LAMal frontalier: why choose this type of insurance?
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The LAMal is a Swiss federal law that governs the Health Insurance system for all people living in Switzerland. It also applies to active people living in France and working in Switzerland (cross-border commuters) and to Swiss pensioners living in France (pensioners).
For cross-border commuters living in France, it is possible to choose between LAMal and French Health Insurance. Here's everything you need to know about LAMal insurance for cross-border commuters: what it's all about, how to enroll, how much it costs, how it differs from French Health Insurance, etc.
Why is Health Insurance for cross-border commuters compulsory?
If you live in France and work in Switzerland, it's necessary to take out insurance for cross-border commuters. Indeed, in this scenario, you can't be affiliated to the general French Social Security scheme. You then have two choices:
- Choose Swiss Health Insurance, i.e. LAMal for cross-border commuters;
- Opt for French Health Insurance, i.e. CMU for cross-border commuters.
These days, it's no longer possible to opt for private insurance. It is therefore necessary to choose between the LAMal (Swiss) and the CMU (French).
How to subscribe to the LAMal for cross-border commuters?
Affiliation to the LAMal is with a private insurance company. Regardless of the organization chosen, the coverage remains the same. However, certain services vary from one fund to another: this is the case, for example, with third-party payment. The key is to choose the LAMal contract that offers you the best services, at the most attractive price.
As an insurance comparator, Comparea helps you find the offer that best suits your needs. Our health insurance comparison tool is free, with no hidden charges and independent: the Comparea group is not owned by any insurance company. So don't wait any longer, and find out now which offer is right for you.
What documents do you need to provide to the LAMal?
To complete the Swiss Health Insurance application, you'll need to provide certain documents such as a photocopy of your identity card and your employment contract. Basic insurance is taken out without a medical questionnaire. However, in the event that you wish to add complementary insurance to it, you will need to provide additional information on your state of health.
Good to know
Once this has been done, you will receive an insurance certificate and form E106. To benefit from care in France, you will need to complete this document and have it attached to the Health Insurance fund in France.
Why choose LAMal instead of the French CMU?
When you exercise your right of option to choose between LAMal and CMU for cross-border work, your decision is based on several factors: your salary, your health needs, the medical service available in the canton where your employment is located and the number of beneficiaries (such as family members). The most important thing to understand is that health insurance in Switzerland is compulsory, and you must be insured from your first day of employment. Our advice is therefore, depending on your family situation, salary and place of work, to carefully evaluate all options to ensure that you benefit from the best service for your health, and that you are adequately covered from your first day of employment. However, there are several advantages to choosing Swiss Health Insurance over French CMU: the possibility of receiving treatment in both countries, and the flat-rate cost of membership (not indexed to income).
You want access to healthcare in both countries
Do you live in an area that lacks medical services and want to be able to receive treatment in Switzerland? If so, you should know that by joining the LAMal, you will be able to receive treatment in either Switzerland or France, with maximum reimbursement.
The French Assurance Maladie, meanwhile, reimburses treatment in Switzerland only if it's an emergency.Non-emergency treatment may be covered at French rates, but a consultation with a general practitioner is 4 times more expensive in Switzerland than in France. To benefit from good coverage, you need to take out a complementary health insurance policy for cross-border commuters.
You're single and earn over 60,000 francs / year
If you're hesitating between CMU and LAMal frontalier, your income is a parameter not to be neglected. And for good reason, the cost of joining the French Assurance Maladie depends on your household's net tax income. For a single person earning more than 60,000 Swiss francs a year, joining the LAMal will be more economical than choosing the CMU Frontalier.
On the other hand, for a family, Health Insurance in France will sometimes be more economical, as the CMU does not charge for the attachment of rightful claimants. With LAMal, an individual premium applies for each member of the household.
When you join LAMal, does your family have to do the same?
It all depends on your spouse's professional activity. If you work in Switzerland, but your spouse works in France, he or she will have to take out insurance in France. In this case, the other members of your household who have no income will be covered by your spouse's insurance; you will thus be the sole beneficiary of the LAMal in your household.
If, however, your spouse works in Switzerland or has no professional activity, all the members of your household who have no income will be attached to the LAMal. An additional contribution will apply for each insured person. Note, however, that the LAMal contribution is lower for a child than for an adult.
Does LAMal cover accidents?
In the event that you have no other coverage, LAMal covers certain accident-related care. However, as an employee in Switzerland, your accident insurance is covered by your employer. In this situation, you do not need the accident benefits provided by the LAMal.
Attention
Be careful, however: if you register family members with the LAMal frontalier, they will not necessarily benefit from accident insurance. This is the case, for example, for a child, since he or she does not work. In this case, you should remember to mention the need for accident insurance when you join LAMal.
How much does it cost to join LAMal?
The cost of joining LAMal depends on several criteria, such as your age and the number of people in your household who are attached to your coverage. However, as we mentioned, the cost of membership does not vary according to your income (unlike French Assurance Maladie).
In the event that you seek treatment in Switzerland, you will have to pay a deductible: this is an annual amount that you assume for your healthcare expenses. It amounts to a fixed 300 francs for cross-border commuters, while Swiss residents can choose between different levels of deductible. More precisely, this means that the first 300 francs spent on your care will remain your responsibility. This deductible does not apply if your treatment is carried out in France.
How does care with Swiss Health Insurance work?
As we've seen: if you opt for LAMal, you can get treatment in Switzerland as well as in France. Here's how treatment with Swiss Health Insurance for cross-border commuters works.
You receive treatment in Switzerland
If you receive treatment in Switzerland with LAMal for cross-border commuters, a 10% co-payment applies. You only pay this percentage, while the rest is reimbursed by the LAMal. This means that a 50-franc consultation will only cost you 5. Note that the co-payment is capped at 700 francs for an adult and 350 francs for a child. Beyond that, healthcare costs are covered at 100% by the LAMal.
However, as a reminder, an annual, flat-rate deductible of 300 francs is applied each year. It applies to adults only.
You seek medical treatment in France
If you seek medical treatment in France under the LAMal frontalier scheme, you are covered by health insurance. Reimbursement is based on the rules of the French compulsory health insurance scheme. The invoice is then sent to the Swiss institution. This means that there is no difference in reimbursement in France between LAMal and CMU.
As a cross-border worker, it's perfectly possible to request a French carte vitale for care received in France.
How to improve your health cover in Switzerland when you're a cross-border worker?
To improve the coverage of your care in Switzerland or France when you're insured under LAMal, you can sign up to a complementary health insurance plan. The choice of complementary health insurance will depend on various criteria, such as:
- Your age and health history;
- Your healthcare preferences;
- Your professional situation;
- Your family situation;
- Your income.
Here again, Comparea will help you find the offer that best suits your needs.
In comparison, how does care work with French Assurance Maladie?
By opting for CMU frontalier, you normally have to carry out your care in France. In Switzerland, only emergencies are covered.
Care is provided in France
With CMU frontalier, care received in France is reimbursed under the same conditions and at the same rates as other insured persons. For a consultation with a general practitioner in sector 1 (€25), 70% (€16.5) is reimbursed. The remaining outlay is therefore €8.5.
The treatment takes place in Switzerland
If the treatment takes place in Switzerland, the French Assurance Maladie only very partially covers the costs. This is because medical costs are around 4 times higher in Switzerland than in France: in the Confederation, a consultation with a general practitioner costs €100. With reimbursement based on French rates, the remaining outlay is €83.5.
In the event of an emergency, you can benefit from reimbursement based on your EHIC (European Health Insurance Card).
Can I switch to LAMal if I'm covered by French health insurance?
If you're covered by CMU frontalier (French health insurance), you've exercised your right of option. This is irrevocable: normally, it is therefore not possible to join the LAMal. However, there are exceptions:
- You change your country of residence;
- You switch to pensioner status instead of worker status;
- You resume work in Switzerland after a period of unemployment.
In these situations, you have technically lost and then regained your status as a cross-border commuter. As a result, you can once again exercise your right of option and be covered by Swiss Health Insurance.
Updated on: 01.02.2024Written by Alexis MilonHead of health insurance department at Comparea.To learn more about our team click here.
Frequently Asked Questions
With LAMal for cross-border commuters, you are free to seek medical treatment in France or Switzerland. Also, depending on your income, LAMal frontalier is less expensive than CMU.
With LAMal for cross-border commuters, you are free to seek medical treatment in France or Switzerland. Also, depending on your income, LAMal frontalier is less expensive than CMU.
