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Compulsory health insurance and exemption

for frontier workers and resident persons from the canton Aargau, Appenzell Ausserrhoden, Basel-Landschaft, Basel-Stadt and Glarus as well as from the cities of Zug, Cham and Risch Rotkreuz

 

1. Frontier workers

Based on the principle of the place of income, generally, every employee living abroad but working in Switzerland is subject to compulsory health insurance in Switzerland. Frontier workers from Germany, Austria, Italy and France have the possibility to request an exemption from compulsory insurance in Switzerland in favor of a health insurance of their country of residence (option). This means that the frontier workers can get an exemption from the compulsory health insurance in Switzerland in order to remain insured in their country of residence. This possibility does not apply to any other areas of social insurance.

What is necessary to obtain an exemption? The frontier worker has to be able to prove possession of an equivalent insurance cover in his/her country of residence and has to apply for an exemption with the responsible cantonal authorities. This has to be done in writing.

The decision, in which state the frontier worker has to be insured for health costs, is final and remains as long as he/she works uninterromped in Switzerland. The option right can, as a rule, only be applied once 

New option right for changes in family circumstances

For Germany, Austria and Italy applies: Frontier workers who are insured in Switzerland according the KVG can even later apply for exemption in the case of new family members through marriage or birth. The application must be submitted within three months after marriage or birth. The exemption applies retrospectively from this event. The Federal Office of Public Health FOPH informs that persons who already have used their option rights can not be insured in Switzerland according the KVG in case of new family members. An annulation of exemption can no longer be applied for.

For France applies: A change in family circumstances (new family members) does not result in a new option right.

The following events do not grant a new option right:

  • Change of economic circumstances
  • Change of health insurance premiums
  • Change of employer
  • Change of Canton of employment

Non active family members

Basically, the non active family members* have to be insured in the same country as the employed member of the family. Exceptions apply to:

Germany and Finland: Non active family members who would basically be subject to the compulsory health insurance in Switzerland, have the possibility, based on a special arrangement between Germany and Switzerland or Finland and Switzerland, to use the option right separately, i.e. it is not compulsory for them to be insured in Switzerland.

*Family members are spouses as well as children up to the completed age of 18 and dependent children who have reached the age of majority.

2. Resident persons

Persons with a Swiss domicile and/or sojourn in Switzerland of more than three months are subject to compulsory health insurance in Switzerland. Also subject to compulsory health insurance in Switzerland are persons with a shorter stay, if they do not have an adequate insurance cover and persons who are working in Switzerland. The non-working, dependent family members of these persons also have to be insured in Switzerland. The insurance obligation does not only start after three months. It starts with the event which triggers the obligation (e.g. taking up employment).

There are, however, certain categories of persons which can be exempted from compulsory health insurance or are not subject to Swiss legislation. 

Who is not subject to compulsory health insurance in Switzerland?

  • Persons who work exclusively in an EU/EFTA state
  • Persons who draw a pension from an EU/EFTA state but do not draw a pension from Switzerland (form E 121 or portable document S1 issued by the health insurance abroad).
  • Persons who draw unemployment benefits from an EU/EFTA state (portable document U2) 

What are possible grounds for an exemption?

Double taxation

Art.2, par. 2 KVV

Exempt from the Swiss compulsory health insurance on request are persons who have a compulsory health insurance according to the legislation of another state and for whom inclusion in Swiss health insurance would result in double taxation (and who have an equivalent insurance protection for treatment in Switzerland). According to the coordination regulations between Switzerland and the EU/EFTA states, these grounds for exemption do not apply to persons from these states. 

 

Necessary documents to be handed in together with the (justified) request:

  • Copy of residence permit
  • Up to date insurance certificate issued by the responsible organisation abroad in respect of insurance cover for treatment in Switzerland (equivalent to KVG)
  • Confirmation of a compulsory insurance assignment from the responsible organisation abroad

Education and further education

Students from the EU/EFTA who are legally insured with health insurance

Non-employed students are exempted from the insurance obligation if they

  • are only temporary in Switzerland and have their primary domicile in the EU/EFTA
  • have their place of residence in Switzerland and are insured by their parents in the EU/EFTA through family insurance

 

Employed students or trainees from Germany, France, Italy or Austria may be exempted from compulsory insurance if they

  • have a short-term residents L or
  • have a residence permit  B and declare their primary domicile in one of the mentioned states above

 

Employed students or trainees from all other countries of the EU/EFTA are subject to compulsory insurance in Switzerland.

 

Students outside the EU/EFTA and privately insured students (Art. 2, par. 4 KVV)

They could be exempted from the compulsory insurance in Switzerland if they have an equivalent insurance according the KVG. An exemption is possible for three years at the most. On request, this can be extended to a further three years. Afterwards, the person will automatically fall under the compulsory health insurance in Switzerland.

 

Necessary documents to be handed in together with the request:

  • Copy of the residence permit in Switzerland
  • Copy of the insurance policy: Legal insurance: EHIC (European Health Insurance Card), Private insurance: Confirmation of the insurer on the second page of the request
  • Copy of the confirmation of enrolment or confirmation of education
  • Copy of the internship contract / employment contract

Delegated workers

Art. 2, par. 5 KVV

Whether a person is classified as a delegated worker, is decided by which legislation pertains to that person. Basically, delegated workers are subject to the legislation of the delegating state. Employees who are paying contributions into the Swiss social system (AHV/IV, ALV etc.) are not classified as delegated workers. Further information in respect of delegated workers.

 

This also concerns accompanying non-working Family members*.

 

Necessary documents to be handed in together with the (justified) request:

  • Copy of residence permit
  • Up to date insurance certificate issued by the responsible organisation abroad in respect of insurance cover for treatment in Switzerland (equivalent to KVG)
  • Employer’s written guarantee
  • Copy of confirmation of delegation

Stay without employment

Art. 2, par. 7 KVV

Exempt from the Swiss compulsory health insurance are persons holding a residence permit for individuals without employment according to the agreement on the free movement of persons or the EFTA convention, providing they possess an equivalent insurance cover for treatment in Switzerland.

 

Necessary documents to be handed in together with the (justified) request:

  • Copy of residence permit
  • Up to date insurance certificate issued by the responsible organisation abroad in respect of insurance cover for treatment in Switzerland (equivalent to KVG)

 

This option of exemption doesn’t apply to non-employed persons from the EU/EFTA who are insured under a legal health insurance system. These persons are to insure compulsorily in (the state of residence) Switzerland.

Regulation in cases of hardship

Art 2, par. 8 KVV

This ground for exemption only applies if a deterioration of the current insurance cover occurs based on age and/or health. Financial disadvantage (e.g. savings for old age) or a future health check-up requested by a new insurance on return to the home country, cannot be considered. The fact that the Swiss health insurances do not pay for dental treatment, is not enough reason for an exemption. This is entirely a difference due to the System.

The person has to possess at least an equivalent insurance cover as well as additional cover for benefits considerably exceeding the range of benefits according to the Swiss health insurance law (KVG). The criteria in respect of age is fulfilled if a person has reached the age of 55. In respect of the state of health, the diagnosis is relevant and the anticipated treatment. This serves to assess whether an additional insurance can be taken out in Switzerland.

Exemptions based on this article are granted very restrictively (hardship regulation).

 

Necessary documents to be handed in together with the (justified) request:

  • Copy of residence permit
  • Up to date confirmation in respect of comprehensive insurance cover
  • Doctor’s certificate in respect of future treatment or rejection of a Swiss comprehensive insurance (if under the age of 55).

       

Equivalent insurance cover

Equivalent insurance cover is considered as per Swiss law. Your insurance abroad has to accept at least the costs according to Federal law in respect of health insurance. Therefore, no limitations must be applied by the foreign health insurance (e.g. max. daily costs, max. insurance cover etc.) Swiss law does not provide for such limitations and, therefore, no limitations whatsoever must be applied by the foreign health insurance either. Further, all benefits which are covered by Swiss law have to be accepted by the foreign health insurance (e.g. maternity benefits, medical care for Swiss residents etc.).

No tariff protection for private insurance

Persons with a foreign private health insurance do not enjoy tariff protection in Switzerland. Please note that the reimbursement of costs based on foreign tariffs can lead to considerable rest costs remaining for payment.

 

Should one of the reasons for exemption apply to you, please find the request form as well as further information under the relevant Canton.