Health insurance for cross-border commuters

As a French national, I work in Switzerland as a cross-border commuter and am affiliated to LaMal. I recently married a charming French woman who is not currently working, so I'm wondering how to insure her. Friends have told me that she has to be affiliated in Switzerland. Is this true?

Marc, Annemasse

Your wife can be insured in Switzerland, but this will only happen if you apply in good time.

When a French resident takes up gainful employment in Switzerland, he or she becomes a frontier worker and must, within three months, choose between two health insurance schemes: the Swiss scheme (LaMal) or the French scheme (CPAM). This «right of option» is set out in Annex II of the Agreement on the Free Movement of Persons (ALCP) between Switzerland and the European Union. If no choice is made within this period, the Swiss Joint Institution may automatically affiliate the person concerned to the Swiss insurance scheme. In principle, this choice is irrevocable as long as the personal or professional situation does not change.

Once this right of option has been exercised, the frontier worker's affiliation to the LAMal can, in certain cases, be extended to the members of his family. But here again, nothing is automatic. According to Article 3 of the Health Insurance Ordinance (OAMal), the family members of a cross-border commuter residing in an EU country such as France are not subject to Swiss insurance. on request, provided that they are not themselves subject to compulsory insurance in their country of residence.

If your wife does not work in France and is not already covered under another scheme, she may be affiliated to a Swiss health insurance fund, but only if you make a formal request. This must be done within three months of the marriage. If she is accepted, she will receive an S1 form issued by the Swiss insurer, which will enable her to be registered with the CPAM. She will then have access to healthcare in France like any other locally insured person, with reimbursements covered by Switzerland. At the same time, she retains the right to treatment in Switzerland under the conditions and at the rates set by the LAMal.

This coordination mechanism is based on Article 17 of Regulation (EC) No 883/2004, which allows members of an insured person's family to receive care in their State of residence, at the expense of the competent institution in the State of employment.

On the other hand, if no request is made within the deadline and no alternative cover is activated in France, your wife may find herself without valid insurance - an illegal and risky situation, both medically and financially. There is no automatic affiliation mechanism for beneficiaries living outside Switzerland.

It should be noted that some people living in an EU or EFTA country are obliged to take out insurance in Switzerland without being able to opt out: this applies, for example, to recipients of Swiss AVS or AI pensions who do not receive a foreign pension, or to their beneficiaries who are not covered in their country of residence (art. 1 para. 2 letters d to ebis OAMal). However, these special cases do not apply to cross-border commuters like you.

To sum up, your wife can benefit from Swiss LaMal insurance if you so request, However, this option is voluntary and separate from your own membership. Cross-border status offers a welcome degree of flexibility, but it still has to be used properly.