Here you will find the answers to questions frequently asked by people who live in France and work as cross-boarders in Switzerland.
- Signing of the French-Swiss agreement concerning health insurance for frontier workers in Switzerland living in France
- Current situation
- Refund of French treatment costs in the event of the CPAM's rejection of form E-106
- Following the Federal Supreme Court judgement 9C_801/2014 of 10 March 2015, I would like to be insured in Switzerland
- I have taken out insurance in Switzerland because of the Federal Supreme Court judgement, but the CPAM is now rejecting form E-106. What do I do now?
- As form E-106 has been rejected, I would like to cancel my insurance in Switzerland again
- As form E-106 has been rejected, I didn't receive a carte vitale and I need to go to the doctor
- Who is classified as a cross-border commuter?
- Do cross-border commuters who work in Switzerland and live in the EU/EFTA have to take out health insurance in Switzerland?
- Employed in several countries – where do I have to take out insurance?
- Must family members of cross-border commuters also take out insurance with Helsana?
- Is there a renewed right to choose the place of health insurance in the event of a change in family circumstances?
- Which cantonal office is responsible for you as a cross-border commuter?
- Can cross-border commuters also take out supplementary insurance with Helsana?
- Where can cross-border commuters obtain medical treatment?
- How does benefits processing work in the case of cross-border commuters?
- What notice periods apply to cross-border commuters?
- Cessation of employment in Switzerland
Signing of the French-Swiss agreement concerning health insurance for frontier workers in Switzerland living in France
As an insurance company we are still waiting for details from the Federal Ministry.
As soon as we know how to proceed, we will let you know.
We thank you for your patience and ask you not to telephone or write to our services since we are unable to answer your questions for the time being.
On the 29th of February 2016 the "Tribunal des Affaires de la Sécurité Sociale de Mulhouse" delivered a verdict in favour of cross-border commuters, a decision which has since been contested. The Colmar appeals court "Cour d'Appel" must now uphold or revoke the verdict/verdicts, provided other "tribunaux des Affaires de la Sécurité" respond to the matter. For this reason there will be no adjustments made to processes (such as reimbursements, online forms etc.) for the moment.
We have informed the Federal Office of Public Health (FOPH) in Bern about the problem of double insurance. FOPH, together with the Federal Social Insurance Office (FSIO) and the French government, are working on a solution on how to proceed in future.
Like you, we are also waiting for more details on this issue and unfortunately cannot give you any further information at this stage. We kindly ask you to please bear with us.
Refund of French treatment costs in the event of the CPAM's rejection of form E-106
Helsana is doing everything it can to find a satisfactory solution.
Invoices – including dental costs – are settled in accordance with French law as far as possible. This means that the co-payment is determined in accordance with French law. Pending matters which have accumulated could be processed, and we are gradually processing received bills. This means that you can soon expect a refund.
If a refund is not possible under French law, however, the costs are assumed under Swiss law pursuant to the KVG, and the Swiss co-payment (annual deductible and excess of 10%) is offset.
In order for us to be able to check your entitlement to a refund, please always send us the original invoices, prescriptions and proof of payment. Refunds cannot be made on the basis of copies.
Please attach a label to each invoice with your insurance number and send the receipts to the following address:
Client Services International KUAF
CH – 8081 Zurich
Following the Federal Supreme Court judgement 9C_801/2014 of 10 March 2015, I would like to be insured in Switzerland
The Federal Supreme Court judgement states that cross-border commuters who have not formally exercised their right to choose an insurer in the past must be insured in Switzerland.
This primarily affects cross-border commuters working in Basel-Stadt and Basel-Landschaft as well as Swiss citizens who have not yet registered as cross-border commuters at the responsible cantonal office in their employer's canton.
If you have previously been privately insured in France, the local obligatory changeover to the state CMU took place on 1 June 2015 at the latest.
However, given the current situation in France, please clarify with your CMU whether you can terminate your CMU membership because of the Swiss Federal Supreme Court judgement. You can only request a quote from us if the CMU confirms that your membership can be terminated – this is to avoid double insurance as the Federal Supreme Court judgement is not binding in France.
I have taken out insurance in Switzerland because of the Federal Supreme Court judgement, but the CPAM is now rejecting form E-106. What do I do now?
This occurs if your former private insurance was transferred over to the state CMU prior to the Federal Supreme Court judgement of March 2015.
The Caisses Primaires d'Assurance-Maladie (CPAM) has received instructions that they must no longer accept form E-106 in such cases.
You have the following options:
- Send a written objection (ideally by registered letter) to the address provided in the rejection letter received from CPAM within 2 months of receiving it.
- You should also send a copy of the rejection letter and the objection to the responsible cantonal office in your employer's canton in Switzerland for their information.
A case of double insurance arising as a result should be reported to the Swiss Federal Office of Public Health (FOPH).
As form E-106 has been rejected, I would like to cancel my insurance in Switzerland again
The Federal Supreme Court ruled that as there is no formal release from the Swiss insurance obligation and that the obligatory KVG minimum in Switzerland remains unchanged.
As soon as the cantonal authorities have received notification of KVG insurance (e.g. receipt of a copy of the KVG policy), the cantonal file is deemed to be closed and it is no longer possible to request retroactive exemption from the Swiss insurance obligation.
It is therefore not possible to be released from the Swiss insurance obligation because form E-106 has been rejected. That would contradict the ruling by the Federal Supreme Court. As a cross-border commuter, you can only lodge an objection in France.
We are aware of the problem of double insurance and have therefore also involved the Federal Office of Public Health (FOPH).
As form E-106 has been rejected, I didn't receive a carte vitale and I need to go to the doctor
If France refuses to register mutual benefits assistance, you can file an objection against this decision.
Since cross-border commuter insurance leaves you free to choose where you want to receive treatment, you can also obtain medical treatment in Switzerland and send the invoice to us.
Who is classified as a cross-border commuter?
Cross-border commuters are people who live in an EU/EFTA country but work in Switzerland and have a cross-border commuter permit (G permit). Swiss citizens do not require a cross-border commuter permit.
Do cross-border commuters who work in Switzerland and live in the EU/EFTA have to take out health insurance in Switzerland?
Under the bilateral agreements between Switzerland and the EU/EFTA states, individuals who obtain cross-border commuter status in Switzerland must as a rule be insured in Switzerland (place of employment principle).
Since 1st of February 2013, cross-border commuters from France have an irrevocable, one-off right to choose where to take out their health insurance within three months of starting work.
This option (exemption from Swiss insurance) allows you to claim exemption from the health insurance obligation in Switzerland if you would like to remain insured in your home country.
Once it has been exercised, the option cannot be revoked as long as you have cross-border commuter status. For this reason, cross-border commuters who are already insured in France can no longer change the country in which they are insured.
Employed in several countries – where do I have to take out insurance?
In the case of multiple employment, your insurance obligations are more complicated.
Please contact our Customer Service International on +41 844 46 84 47 or send an e-mail to firstname.lastname@example.org.
Must family members of cross-border commuters also take out insurance with Helsana?
Yes, provided that neither of the parents is employed, unemployed or receiving a pension in the home country.
If one of the parents is employed, unemployed or receiving a pension in the home country, all children who are not in employment must be/remain insured with this parent in the home country.
Family members are defined as spouses, children under the age of majority and dependent children who have reached the age of majority but are not older than 25.
Please note: Your family members who are not in employment must be insured with you by the same health insurer in Switzerland, with premiums charged per person.
Is there a renewed right to choose the place of health insurance in the event of a change in family circumstances?
For French cross-border commuters, the renewed right of option in the event of a change in family composition (marriage, divorce, death of a spouse, birth of a child) was revoked as of 1 February 2013.
Which cantonal office is responsible for you as a cross-border commuter?
The cantonal office in your employer's canton in Switzerland checks the insurance obligation in Switzerland and is also responsible for you if you want to be released from the insurance obligation.
Can cross-border commuters also take out supplementary insurance with Helsana?
Helsana has developed the "Swiss Package santé" health insurance solution exclusively for cross-border commuters from France.
This is specifically tailored to the needs of French cross-border commuters and includes, in addition to the compulsory health insurance product BASIS, the two supplementary insurance products COMPLETA and HOSPITAL PLUS or HOSPITAL COMFORT.
A further option is to take out DENTAplus supplementary dental insurance.Up
Where can cross-border commuters obtain medical treatment?
Cross-border commuters and their insured family members who are not in employment can choose to obtain medical treatment in accordance with the applicable statutory benefits either in their home country or in Switzerland.
- If you obtain treatment in Switzerland, Swiss law applies, i.e. the benefits catalogue and the co-payment rules in accordance with compulsory basic insurance pursuant to the Health Insurance Act (KVG).
- If the treatment is provided in your home country, the local statutory benefits and co-payment rules apply.
How does benefits processing work in the case of cross-border commuters?
If all the requirements for cross-border commuter insurance in Switzerland have been met, Helsana will send you two E-106 forms for applying for mutual benefits assistance in your home country. To register for mutual benefits assistance, please forward these to your local state health insurer "Caisse Primaire d'Assurance Maladie" (CPAM) in your home department in France.
You will then receive a local insurance card (carte vitale), with which you can claim medical services listed in the statutory benefits catalogue in your home country. When you submit the E-106 forms, you will receive specific instructions on what to do next.
Helsana will also send you a Swiss health insurance card. You can use this card in Swiss pharmacies to make cash-free purchases of medicines prescribed for you by Swiss doctors or when you go to a doctor or hospital in Switzerland. Frequently, the patient is invoiced directly for the cost of the medical or hospital treatment. In this case you have to pay the invoice directly and then send it to Helsana in order to obtain a refund.
As the Helsana insurance card is also a European Health Insurance Card, it gives you cover in the event of acute illness or medical emergencies during a temporary stay in an EU/EFTA country in accordance with the applicable local provisions.Up
What notice periods apply to cross-border commuters?
If you are already insured in Switzerland and would like to switch to another Swiss health insurer, you must comply with the statutory termination dates (31 March and 30 November). The actual change can then take place at the end of the half-year period (either 30 June or 31 December). Please note that your termination must be submitted in writing and must be received by your current insurer by the last working day before the notice period expires.
Cessation of employment in Switzerland
If you cease to have cross-border commuter status in Switzerland and/or become unemployed, you are no longer subject to compulsory health insurance in Switzerland. In this case it is compulsory to terminate your insurance as of the end of your employment in Switzerland without any notice period. To do this, Helsana requires written notice of termination detailing your reasons for doing so and a confirmation from your new health insurer in your home country or your unemployment insurance.
If you retire and cease to work in Switzerland, you may terminate your insurance subject to certain conditions. However, since pensioners may still be subject to compulsory health insurance, we recommend that you obtain expert advice before you retire by calling a specialist at our Customer Service International on +41 844 46 84 47 or send an e-mail to email@example.com.