LAMal for frontaliers : functioning, cover and costs
You live in France and you are about to start (or have just started) a new job in Switzerland?
You have 90 days from the first day of work to choose between the French system the Universal Health Coverage (CMU) and the Swiss system, the LAMal.
Your choice is even more so important because it is final. You cannot go back.
This article, dedicated to the LAMal, aims to help you understand quickly what the best decision is.
To find out more about the CMU, you can consult our other two articles:
What is the LAMal?
The LAMal, short for Health Insurance Act, referrers to the Swiss health system.
It is a mandatory insurance for everyone who lives in Switzerland whether they are employed or not.
To find out everything about the LAMal, you can read the article dedicated to this topic.
The LAMal for frontaliers differs slightly from the LAMAL for Swiss residents.
What is the right of option?
We call “right of option” the 90-day period during which you may choose between the LAMal and the CMU.
The three months begin from your first day of work.
If you did not inform the Swiss authorities of your decision within the given time period, they will decide for you.
You will be affiliated to the LAMal as a default insurance. Furthermore the said insurance will charge delay penalties.
In other words, you can decide, but you must decide quickly.
Exceptions allowing for a change of health insurance regime
As I said above, the decision is final.
- You live in France and move to Switzerland. If you are affiliated with the CMU, it is mandatory by law to get an LAMal insurance. The opposite is not possible.
- You benefit from unemployment benefits after a cross border employment. You then get a new right of option if you find a job in Switzerland again. You have 90 days starting from the first day of unemployment to choose between the CMU and the LAMal. Regardless of your previous affiliation.
Is my partner covered by the LAMal?
No. In Switzerland the health system is individual. Each family member must be insured independently.
Are my children covered by the LAMal?
Your health insurance will not automatically cover your children’s care.
- If both parents are affiliated with the CMU, the children are covered by the French system.
- If one parent is affiliated with the CMU, the children are also covered by the French system.
- But if both parents are affiliated with the LAMal, the insurance will ask you for an additional contribution for each child. This is also the case if the couple is divorced or separated and the custodial parent is affiliated with the LAMal.
Where can I receive care if I am covered by the LAMal?
Everywhere. The base health insurance of the LAMAL allows you to choose where you would rather receive care and bears the costs of the country chosen.
How does the LAMal reimburse the treatments?
The Swiss health system functions slightly differently from the French one. Don’t worry: it is relatively simple.
The LAMal requires two types of financial contributions (on top of insurance premiums, of course).
- The franchise. It is of 300 CHF for every frontalier. You will bear the cost of the first 300 francs spent in care. then, the LAMal will take over.
- The quote-part. Once the franchise is paid, you will still have to pay 10% of the bill. That being said the quote-part is capped at 7000 CHF for adults and 350 CHF for children. If the bill exceeds 7,000 CHF, the caped amount of the quote-part is relevant and not the 10%.
Here are three examples:
Just so you know, Swiss residents have the same benefits, I invite you to have a look at our full explanation of the reimbursements of care in Switzerland in this article. (65)
What happens in case of unemployment or termination of the employment contract?
If you lose your job, you will no longer be insured at the age I. While you are unemployed, you lose your frontalier status and are insured with the social security of your country of residence again.
Compared to those of the CMU, what are the advantages of the LAMal?
Here is a comparative table which sums up the main characteristics of being insured with the LAMAL on the left and with the CMU on the right:
Unlike that of the CMU, the cost of membership to the LAMal is a fixed rate. Premiums are not good German spy your immediate or future income.
This is a significant advantage if your salary is high or if you are expecting a career evolution.
However, you should keep in mind that the CMU covers the care of your partner and your children and that the LAMal is individual.
In the end, the best way is to compare, is to count…
How much does the LAMal for frontaliers cost?
If you want to know the exact amount of your (potential) future LAMal premiums, I prepared a little article for you which will explain clearly an easily how to calculate: How to calculate precisely the cost of the LAMal insurance for frontaliers?
This was Noé, the FBK Conseils mascot, who spends its life making yours easier.
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I understand I have maximum 3 months to take out LAMal health insurance. But what happens when I need medical care before I take LAMal insurance? Is this then covered retrospectively?
Exactly, you have 3 months to choose your insurance. Of course, if you have a medical issue before you made that choice, you will be taking care of, and covered retrospectively. If you haven’t chose an insurance after the 3 months, an insurance compagny will automatically be chosen for you, and the doctors or specialists you have seen during this time will send the bill there.