Swiss cross-border worker health insurance: LAMal or CMU

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Three months to choose

You live in France and are starting work in Switzerland, as a cross-border worker (frontalier)? You must choose your health insurance: the Swiss LAMal (compulsory Swiss health insurance), or the French general scheme (régime général). This is the right of option (droit d’option). The deadline is three months:

“You can exercise your right of option between Swiss health insurance and French health insurance within 3 months of starting work in Switzerland or of taking up residence in France.”

ameli.fr, “Travailleur frontalier suisse” (in French), the website of the Assurance Maladie (French national health insurance), page dated 30 April 2026, read on 11 September 2026. Our translation.

The deadline runs from the event that applies to you: starting your first job, returning to work after a period of unemployment, moving to France, or retiring on a Swiss pension. The form “Choix du système d’assurance maladie” (choice of health insurance system), stamped by your CPAM (your local Assurance Maladie office), is then filed with the Swiss authority of the canton where you work. In Geneva, that is the health insurance service, the Service de l’assurance-maladie (in French). The canton warns that the CPAM does not forward the form itself, and that getting it stamped can take a long time. Start early.

A final choice

The official sources agree: the right of option “can only be exercised once and is irrevocable”, according to cleiss.fr (in French), our translation. Only a new event reopens it: returning to work in Switzerland after a period of unemployment, moving your home back to France, or retiring on a Swiss pension. Changing employer with no unemployment in between reopens nothing. Neither does a marriage or a birth.

While you receive unemployment benefit from France, you are covered by French health insurance, even if you had chosen the LAMal. This is Article 11(3)(c) of European Regulation 883/2004. Unemployment for cross-border workers has its own page.

If you do nothing

“After this deadline, you are compulsorily enrolled in Swiss health insurance.”

ameli.fr, same page. Our translation.

So doing nothing does not count as choosing France: you are automatically registered with a Swiss health insurer you did not choose. The Federal Office of Public Health (in French) adds that a delay without valid reason can cost a premium surcharge, and that your medical costs remain yours to pay until the date you are enrolled. Of the three possible outcomes, this is the most expensive, and the only one that applies without you doing anything.

The French option: the general scheme

Since 1 June 2014, choosing France means the general scheme of the Sécurité sociale (French social security). The former private insurance for cross-border workers no longer exists. Your health insurance contribution, which many still call “CMU frontalier”, is declared and paid to the Urssaf (the body that collects French social contributions), through its service des travailleurs frontaliers en Suisse (unit for cross-border workers in Switzerland), long known by the acronym CNTFS. Your registration and your reimbursements stay with your CPAM. The Urssaf page gives this year’s rule:

“In 2026, the health insurance contribution rate is 8%.”

urssaf.fr, “Travailleur frontalier en Suisse : déclarer vos revenus” (in French), page updated on 24 September 2026, read again on 20 October 2026. Our translation.

The rate applies to your income from two years earlier, minus a fixed portion equal to 25% of the annual social security ceiling (plafond annuel de la Sécurité sociale), according to Article D380-2 of the French Social Security Code (in French). What remains is called the assessment base (assiette). The Urssaf simulator calculates your contribution for your situation; its page does not put a euro figure on this fixed portion.

The same page gives two warnings. First, the Urssaf declaration is separate from your tax return: every year, you report to the Urssaf your income from the year before last, before mid-October (14 October in 2026, for the 2027 contribution). Second, without a declaration, the contribution is calculated automatically on a flat base of five times the annual social security ceiling, that is EUR 240,300 in 2026.

The Urssaf answers cross-border workers on 0806 807 713 from France, according to ameli. From Switzerland, dial +33 806 807 713 for the Urssaf and +33 1 84 90 36 46 for your CPAM. See also the numbers of French public bodies to dial from Switzerland.

In France, your medical costs are reimbursed like those of any insured person. In Switzerland, access exists, but within limits. According to ameli, you can see a doctor without prior authorisation, and outpatient care is reimbursed at French rates, far below Swiss prices. A planned hospital stay requires prior authorisation. The canton of Geneva presents this access more restrictively. The two official readings do not fully agree: before planned treatment in Switzerland under the French option, ask your CPAM in writing.

The LAMal option

Choosing Switzerland means signing up with a LAMal insurer that accepts residents of France. Only some insurers do, with a premium calculated for each country of residence. The premium tables can be compared on Priminfo, the official premiums website. The insurer then gives you the portable document S1, to present to your CPAM: it opens cover for your medical care in France, on behalf of the Swiss scheme. As a LAMal policyholder, you can therefore be treated on both sides of the border. Depending on your income, the canton may pay part of the premium. If your family members live in France, their cover follows the option you exercise.

Who pays during sick leave?

The Swiss scheme, whichever option you choose. According to ameli, accidents at work, occupational diseases, invalidity, and the benefits paid during sick leave or maternity leave always come under it: French health insurance, even if you chose it, only covers your medical care. So it is your Swiss employer who tells you how your salary is paid during the leave.

The right of option concerns cross-border workers insured under Swiss social security. Teleworking from France can change which country you are insured in:

under 25% of your working time spent teleworking, you remain insured in Switzerland;
from 25% to under 50%, you can remain insured there if your employer requests it, with your agreement. Your employer applies on your behalf for an A1 certificate from its AVS compensation fund (caisse de compensation AVS; AVS is Swiss old-age and survivors’ insurance), valid for three years at most and renewable;
from 50%, French social security applies in principle.

This rule comes from a European framework agreement that France and Switzerland have applied since 1 July 2023, according to the Federal Social Insurance Office (in French) and the French centre for European and international social security liaison, the Cleiss (in French), both read again on 20 October 2026. It applies only to social security. Tax has its own threshold, 40%, explained on the tax page.

The limits of this page

Two figures are not on this page.

The euro amount of the fixed portion in 2026: the text does not say which year’s ceiling is used, and we do not calculate it in place of the Urssaf.
LAMal premiums for a resident of France this year: they vary from one insurer to another, and can be compared on Priminfo, the official premiums website.

For these questions, as for your own situation, the Assurance Maladie, the Urssaf and your canton’s service are the reference.