since the entry into force of the Agreement on the Free Movement of Persons between Switzerland and the EU, the place of work determines whether you are covered by health insurance.
Cross-border commuters (who live in France, Germany, Italy or Austria in particular and work in Switzerland) have the option right with regard to health insurance. They can choose to be insured under the compulsory health insurance scheme according to the KVG or be exempted from it and choose a different health insurance scheme.
You decide for the KVG EU in Switzerland.
KVG-EU tariff ranking list for 2023* (Adults)
- Vivao Sympany CHF 214.00, service@ sympany.ch
- Provita (Swica) CHF 218.90, novartis@ swica.ch
- KPT CHF 280.00, +41 (0)58 310 91 11
- You choose one of the two German systems (private/statutory) and take out your insurance in Germany.
It is also important to consider and question the insurance situation in retirement age, as well as additional insurances such as supplementary nursing care insurance, eyeglass reimbursements, naturopathic treatment, preventive care or dental prosthesis - through inpatient or outpatient supplementary insurance, you receive benefits that are otherwise reserved for private patients.
Once the cross-border commuter has opted for a health insurance system in the corresponding country, he or she can normally no longer switch to another country's system.
Important to know: Since March 2017, you can only make use of your right of choice or exemption from compulsory insurance once. Once you are exempt from compulsory insurance under the KVG, it is no longer possible to switch back to Swiss insurance.
There are no exceptions for this case. A change in marital status due to marriage, divorce, death or birth of a child are not triggering criteria for a change to Swiss insurance. The attractive option of taking out private insurance in Germany as a single person and switching back to the Swiss statutory health insurance fund when starting a family is thus no longer available.
What happens when you go to the doctor in Germany?
If you are in the German health insurance, there is no difference for you. If you are insured in Switzerland, you will need the EU/EFTA Form 106 prescription.
Based on an intergovernmental agreement on social security, cross-border commuters can also receive benefits at their German place of residence in the event of illness. To do this, the employee must submit the E 106 form confirmed by the Swiss insurance company to a German statutory health insurance fund (Aushilfskasse). The cross-border commuter insured in Switzerland receives another insurance card from this German temporary health insurance fund free of charge.
It is up to you to decide whether you choose the AOK, Techniker, Barmer or another health insurance fund as your temporary health insurance fund. We recommend that you stay with your old health insurance company and only report your status as a cross-border worker under E 106.
One advantage of this option is that there is no deductible and no cost sharing (excess). German doctors and dentists will bill the German statutory transitional health insurance fund directly. This in turn contacts your Swiss health insurance company and has the doctor and treatment costs reimbursed. In principle, you will be treated like a legally insured person in Germany.
The verification of compulsory insurance is regulated on a cantonal basis in Switzerland.
Each canton is responsible for verifying the insurance obligation for its residents or cross-border commuters. The Gemeinsame Einrichtung KVG assumes this task for the cantons of Aargau, Appenzell Ausserrhoden, Basel-Landschaft, Basel-Stadt, Glarus, Uri as well as for the municipalities of Cham, Risch Rotkreuz, Steinhausen and the city of Zug. Request for exemption
*Caution when changing status cross-border commuter to status domicile Switzerland or vice versa!
- Let's assume your current status is "cross-border commuter France or Germany" and you pay e.g. a monthly adult premium at Provita (Swica subsidiary for the cross-border commuter collective) of CH 287.30. In October you plan to give up this status to change to Switzerland, so you change your status from a.) cross-border commuter to b.) status "resident Switzerland".
- Important: Inform your health insurance company, in this example "SWICA", within 3 months from the beginning of the new status. Inform your health insurance company that you would like to have a new offer, e.g. instead of a Provita offer, you would like to have a Swica offer. If you miss this deadline of 3 months, you are "trapped" in the Swiss tariff of Provita for the following year - in this example - and can mean painful premium increases of over 200%! The complexity, has to do with the insured structure (an EU cross-border collective is not the same as a Swiss/Cantonal insured collective!).
- The health insurers are bound by the legal foundations (Art. 35 para. 2 BV) and must observe the other principles of constitutional and administrative law, such as the principle of equality (principle of legality). This means that after missing this deadline, - even with the reasoning "I did not know that" or "I was not told that" - would violate the principle of legality and is therefore legally not heard. As the saying goes, " Lack of knowledge does not protect from punishment".
- Please inform the Novartis Service Center at Swica in good time of your intention to change your status and request the corresponding offer for an internal health insurance change. Or get in touch with us. As you can see - as an immigrant you have to think about a lot of things. We will be happy to assist you with our professional qualifications.
+49 7623 79 90 61
dirk.friedmann @ axa.de