Cross-border commuter

What is a cross-border commuter?

Cross-border commuters (Grenzgänger) are people who live abroad and work in Switzerland. They commute between their place of residence and their place of work, usually every day or at least once a week. They hold a cross-border commuter permit, the G permit (Ausweis G). This group is special for health insurance because two legal systems meet: that of the country of residence and that of Switzerland.

For people from the EU, Iceland, Norway, Liechtenstein and the United Kingdom, the Agreement on the Free Movement of Persons with the EU, the EFTA Convention and the social security agreement with the United Kingdom determine which country is responsible. The basic rule is the country of employment principle: if you work in Switzerland, you are covered by Swiss social insurance, including health insurance. This also applies to family members who are not in gainful employment, such as a spouse and children living in the country of residence.

It is important to distinguish this group from others. If you are resident in Switzerland, the normal rules on compulsory insurance apply. If a Swiss employer sends you abroad temporarily, the rules on posting apply. And if you commute from a state outside the EU, EFTA and the United Kingdom, for example while resident in another non-EU country, you are not automatically covered by Swiss insurance, but only if you apply for it yourself.

How it works

Compulsory from the first working day

Cross-border commuters from the EU/EFTA/UK with a G permit are subject to compulsory insurance in Switzerland from the start of their employment. They have three months to join a Swiss health insurer. If they miss this deadline, the authorities can assign them to an insurer. If the delay is inexcusable, they face a premium surcharge and have to pay for any treatment before the date they joined themselves. Compulsory insurance ends when the employment ends.

The right of option

Switzerland has concluded special arrangements with neighbouring states. According to the FOPH (Federal Office of Public Health) overview, cross-border commuters resident in Germany, France, Italy and Austria have a choice: instead of taking out insurance in Switzerland, they can be insured in their country of residence. This is called the right of option. If you want to use this option, you submit an application for exemption to the competent office of the canton where you work within three months of starting work. The FOPH publishes the list of cantonal offices.

A special procedure applies to France: the form “Choix du système d’assurance-maladie” (choice of health insurance system) must be completed within three months, stamped by the French health insurance fund CPAM and then sent to the authority of the canton where you work. It is based on an agreement between Switzerland and France of 07.07.2016.

On 10.03.2015, the Federal Supreme Court ruled that exercising the right of option tacitly is not valid. If you have so far been insured abroad without a formal application, you can therefore take out insurance in Switzerland under the Federal Health Insurance Act (KVG/LAMal), provided the canton where you work confirms that the right of option has not yet been validly exercised.

According to the FOPH overview, cross-border commuters in Liechtenstein and the United Kingdom have no such choice; for the other EU and EFTA states, insurance in Switzerland applies.

Premium based on the country of residence

Cross-border commuters do not pay the premium of a Swiss premium region, but the premium their health insurer calculates for their country of residence. The FOPH approves these premiums separately. According to the FOPH, around a third of Swiss health insurers offer insurance for people resident in the EU, EFTA or the United Kingdom, some only in certain states. Insured persons resident in these states cannot choose the special types of insurance, i.e. GP, HMO and telemedicine models, optional deductibles and bonus insurance. The canton of the place of work is responsible for premium subsidies for cross-border commuters.

Treatment in two countries

If you are insured in Switzerland as a cross-border commuter, you can get treatment in Switzerland and in your country of residence. For inpatient treatment in Switzerland, you can choose freely among the listed hospitals; the health insurer and the canton pay at most according to the tariff of the canton with which you have a connection. In your country of residence, the rules on international benefits assistance apply; the European Health Insurance Card helps there, see EHIC.

Legal basis

The compulsory insurance of cross-border commuters results from the interaction of international treaties and Swiss ordinances:

• Agreement on the Free Movement of Persons (AFMP), Annex II: coordinates social security between Switzerland and the EU. The EFTA Convention and the agreement with the United Kingdom contain corresponding rules.
• Art. 3 para. 3 KVG: the Federal Council can extend compulsory insurance to people not resident in Switzerland, in particular those working here.
• Art. 1 para. 2 let. d and e KVV: people resident in the EU, Iceland or Norway who are subject to Swiss insurance under the AFMP or the EFTA Convention are subject to compulsory insurance.
• Art. 2 para. 6 KVV: people resident in the EU who can be exempted under the AFMP and prove that they are covered for illness in their state of residence, in other EU states and in Switzerland are exempted from compulsory insurance on application.
• Art. 3 KVV: cross-border commuters who are not covered by these treaties, and their family members, become subject to Swiss insurance on their own application. Family members are spouses, children up to 18 and children in education or training up to 25 (para. 2).
• Art. 41 para. 2 and 2bis KVG: free choice among the listed hospitals for inpatient treatment in Switzerland; the health insurer and the canton pay at most according to the tariff of the canton with which there is a connection.

According to the FOPH, cross-border commuters from non-EU/EFTA states must submit their application within three months once the G permit is valid. If they miss the deadline, cover only begins when they join. If they later give up Swiss insurance, they cannot submit a new application without a specific reason.

Example: two cross-border commuters, two routes

Jonas lives in Konstanz (Germany) and starts a job in Kreuzlingen in the canton of Thurgau on 01.04.2026. Claire lives in Annemasse (France) and starts a job in Geneva on the same day. Both have a G permit.

For cross-border commuters with Swiss insurance, the deductible in this table is the standard deductible of CHF 300, because according to the FOPH, optional deductibles are not available to insured persons resident in the EU/EFTA/UK.

What this means for you

Make the choice between Switzerland and your country of residence consciously and early. It applies to you and to your family members who are not in gainful employment, and it can only be changed to a limited extent later.

1. Find out the rules in your country of residence. How high would contributions and benefits be there? The offices in that country can tell you.
2. Compare Swiss health insurers. Not every insurer offers insurance for your state of residence. The profiles under Health insurers show data for each insurer. The premium calculator uses Swiss premium regions; for residence abroad, the separate premiums for the EU/EFTA/UK apply.
3. Meet the three-month deadline. Note the date of your first working day and add three months.
4. Think about accident cover. If you work for a Swiss employer, you are usually insured against accidents under the Accident Insurance Act (UVG). Whether you can suspend the accident cover in your basic health insurance, you can check under Suspend accident cover.
5. If you want advice: you can request advice via Request; there is no obligation to do so.

Common mistakes

• Letting the deadline pass. The three months from the start of work apply both to joining an insurer and to the application for exemption.
• Relying on a tacit exemption. Since the Federal Supreme Court ruling of 10.03.2015, a formal application is required.
• Calculating with Swiss regional premiums. Cross-border commuters pay the premium for their state of residence, not the premium at their place of work.
• Expecting a GP or telemedicine model. Special types of insurance are not available to insured persons resident in the EU/EFTA/UK.
• Forgetting the family. Depending on the state of residence, family members who are not in gainful employment follow your insurance or have their own rights of choice. Clarify their situation at the same time.

We explain how we prepare data on health insurers under How we calculate.