FAQ – health and accident insurance information for cross-border commuters

From the Swiss perspective, the term “cross-border commuter” refers to anyone working or being self-employed in Switzerland but living in another country (usually within the EU/EFTA zone) to which he or she returns daily or at least once a week.

With respect to mandatory health insurance, the Agreement on the Free Movement of Persons lays out the principle defining the place of employment, whereby cross-border commuters with (exclusive) gainful employment in Switzerland must also be insured there.

Commuters who cross Switzerland's borders with Germany, Austria, Italy or France can choose their own cover and be exempt from mandatory insurance in Switzerland in order to maintain their cover in their country of residence.

To be exempt from mandatory health insurance in Switzerland the person concerned must apply to the competent cantonal authority (BAG) within three months of becoming gainfully employed in Switzerland. This option also applies to the person’s not gainfully employed family members (with the exception of Germany) and is irrevocable.

By way of an exception, cross-border commuters from Germany, Italy or Austria can be exempted from mandatory insurance in Switzerland when new members join the family, for example through marriage or birth. The exemption must be requested from the competent cantonal authority (BAG) within three months of the event date.

However, the following does not constitute a change in personal circumstances:

• a change in the economic situation
• a change in the amount of the health insurance premium
• a change of employers
• a change of canton in which the person is gainfully employed

There is no legal provision for retroactively suspending the exemption of an insurance obligation instituted at an earlier time – even if there is a change in the person's circumstances, such as through marriage, birth, divorce or widowhood.

The insurance obligation in Switzerland comes into effect when the person becomes gainfully employed in Switzerland (usually from the date of the cross-border commuter permit or the employment notification, in accordance with the notification procedure). For persons who apply for insurance within three months from becoming a cross-border commuter (= timely enrolment), cover begins retroactively from when they started to work.

For persons who take out insurance late (after three months from when they started to work), cover starts at the earliest from the date of the insurance application, and by law this person may face a penalty on his or her premium due to late enrolment in a plan. It is therefore impossible to backdate the start of the insurance once the three-month period has expired, and the person concerned must therefore close the insurance gap with an insurer in Germany in such cases. As a rule, persons who previously were covered under a statutory plan can have their insurance converted into a "voluntary membership" plan and pay contributions that are linked to their income in Germany until their cover in Switzerland starts.

Based on the principle that applies to the place of work, gainfully employed family members must also take out insurance in the country where they work. Not gainfully employed family members are subject to mandatory insurance in Switzerland together with the cross-border commuter, provided their family status falls within the definition of the applicable national law (this generally applies to underage children or children in school up to the age of 25, as well as dependants who are of age and are entitled to support).

As a cross-border commuter you can opt for treatment either in Switzerland or in your country of residence. This also applies to co-insured family members who are not gainfully employed.

When you take out statutory insurance you receive Form E106 when you purchase the contract, and you must submit the form to any statutory health insurer (referred to as the "assisting carrier") in your country of residence. This health insurer then sends you an insurance card, which you can use to obtain medical services in your country of residence.

You can reclaim the cost of services you use in your country of residence only if you use Form E106 when applying to a health insurer in your country of residence. Please also note that registration in the country of residence is generally not retroactive, and you therefore won’t be able to reclaim any costs you incur up to the time of registration.

If you change your insurer, the following notice periods apply to mandatory basic insurance under the KVG:

• You can terminate the insurance effective 31 December, whereby written notice must reach the previous insurer no later than on the last working day in November.
• If you have ordinary basic insurance with an excess of CHF 300, you can terminate your health insurance effective from 30 June, whereby written notice must reach the current insurer no later than on the last working day in March. You won't be able to change your insurer in the middle of the year if you have basic insurance with a higher excess or with a limited choice of service providers (health network, HMO, family doctor model).

Please note that you must give notice in writing.

By moving to Switzerland you become subject to the insurance obligation in accordance with the Federal Health Insurance Act (KVG). Unless your municipality exempts you from this obligation, you must at least take out basic KVG insurance from the time you become a resident.

If you previously had statutory basic KVG insurance as a cross-border commuter, you can either adjust the premium with your current health insurer based on your new place of residence or you can switch to another health insurer. Please note that you must change your health insurer within 3 months of becoming a resident to prevent any interruptions in cover.

If you cease to be gainfully employed in Switzerland, you will no longer be subject to mandatory health insurance in Switzerland unless you receive a pension exclusively from Switzerland. Your contract will terminate without notice period on the day when you stop working in Switzerland.

SWICA offers the EUROLINE-PLUS insurance plan, which provides statutory basic cover in accordance with the KVG (insurance carrier: PROVITA Health Insurance Ltd).

On 10 March 2015 the Federal Supreme Court ruled in its Decision 9C_801/2014 that all cross-border commuters without statutory (KVG) cross-border commuter insurance who have not submitted a written request for exemption can petition the canton to have their KVG cover reinstated. The current situation of “tacit exemption” in effect in the cantons of Aargau, Basel-Landschaft, and Basel Stadt is therefore not legally sound. The affected cross-border commuters now can switch from their current insurer (private insurance or voluntary statutory insurance in Germany) to basic insurance under the KVG if necessary.

Here it is important to note that the affected persons themselves must undertake such a switch and contact the cantonal authority of their own accord. For the cantons Basel-Stadt and Aargau you will find further information about the requirements and procedures under "Important information for cross-border commuters with gainful employment in the cantons Basel-Stadt and Aargau" on the website of Gemeinsame Einrichtung KVG.

If you have mandatory basic KVG insurance (EUROLINE PLUS), you have already insured all non-cash benefits in your country of residence in accordance with European law via Form E106 and as provided for under the social tariff of your country of residence (on condition that you have used Form E106 to purchase health insurance in Germany). In Germany, this already includes non-cash benefits for home care as well as partial or full inpatient care and short-term care. We recommend that you contact your insurance advisor in Germany to clarify if and to what extent it makes sense to voluntarily extend these benefits by taking out supplementary insurance.

Your family members can exercise their right of exemption from mandatory health insurance in Switzerland even if they themselves are subject to such insurance in Switzerland. Therefore, under current law you can for example be required to have mandatory insurance in Switzerland (the advantage of income-linked contributions) while your not gainfully employed wife and your children are jointly released from their insurance obligation in Switzerland so as to be statutorily insured in Germany (the advantage of family insurance).

Please note that you can exercise the separate option right of your family members only as a unit (you on the one hand, and all family members jointly on the other).

It is impossible to answer the question of how to co-insure children in general terms. Besides the terms of your current insurance plan, the decisive factors are in which country and how (statutorily or privately) the other parent is insured and the nature of the income situation

In principle, however, your children must be insured in Germany if the other parent is gainfully employed in Germany, even if this activity is not subject to mandatory insurance (e.g. a small job).

If you receive unemployment benefits, you are subject to the laws of the country from where these benefits originate (usually Germany), which is why you must in principle also take out health insurance in Germany.

Since there is a two-tier insurance system in Germany (statutory and private), you must, in principle, insure yourself in Germany; however, this does not constitute the right to enrol in a statutory health insurance plan.

If you receive unemployment benefits in Germany, you generally must have cover that complies with the statutory health and long-term care insurance provision, but from the age of 55 you remain exempt from the insurance obligation unless you were insured with a statutory health insurer (or under the KVG in Switzerland) in the last five years before any benefits came into effect.

If you have any further questions, please contact the Federal Employment Agency in Germany in good time.

If you are currently gainfully employed in your country of residence, you are also subject to the laws of your country of residence and must take out health insurance in Germany.

If you move to Switzerland, you must adjust your insurance cover to the requirements of your new place of residence since all Swiss residents must at least have mandatory basic insurance in accordance with the KVG. Depending on your current insurance plan, you may also be able to keep your previous supplementary insurance, for example to continue consulting your current doctors in Germany.

This depends in particular on the country where you will live when you start receiving your pension, the countries from which the pension is paid, and the kind of health insurance you have before the pension begins.

If your usual place of residence is Germany and you had mandatory KVG health insurance (EUROLINE PLUS) as a cross-border commuter before receiving your pension from Germany in addition to your pension from Switzerland (the amount of the pension is irrelevant here), you must also take out health insurance in your country of residence from the time you receive your pension. If you would like to keep your current insurance plan in Switzerland, you will need to forgo this pension before the pension decision is made in Germany (e.g. in the case of low pension entitlements).