First of all, it is necessary to understand what is meant by a frontier worker. Cross-border commuters in Switzerland can also be German, Italian, French or Austrian. In our article we will mainly focus on the Franco-Swiss cross-border commuters. To be considered such, you must reside in France and you must be holder of an employment contract in Switzerland or also the holder of a pension or an annuity paid in Switzerland.
France and Switzerland, but also Switzerland and the other countries with which it shares borders, have signed the so-called bilateral agreements both for the free movement of persons and for social security.
As a Franco-Swiss cross-border worker, you have the option ofopt for the French health insurance scheme (Cpam) by registering with the CNTFS. But you can too opt for compulsory health insurance in Switzerland (AOS) by signing a KVG contract.
The two plans are obviously different and offer different benefits. But, overall, regardless of whether you choose one plan or the other, supplementing your health insurance coverage with a supplementary health insurance for cross-border commuters offers you comprehensive and global coverage.
KVG or CMU option: lack of coverage
Comprehensive, comprehensive coverage is basic health insurance and adapted complementary health. So let’s start from the beginning and from what is not only the basis of your health coverage, but which is still an obligation and not an option. Whichever health insurance plan you choose, you have theobligation to insure.
The difference between the two is due to the CNTFS contribution or the KVG bonus, the inclusion of the beneficiaries in this contribution, the reimbursements or the possibility of receiving treatment in France and / or Switzerland. Before making your choice, you will need to carefully study the details of these two plans. Income, health needs, existence of beneficiaries, all these points should allow you to exercise your right of option.
We remind you that you must choose French or Swiss health insurance (Lamal) within 3 months of starting the activity in Switzerland. Please note that this choice is irrevocable for the duration of your employment contract. Without option on your part, you will be obligatorily affiliated with the Swiss system through the AOS, also called KVG Frontalier or BILAS for bilateral insurance.
You have opted for French health insurance (CPAM)
If you opt for the French health insurance scheme, you will be affiliated with the Cpam (Caisse Primaire d’Assurance Maladie, like all French residents. You will have to pay a contribution to the CNTFS – National Center for Frontier Workers in Switzerland. The CNTFS contribution is based on the income received during the penultimate year. Therefore, for the CNTFS 2022 contribution, you will have to declare the income you received in 2020.
This first notion generally poses a problem if we focus only on the first year of business in Switzerland. In fact, your first CNTFS contribution will be based on French income, which is much less than Swiss income. This can mislead many people if you are content to compare only this first year with a KVG contribution. You need to take into account other elements, such as having dependents, but also calculating your contribution based on your Swiss income. As a reminder on the calculation of the CNTFS contributionthe the contribution rate is 8% and applies to your taxable income minus an allowance equal to 25% of the social security ceiling for the year.
Overall, this calculation will be a first aid in making your choice, but taking into account your eventualities.rights holders. Regarding the Frontalier CMU (Universal Health Coverage), the beneficiaries are taken into account in this CNTFS contribution. This is not the case with a Swiss health insurance, every member, including children, signs a contract and is therefore subject to a KVG premium.
The downside to this choice is that you have to carry out your treatments in France except in a life-threatening emergency.
For more information, please read our page dedicated to adhesion to the CMU for frontier workers.
You have opted for Swiss health insurance (KVG)
If you have opted for Swiss health insurance, you will need to do so take out a cross-border KVG insurance policy for you, but also for your heirs. For example, if your spouse has also opted for AOS, your children must be covered by a KVG contract. For example, for a couple with two children, this means paying 4 KVG premiums. Sure, the KVG Award for children it is less expensive, but you have to take it into account in your calculations.
The advantage of opting for Swiss health insurance is the possibility of being treated in both Switzerland and France. For your treatment in France, you benefit vital card. You are entitled to French third party payment.
Another advantage, even if the KVG has deficiencies in terms of performance, its reimbursement is based on actual costs. With the CMU, on the other hand, reimbursements are obtained from the CPAM on the basis of a refund percentage equal to 70% of the conventional rate.
On the contrary, the KVG Frontalier is provideda deductible of 300 fr for adults and 0 fr for children. Furthermore, a contribution of 10% of health costs, in addition to the deductible, said share must be paid. To make your choice, of course, you need to know the amount of your KVG premium. We offer you, in a few clicks, calculate the cross-border health insurance premium.