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Guide

Swiss health insurance: cross-border commuting or moving

Swiss health insurance for doctors: the option for cross-border commuters from Germany and Austria, the three-month deadline, family and accident cover.

14 October 2026

Doctors starting at a Swiss hospital or practice need to settle their health insurance early, whether they move to Switzerland or stay in Germany or Austria. Either way a three-month deadline runs, but it starts on a different day. Whether to commute or move is the subject of a separate article; that the premium does not come off your salary is covered in Swiss salary gross to net. This article concerns your own insurance, not the authorisation to bill health insurance discussed in MEBEKO recognition.

You are insured where you work

For nationals of EU and EFTA states, the Agreement on the Free Movement of Persons and the EFTA Convention tie compulsory insurance to the place of work. Anyone working in Switzerland must in principle be insured there, together with family members not in work (FOPH).

With a cross-border commuter permit G you must be insured from the start of your employment and have three months to join a Swiss insurer (FOPH). Join in time and cover runs back to the start of the obligation; join later and it starts only when you join (KVV, Art. 7(8)).

The option for cross-border commuters from Germany and Austria

If you commute from Germany or Austria, you can be exempted from Swiss compulsory insurance and be insured where you live. To do so, you apply for exemption to the authority responsible in your canton of work within three months of starting work (FOPH). You are exempted only if you show that you are covered for sickness in your country of residence, during stays in another EU state and in Switzerland (KVV, Art. 2(6)).

The choice has to be made expressly. Simply staying insured at home without applying is not a valid exercise of the option, according to a Federal Supreme Court ruling of March 2015 (FOPH).

It is also irrevocable and applies for as long as your cross-border work continues without a break. A change of employer or canton does not reopen it, nor does a change in premiums or in your financial circumstances. For junior doctors this means that moving to another hospital without a break changes nothing. A new option arises only after a break, documented in writing, in which you were compulsorily insured at home, for instance through unemployment (Gemeinsame Einrichtung KVG).

The responsible office differs from canton to canton; in several cantons it is the Gemeinsame Einrichtung KVG, the joint institution under the Health Insurance Act (kvg.org). The full list is published by the FOPH. The joint institution asks for the signed notification form, current proof of cover in your country of residence and in Switzerland, and both sides of your G permit (leaflet). If you are privately insured, your insurer confirms on the notification form that its cover is equivalent to statutory health insurance in your country of residence; check whether it pays for treatment in Switzerland at Swiss rates, or considerable extra costs may follow (notification form).

What the choice means in practice

We make no recommendation, since it turns on family, home and health, but the consequences can be set out.

Insurance in Switzerland. You take out basic insurance with a Swiss insurer, for each person separately; family members in your country of residence who are subject to Swiss insurance are insured with the same insurer as you (KVG, Art. 4a). For insured persons living in the EU there is a separate premium for each country of residence, and only about a third of Swiss insurers offer this cover, some only for particular countries (FOPH); priminfo.admin.ch gives an overview. At home you hand your insurer's S1 certificate to a local health insurer and are then treated as if insured there (FOPH).

Insurance in Germany. When compulsory insurance in Germany ends, statutory health insurance generally continues as voluntary membership (SGB V, section 188). Voluntary members pay the whole contribution themselves (SGB V, section 250) and are compulsorily covered by statutory long-term care insurance (SGB XI, section 20). A Swiss employer pays no employer contribution towards your health insurance, as one statutory insurer notes in its leaflet for cross-border commuters; by its account, free family cover remains in place (leaflet 109). Your insurer can tell you what contribution applies and whether your family stays covered.

Insurance in Austria. The Austrian health insurance fund (ÖGK) names two ways of insuring yourself in Austria (ÖGK). Self-insurance with the ÖGK is recognised as equivalent; with private Austrian insurance, equivalence first has to be checked. Once you are privately insured, you can no longer switch to ÖGK self-insurance as a cross-border commuter; if the private cover ends or is not equivalent, you are assigned to a Swiss insurer again. Self-insurance includes no cash benefits such as sick pay, and depending on your previous cover a six-month waiting period applies (ÖGK, self-insurance).

Family: who is insured where

Family members are a spouse, children up to their 18th birthday and adult children entitled to maintenance (Gemeinsame Einrichtung KVG). If they live in the same country as you and are not in work, your exemption includes them. If your spouse or the other parent works in your country of residence, that person and the children are to be insured there; Swiss health insurance for the children is then not possible (leaflet).

Cross-border commuters from Germany have a separate option for their family. If you choose Switzerland, your non-working family members can be insured in Germany, but only together. If you have chosen Germany, your family members must be insured there too (SVA Zürich, leaflet).

If the family grows later through marriage, birth or adoption and you have been insured in Switzerland so far, as a cross-border commuter from Germany or Austria you can still apply for exemption within three months of the event, with effect back to that date. Anyone already exempted cannot insure new family members in Switzerland (SVA Zürich, leaflet).

Moving to Switzerland: three months from registration

If you move to Switzerland, you must take out insurance within three months of taking up residence; for newborns the period runs from birth (KVG, Art. 3). With a residence permit B or a short-term permit L under the free movement agreement that is valid for at least three months, the period runs from your registration with the residents' office, and if you join in time, cover begins on the day you registered (KVV, Art. 1 and 7).

Retroactive works both ways: the insurer reimburses costs back to the start of cover, and you pay premiums back to that date too. Every family member is insured individually, and in basic insurance insurers must accept everyone without reservations or waiting periods, regardless of age or health (FOPH). You choose your insurer freely (KVG, Art. 4); the calculator on priminfo.admin.ch compares premiums.

Keeping your insurance from Germany or Austria is possible only by exception, on application: if Swiss insurance would clearly worsen your existing cover and, because of age or health, you could take out supplementary insurance to the same extent only on barely affordable terms or not at all (KVV, Art. 2(8)).

If your family stays in Germany or Austria for now, members not in work must in principle also be insured in Switzerland (FOPH). For these two countries an FOPH overview shows a right to choose (FOPH overview); ask the office responsible in your canton of residence about the procedure and the deadline.

Insured persons in modest financial circumstances can receive a premium reduction, even when resident in the EU, from the canton of residence or, for cross-border commuters, the canton of work (FOPH); the cantonal offices are listed via priminfo.admin.ch.

If the deadline passes

Anyone not insured in time is assigned to an insurer by the authority responsible (KVG, Art. 6 and 6a), so you do not choose it yourself (FOPH). For cross-border commuters, SVA Zürich adds that the deductible is not yours to choose either and the premium is owed as under your own contract (SVA Zürich). Cover begins only when you join, you pay for treatment before that yourself, and if the delay is not excusable a premium surcharge is added (FOPH, KVG, Art. 5). After a move it amounts to 30 to 50 per cent of the premium depending on your finances, less in cases of hardship, and is charged for twice the length of the delay, for at most five years (KVV, Art. 8).

Accident insurance through your employer

You are insured against accidents through your employment whether you commute or move, since employees working in Switzerland are covered compulsorily (UVG, Art. 1a). If you work at least eight hours a week for one employer, accidents outside work are covered too (UVV, Art. 13). The employer pays the premium for occupational accidents; the premium for non-occupational accidents is deducted from your salary unless your contract provides something more favourable (UVG, Art. 91).

If you have Swiss health insurance and are fully covered against accidents under the UVG, you can apply to have the accident cover of your health insurance suspended, which lowers the premium. When cover under the UVG ends, for instance during a longer gap between two posts, accidents are covered by the health insurer again (KVG, Art. 8).

Three months, three starting points

For cross-border commuters the period starts with work, after a move with registration, and for new family members with marriage, birth or adoption. When we discuss a specific post with you, we go through these dates before you start. Binding information comes only from the office responsible in your canton of work or residence and from your health insurer.

Sources

All sources are German-language originals and were accessed on 12 October 2026.