LAMal vs CMU: How to Choose Health Insurance as a Cross-Border Worker in Switzerland

Under the Agreement on the Free Movement of Persons (AFMP) between Switzerland and the EU — which makes Regulation (EC) No 883/2004 on the coordination of social security systems applicable — a person working in Switzerland is in principle covered by Swiss health insurance. A frontalier living in France nonetheless has a droit d'option. Within 3 months of starting work in Switzerland, they can choose:

• LAMal — Swiss compulsory health insurance (Federal Health Insurance Act, RS 832.10)

• French health insurance (PUMa, often called « CMU » by frontaliers) — affiliation by the CPAM and a specific contribution (Code de la sécurité sociale, arts. L. 380-3-1 and D. 380-2)

Who can choose? The official form is meant for Swiss or EU nationals living in France, and the Swiss FOPH describes the option as open to EU nationals (FOPH). EFTA and UK nationals, and those of other countries, cannot use it: ask your CPAM and the canton of work before doing anything.

The choice is irrevocable. Only resuming work in Switzerland (e.g. after a period of unemployment), taking up residence in France or retiring on a Swiss-only pension opens a new option; marriage, divorce, a birth or a change of employer without a period of unemployment do not reopen it (CLEISS). Before you commit, compare both systems on real numbers with the free LAMal vs CMU calculator.

Under LAMal, you pay a monthly premium to a Swiss insurer that covers residents of France. Key characteristics:

• Premiums are not income-based. For a resident of France they follow a « residents of France » tariff published by the FOPH, which varies with the insurer, age and chosen franchise — not with the canton of work

• Cover is individual: each adult and each child is insured separately, with no family insurance (FOPH), and non-working family members living in France are insured in Switzerland too

• Covered in both Switzerland and France: for care in France, the Swiss insurer gives you an S1 form to register with your CPAM

• Compare insurers and their « residents of France » premiums on priminfo.admin.ch

• Complementary insurance is optional (dental, optical, alternative medicine…)

If you opt for France, the CPAM affiliates you to French health insurance. Key characteristics:

• The contribution is income-based: 8% × (income of the last known calendar year − 25% of the annual social-security ceiling) (Code de la sécurité sociale, art. D. 380-2). It is computed by the Urssaf's national centre for Swiss frontaliers; the article does not say which year's ceiling applies: the exact amount is the one the Urssaf computes

• Cover is mainly in France: in Switzerland, the European health insurance card gives access to medically necessary care during a stay, and planned care needs prior authorisation (form S2). Cross-border workers should also be aware of the upcoming EHIC 2026 reform that changes European health coverage rules

• You benefit from the full French reimbursement system (carte Vitale, tiers payant)

• You can add a mutuelle (complementary insurance) for better coverage

• Family members living in France follow the option you exercise

Cost structure: LAMal = premium per person (insurer, age, franchise; « residents of France » tariff); France = 8% of income above the allowance

Coverage territory: LAMal = Switzerland + France; France = France, and in Switzerland medically necessary care during a stay (EHIC) or planned care with authorisation (S2)

Family: LAMal = each member is insured and pays their own premium; France = family members living in France follow your option, with no per-person premium

Out-of-pocket: LAMal = chosen annual franchise and co-payment; France = ticket modérateur, flat-rate participations and franchises médicales

Switching: the choice is irrevocable, unless a new event opens the option

Comparative cost: there is no universal salary threshold — the result depends on your income, how many people must be insured, their age and the franchise. Run your own numbers

Step 1 — Calculate your projected French contribution: 8% × (your income of the last known year − 25% of the annual social-security ceiling), per article D. 380-2 of the Code de la sécurité sociale; the exact amount is computed by the Urssaf.

Step 2 — Get « residents of France » LAMal quotes from several Swiss insurers for your age and franchise. Use the FOPH premium comparison tool (priminfo.admin.ch).

Step 3 — Factor in family: under LAMal each member pays a premium; on the French side, family members living in France follow your option.

Step 4 — Consider where you seek medical care: if you mostly see Swiss doctors, LAMal gives direct access.

Step 5 — Get support. The AdminLanding Cross-Border module (AdminLanding membership: €6 a month or €59 a year, renewed automatically, cancel any time) includes a personalised LAMal vs CMU cost simulation, step-by-step affiliation guidance, and document templates — designed specifically for France-Switzerland frontaliers.

Step 6 — When you finally sit down to affiliate at CPAM or Ameli, Guide: Démarches en France annotates every field on ameli.fr — in English or French — explaining what each box expects and which documents to attach. Available as a Chrome extension or Android app on Google Play.

• 3-month deadline: it runs from starting work in Switzerland (or taking up residence in France). Without a choice in time, the Swiss authority enrols you in LAMal automatically.

• The form: « Choix du système d'assurance-maladie » (downloadable from ameli.fr). Fill in parts 1, 2 and 4 and tick your choice in part 5.

• In every case, the CPAM: whatever you choose (France or Switzerland), have part 6 completed by the CPAM of your place of residence.

• Then the canton: send the form within the 3-month deadline to the competent authority of your canton of work. If you choose LAMal, also sign up with a Swiss insurer that covers residents of France.

• The French contribution is computed by the Urssaf's national centre for Swiss frontaliers on the income you declare to it each year: the declaration is individual and covers your own income, the revenu fiscal de référence serving only as a check (Urssaf).

• Missing the 3-month window: without a choice sent in time, the Swiss authority enrols you in LAMal automatically. If you had made your choice (form completed by the CPAM) but the Swiss authority was not told in time, some cantons cancel the automatic enrolment on request — in Geneva, the « Annulation d'affiliation d'office » form, to be sent without delay to the health-insurance service (ge.ch).

• Skipping the CPAM step: even if you choose LAMal, part 6 of the form must be completed by the CPAM before it goes to the canton.

• Ignoring family impact: a single person's calculation changes dramatically with dependants.

• Forgetting complementary insurance: neither LAMal nor French health insurance covers 100%. Budget for a mutuelle or complémentaire.

• Comparing cantonal premiums: for a resident of France, the LAMal premium follows the insurer's « residents of France » tariff, not the canton-of-work scale — compare those tariffs.

• Confusing CMU-C with the frontalier regime: CMU-C (now complémentaire santé solidaire, CSS) is means-tested assistance — different from the frontalier regime.