obligatoirement au régime général dans les conditions fixées par l'article L. 160-1.
[…]
Ils sont redevables d'une cotisation fixée en pourcentage du montant de leurs revenus définis selon les modalités fixées au IV de l'article 1417 du code général des impôts. Un décret détermine le taux et les modalités de calcul de cette cotisation ainsi que les obligations déclaratives incombant aux assujettis.
In plain English: A cross-border worker living in France who asks for and obtains exemption from Swiss health insurance is enrolled in the French general scheme. That person pays a contribution worked out on the reference taxable income, at a rate (8 %) and by a method set by decree.
Part IV of the same article exempts that income from CSG and CRDS; part III applies these rules to people drawing Swiss pensions.
LAMal or the French scheme: which costs your household less?
Enter the income taken into account, the PASS for the year and the monthly LAMal premiums quoted for your household: the worksheet works out the French contribution under article D380-2, sets it beside the yearly LAMal cost and dates your three-month deadline. It does not choose for you and does not forecast future premiums.
Fictional example · French contribution, LAMal premiums and deadline
The choice covers you and your non-working family, it is final, and it must reach the authority of your canton of work within three months, that is before {deadline}. Without a choice, the canton enrols you in LAMal automatically (LAMal article 6a).
- Allowance (0.25 × PASS)
- 12,015.00 €
- Base of the French contribution
- 39,985.00 €
- French contribution for the period
- 3,198.80 €
- Household LAMal premiums for the period
- 11,400.00 €
- Difference (LAMal minus France)
- 8,201.20 €
- Indicative deadline to choose
- 2027-02-02
- Have your CPAM complete part 6 of the form, then send it to the authority of your canton of work before 2027-02-02.
- Check the income on your latest French tax notice: for a couple, shared income counts for half.
- If you choose LAMal, get the S1 certificate from your Swiss insurer before you go to the CPAM.
- Keep a dated copy of what you sent: it proves you met the deadline.
Worked out with the article D380-2 formula and the PASS and premiums you enter; it ignores future premiums, top-up insurance and the exchange rate. It helps you compare and does not replace the decision of the canton or the CPAM.
Does your spouse and children's cover follow your choice?
Yes, as a rule: your choice applies to family members who do not work and do not draw a pension from a Swiss-only scheme (dependants, ayants droit). If you choose France, your spouse, civil partner and dependent children are covered under the French general scheme (régime général) with you, and the contribution is still worked out on your income alone. If you choose LAMal, the French local health insurance fund (CPAM) checks whether they can be covered in France without a contribution.
Two exceptions change the sums. If your spouse works in France, your spouse and children must be insured in France and LAMal cover for the children is not possible, so only your own LAMal premium belongs in the comparison. If you are both cross-border workers and choose differently, Geneva attaches the non-working family members to the scheme of your country of residence. A family member who works in Switzerland fills in a separate form.
Cleiss: Je réside en France et je travaille en Suisse (in French)Institution commune LAMal: Droit d’option des frontaliers, October 2018 (in French)Canton of Geneva: Nouveau travailleur frontalier (pays limitrophes de la Suisse) (in French)
How do you fill in and send the choice form?
You fill in the form « Choix du système d’assurance maladie » (choice of health insurance system), have it stamped by your CPAM, then send it within three months to the competent authority of the canton where you work. Cleiss says to complete parts 1, 2 and 4, tick the chosen system in part 5 and have part 6 completed by the CPAM where you live. If you choose Switzerland, first give the CPAM a certificate or copy of the S1 form issued by your Swiss insurer.
In Geneva, the dated and signed form goes to the Service de l’assurance-maladie, route de Frontenex 62, 1207 Geneva. Enclose:
- the fully completed and signed form, listing non-working family members;
- proof of your current health cover in France and in Switzerland;
- proof of cross-border work (G permit or employer certificate).
Cleiss: Je réside en France et je travaille en Suisse (in French)Canton of Geneva: Nouveau travailleur frontalier (pays limitrophes de la Suisse) (in French)Institution commune LAMal: Droit d’option des frontaliers, October 2018 (in French)
Missed deadline, new job, retirement: how do the common right-of-option cases work?
What happens if you miss the three-month deadline?
If no form is sent within three months, the authority of the canton of work enrols the cross-border worker automatically with a LAMal insurer (LAMal article 6a). That enrolment is final and covers non-working family members. Geneva also charges administrative fees. Only a new triggering event, such as returning to a Swiss job after unemployment in France, reopens the choice later.
Federal Health Insurance Act (LAMal), art. 6a (in French)Canton of Geneva: Nouveau travailleur frontalier (pays limitrophes de la Suisse) (in French)Cleiss: Je réside en France et je travaille en Suisse (in French)
Does a new Swiss employer or canton reopen the right of option?
No. A new Swiss employer or canton of work does not reopen the right of option for a cross-border worker, nor does a rise in premiums or a change in income. According to the Institution commune LAMal, the first choice stands as long as Swiss work continues without a break. Only a real break, such as paid unemployment in France between the two jobs, opens a new three-month period.
Institution commune LAMal: Droit d’option des frontaliers, October 2018 (in French)Cleiss: Je réside en France et je travaille en Suisse (in French)
Do you need an S1 form if you choose LAMal?
Yes, in practice. A cross-border worker who chooses LAMal must give the French CPAM a certificate or copy of the S1 form issued by the Swiss insurer, so the CPAM can complete part 6 of the choice form. With it, care received in France is reimbursed by the CPAM on behalf of the Swiss insurer, at French rates, according to Cleiss.
Cleiss: Je réside en France et je travaille en Suisse (in French)
Is the French contribution charged on top of CSG and CRDS?
No. A cross-border worker covered in France under article L380-3-1 of the French Social Security Code pays neither CSG nor CRDS on the income taken into account, and no subsidiary health contribution under article L380-2. The only charge is the 8 % contribution on income above a quarter of the PASS, set by article D380-2.
French Social Security Code: article L380-3-1French Social Security Code (Code de la sécurité sociale): article D380-2
Which health cover applies when you retire on a Swiss pension only?
Moving from employee to pensioner of a Swiss-only scheme reopens the right of option, according to Cleiss, so a former cross-border worker can choose again between LAMal and the French general scheme. Article L380-3-1 III of the French Social Security Code applies the same rules, including the contribution on reference taxable income, to Swiss pensioners exempted from LAMal.
Cleiss: Je réside en France et je travaille en Suisse (in French)French Social Security Code: article L380-3-1
Which laws and official pages does this LAMal and French cover comparison rely on?
- Cleiss: Je réside en France et je travaille en Suisse (in French)Centre des liaisons européennes et internationales de sécurité sociale (Cleiss)
- Canton of Geneva: Nouveau travailleur frontalier (pays limitrophes de la Suisse) (in French)Republic and Canton of Geneva, Service de l’assurance-maladie
- Institution commune LAMal: Droit d’option des frontaliers, October 2018 (in French)Institution commune LAMal (Common Institution under LAMal)
- Federal Health Insurance Act (LAMal), art. 6a (in French)Swiss Confederation: Fedlex
- Health Insurance Ordinance (OAMal), art. 2 para. 6 (in French)Swiss Confederation: Fedlex
- French Social Security Code (Code de la sécurité sociale): article D380-2French Republic / DILA: Légifrance
- Service-public.fr: Sécurité sociale, quel sera le plafond annuel en 2027 ? (19 October 2026, in French)French Republic / DILA: Service-public.fr
- French Social Security Code: article D380-5French Republic / DILA: Légifrance
- French Social Security Code: article L380-3-1French Republic / DILA: Légifrance
- French Social Security Code: article D380-1French Republic / DILA: Légifrance
- Priminfo: health insurance premiums 2027, release of 29 September 2026 (in French)Federal Office of Public Health (FOPH)
- French Social Security Code: article R380-5French Republic / DILA: Légifrance
Texts cited last checked: 30 October 2026