Choosing between LAMal and CMU as a cross-border commuter?

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LAMal/CMU comparison

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In 2020, over 340,000 French nationals were working in Switzerland. Among them are frontier workers, who choose to live in France and ply their trade on the other side of the border. If you're in this situation, you know that you have to choose between LAMal and CMU for your health insurance scheme. There are certain points of convergence between the Swiss and French schemes. Differences in rates or coverage generally guide workers.
Comparea reviews the major differences between LAMal and CMU and guides you in your choice.

What is CMU for Swiss cross-border workers?

The acronym CMU stands for Couverture Maladie Universelle. In recent years, it has been replaced by what is known as PUMA: Protection Maladie Universelle. This is a French health insurance scheme, which provides coverage for certain basic healthcare.
In the minds of French people, the CMU frontalier is often limited to the scheme offered to the most destitute. In reality, it also applies to other income categories, and will be offered in particular to people working in Switzerland and living in France. To benefit from the CMU frontalier, you must meet the following conditions:
  • Be a French national, possess or be in the process of applying for a residence permit
  • Not be affiliated to any other Health Insurance scheme
  • You have been writing in France or the French overseas departments for at least 3 months without interruption
  • For a new Swiss border worker, return to France at least once a week.

What is LAMal for Swiss cross-border commuters?

LAMal is a Swiss federal law regulating the basic health insurance scheme, compulsory for all persons residing in Switzerland. This law may also apply to French nationals working in Switzerland or to Swiss pensioners living in France.
The entire Swiss population is therefore subject to LAMal. European workers working or living in Switzerland may also be covered by this scheme. It is important to note that most French workers choose to join the Swiss scheme, which has many advantages over the French system (French social security).
Unlike the CMU, several criteria specific to the LAMal apply, such as the deductible or accident coverage. These criteria should be taken into account when subscribing, to avoid under/over-insurance.

LAMal or CMU frontalier: what is the right of option?

All new Swiss cross-border workers are confronted from their first day of work with what is known as the right of option. It is important to understand this concept, to realize the importance of the choice between LAMal and CMU frontalier.

Definition of the right of option

Switzerland has signed a bilateral agreement with the European Union, concerning the possibility of individuals to circulate on its territory. Among the important information contained in this agreement is the need to be affiliated to a health insurance scheme recognized by Switzerland in order to work or reside there.
The so-called right of option represents the possibility, for a French or European national, to choose his/her health insurance scheme. For a French national, this means choosing between the French system, known as CMU frontalier or PUMA, and the Swiss system known as LAMal.

How long does it take to use the right of option?

A French national working in Switzerland has 3 months to use the right of option and choose his or her insurance between CMU and LAMal frontalier. The deadline runs from the moment the national:
  • Starts work on Swiss territory;
  • Settles in a European Union country and is already working in Switzerland;
  • Retires, without being entitled to a pension in France.

How to declare your choice between CMU and LAMal frontalier?

To be able to declare your choice between LAMal and CMU, the best thing to do is to submit form 726 to CNAMTS (Caisse nationale de l'assurance maladie des travailleurs salariés). This document is also known as the form for choosing the applicable health insurance system.
It is possible to find this document to be completed on the website. The information requested relates to the identity of the French worker. You must also provide information on the professional activity carried out and the Swiss employer.
To ensure that your health insurance scheme is tailored to your needs, you must fill in information about the people making up your household. The document ends with checkboxes for choosing between the Swiss and French health insurance schemes. The steps are therefore fairly straightforward to make this choice, which may have consequences for the quality of your reimbursements or your healthcare budget.

What happens when you don't choose between LAMal and CMU frontalier?

The worker has 3 months to choose between one or the other of these two schemes. Until he uses his right of option, he is automatically affiliated to LAMal frontalier, from the first day of work in Switzerland. LAMal being the basic scheme in Switzerland.
If he does not make a choice, he remains affiliated to the Swiss scheme. Note that in Switzerland, this scheme is managed by different organizations.
It therefore remains essential to complete form 726, in particular so that you are affiliated to the health insurance fund of the canton in which you work. Prices can vary greatly from one company to another. It is therefore in your interest to make your choice, so that you can choose your rates and options.

LAMal or CMU frontalier: can you change your mind?

Whether or not you have made a choice within the 3 months during which you can use the right of option, you will no longer be able to change your Health Insurance scheme.
The only way to change your health insurance scheme is if you have interrupted your work in Switzerland. French nationals must also be able to prove that they were indeed employed in France, or receiving unemployment benefit, during this period of interruption. There are therefore many constraints on reversing the choice of health insurance scheme as a French national.
Choix LAMal ou CMU

CMU or LAMal, the main differences

Here's a list of the strengths and weaknesses of the two frontier health insurance schemes:
Costs The monthly premium depends on your age but is not indexed to your income. The monthly premium is calculated based on your income. If your income increases you will pay more for your CMU.
Access to care Care possible in Switzerland and France Care only in France
Family situation If your spouse has no income in France and you have children, they are not insured. It will therefore be necessary to take out a fronalier LAMal for each child. If your spouse does not receive income in France and you have children, they are automatically insured, at no additional cost.

Common points between LAMal and CMU frontalier

Before we focus on the points that differentiate LAMal insurance from CMU, it's important to stress that the two schemes have many points in common.

Reimbursements for benefits

First of all, these two basic schemes give entitlement to reimbursements. These may, of course, be higher or lower, depending on the medical procedures involved. The fact remains, however, that the member will be issued with a carte vitale, enabling him/her to access coverage for some of his/her healthcare expenses.
As you will have gathered, in terms of operation, there is therefore no fundamental difference between the two systems. A person opting for the Swiss social security system will therefore not be faced with any particular administrative difficulties in obtaining coverage for his or her healthcare.

The need for complementary health care

LAMal and CMU frontalier are basic schemes. Whether you opt for the French or the Swiss scheme, setting up a complementary solution is therefore still a must. For example, you can opt for a mutuelle, to increase the reimbursements you receive for your healthcare expenses.
The advantage of these supplementary plans is that you can choose the cover you need yourself, right from the outset. If you particularly need to be reimbursed for glasses or dental expenses, the best thing to do is to adapt your contract with your chosen private insurance company.

Tax deductions

LAMal and CMU (social security) entitle you to tax deductions. This means that the CMU contribution paid to qualify for one of these basic schemes can be deducted from your taxes. If you choose CMU frontalier, all the contributions paid can be deducted from your tax return. To make this request, simply complete box 6DD of your French tax return.
The same applies to LAMal frontalier contributions, which can be deducted from taxes. Note, however, that the deduction does not apply to any supplementary insurance you may take out in conjunction with the compulsory scheme.

Choosing between LAMal and CMU frontalier: a question of price

The price of affiliation each of these two systems is different. While the Swiss system does not take income into account, the French system is based on reference tax income.

The price of LAMal

The amount of LAMal premiums depends on the worker's age bracket. The calculation is based on three brackets:
  • 0/18-year-olds,
  • 19/25-year-olds,
  • 26-year-olds and over.
The cost is thus fixed and does not depend on the salary received by the worker. As an example, a cross-border worker earning 7,000 francs a month will have to pay 162 francs to be affiliated to LAMal, according to the latest known current rates.

The price of CMU

As for the price of CMU, it is directly indexed to what is known as reference tax income. This is not the income received by the member, but an indicator that takes into account the standard of living of the tax household. According to the latest updates, a person earning CHF 7,000 a month will have to pay CHF 407 a month to be affiliated to the French scheme. As the cost is proportional to income, the more the worker earns, the higher the contributions will be. For example, on a salary of CHF 10,000, the contribution to the "malle" remains at CHF 162 per month, whereas it rises to CHF 727 per month with the CMU frontalier. That's €691 per month.
Beware, however, that price should not be the only selection criterion. Each of the two systems has its own advantages and disadvantages.

Choosing between LAMal and CMU frontalier depending on your career

As a reminder, the choice between CMU and LAMal is irrevocable. When choosing between the two, it's essential to look ahead to the medium and long term, to see how the worker's career is likely to evolve.
Ideally, therefore, you shouldn't base your estimate solely on the salary received at the start of work on Swiss territory. It's also important to take into account any professional developments that may lead to salary increases. As you can see, when the insured chooses CMU (social security), the differences in contribution rates can be very significant.

Choosing between LAMal and CMU frontalier depending on the insured's place of care

The quality of medical care is relatively similar in France and Switzerland. In fact, the facilities available to individuals are quite similar. You should be aware, however, that depending on the plan you choose, you may not receive reimbursement for treatment carried out in Switzerland. If you spend most of your time in this territory, your choice may therefore be guided by this constraint.

Care in France

Whether you choose LAMal or CMU, as a French national, you will be entitled to reimbursements for care in France. All you need to do is present your carte Vitale to a doctor or hospital.

Care in Switzerland

Please note that if you need care in Switzerland, the choice of your basic scheme is absolutely crucial. For the record, the CMU does not entitle you to reimbursements for treatment carried out in Switzerland. This is why most workers, who spend most of their week in Switzerland, use their right of option to choose LAMal.
Care in Switzerland is generally more expensive than in France. For example, you'll have to pay more than €90 for a simple consultation with your GP. So it's important to think about where you might need access to care, before choosing your plan.

Choosing between CMU and LAMal frontalier according to family situation

Finally, your family situation can influence your choice between one or other of these two plans. You should therefore ask yourself what coverage you need for your spouse or your children.

Covering your spouse and children under the CMU

As a French worker in Switzerland, the CMU frontalier automatically covers all your beneficiaries. This means that your spouse and children will be covered by this basic scheme. Please note that for the choice of spouse, you must already be married before choosing the CMU (social security) scheme. If this is not the case, he or she will remain affiliated to the scheme with which he or she was associated before the date of your union.

Spouse and children covered by LAMal

If you choose LAMal, in general, the system only covers you. You will have to choose private insurance, to cover your spouse and children.
Note, moreover, that if a child is born while you are affiliated to LAMal and your spouse is working in France, the child of French nationality will automatically join the French coverage.
Finally, if your spouse is not working in France and is not affiliated to any European scheme, he or she will be taken into account by LAMal. This is the only case in which he or she can join the Swiss basic scheme without working there.
Choix CMU ou LAMal

The evolution of Swiss and French schemes

The very management of Swiss and French insurance is not the same. In France, the cost of the basic scheme has risen steadily in recent years, and is set to continue to do so. In fact, the French system is in deficit, and there is no reason to expect a drop in CMU contributions.
The Swiss system, for its part, has been stable for many years, in terms of contribution costs. In the last two years, contributions have actually fallen. There is, however, a slight increase for 2024. Here too, LAMal seems to be winning the duel between the two systems.

Choosing between LAMal and CMU in brief

If we were to summarize this analysis, in most cases, it remains pertinent to choose LAMal. Indeed, the latter's fixed cost, which does not depend on income, remains very attractive for French nationals.
Furthermore, calling on the Swiss Health Insurance means you can be treated in France, but also on the other side of the border. This means greater flexibility for policyholders, who can seek treatment wherever they choose.

When should you choose CMU?

But then faced with all these arguments in favor of LAMal, it may be pertinent to ask why some people continue to choose CMU. Indeed, reimbursements from these two basic schemes appear to be similar, with differences in rates that can be very significant depending on income.
Most of the time, those who make this choice are those on low incomes. Indeed, below CHF 3,000 per month, contributions will be cheaper than if they had chosen LAMal. The choice of this system therefore lends itself particularly well to part-time contracts.
Furthermore, when the period of work on Swiss territory is short, some French people choose not to affiliate with LAMal for reasons of administrative simplicity. This may also enable the whole family to benefit from the same scheme, when the spouse and children remain affiliated to the CMU. Apart from these cases, the choice of LAMal seems to be an obvious one for many.
We hope this article has been able to help.
Alexis Milon
Updated on: 01.02.2024Written by Alexis MilonHead of health insurance department at Comparea.
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