Heidi › Cross-border workers
Cross-border workers: LAMal or French cover? The right to choose explained
You have three months from the day you actually start work in Switzerland to choose between Swiss basic health insurance (LAMal) and French health cover (CMU). Once only, for your whole household, and it is final.
If you do nothing, you are put into LAMal automatically, with an insurer you did not pick.
What tips the balance is not the price of a premium, but your family. CMU costs 8% of your taxable income and covers the whole household in one go. LAMal is paid per person, children included, and takes no account of your income.
To choose, once only in your working life across the border
From your first day of work, not from signing the contract.
The CMU contribution rate
On your reference taxable income, after an allowance.
What CMU costs
(reference taxable income − 12,225 €) × 8%
The allowance is 25% of the annual French social security ceiling, which comes to 12,225 € for 2027.
An example. On a reference taxable income of 60,000 €, the contribution is (60,000 − 12,225) × 8% = 3,822 € a year, or about 318 € a month. That amount covers your whole household: partner, children, however many there are.
The basis is your reference taxable income from two years back — for 2027, that means 2025. So it takes in all your income, not just the Swiss salary: rent, your partner's income, investments.
A flat you let out that brings in 6,300 € of taxable income adds roughly 500 € of contribution a year. Plenty of cross-border workers find that line too late.
What LAMal costs
Nothing like it: LAMal takes no account of your income. You pay a premium per insured person, with a free choice of insurer and a deductible you set yourself. Children have their own premium, at a reduced rate.
The direct consequence: a well-paid single person pays little under LAMal and a lot under CMU. A family of four on one salary pays four premiums under LAMal, against a single contribution under CMU.
The two systems side by side
| LAMal (Switzerland) | CMU (France) | |
|---|---|---|
| What it is based on | One premium per person, whatever you earn | 8% of the household's taxable income |
| Children and a partner without a job | Each pays their own premium | Included, at no extra cost |
| Treatment in Switzerland | Yes, as a matter of course | Emergencies only |
| Treatment in France | Yes, once you have registered with the CPAM | Yes, as a matter of course |
| Choice of insurer | Free, and worth comparing every year | None, it is the state scheme |
| Deductible | From 300 to 2,500 CHF, as you choose | No deductible, but costs you have to meet yourself |
| If your income goes up | The premium does not move | The contribution follows |
| Top-up cover | Optional, not much use at the start | All but essential, on top of the 8% |
This is the most widespread belief, and it is wrong. If you choose LAMal, you register with your CPAM using the document your Swiss insurer gives you, and you keep access to treatment in France. You are covered on both sides of the border.
The tipping point
There is no single threshold: it all depends on who is in your household and what you earn beyond your salary. The patterns, though, are clear.
| Your situation | Tends towards | Why |
|---|---|---|
| Single, good salary | LAMal | One premium only, and 8% of a big income costs a lot |
| Couple, two Swiss salaries | LAMal | Two fixed premiums against 8% of two incomes |
| Family, one salary, children | CMU | One contribution covers everyone |
| Partner not working | CMU | They would have to be insured separately under LAMal |
| Substantial rental income | LAMal | It swells the base the 8% is applied to |
| Ongoing treatment in Switzerland | LAMal | CMU only covers Switzerland in an emergency |
The choice cannot be undone and it binds the whole household: you cannot put your partner on CMU and the children on LAMal. A birth, a partner arriving without a job, or a move to part-time work all shift the tipping point — but none of them reopens the right to choose.
Only the end of your cross-border status, losing your job, moving house or going back to France put the question back on the table.
How to exercise the right to choose
-
Fill in the choice form
The form for choosing a health insurance system as a cross-border worker. Attach a copy of your Swiss employment contract and recent proof of address in France.
-
Send it to your CPAM by registered post
The one for the département you live in. The receipt is your proof that you met the three-month deadline — keep it.
-
Tell your Swiss employer
This is the step people forget. Unless you say otherwise, they will sign you up to a LAMal insurer by default, and you will end up with two memberships to untangle.
Do the sum on your reference taxable income, not on your salary. Plenty of people compare the 8% with their Swiss payslip and get it wrong by several hundred euros — in either direction, depending on whether they have left out the rent or their partner's income.
And if you are going for LAMal, compare insurers before the three months are up: once the deadline has passed, the canton picks for you.
The three most common mistakes
- Letting the three months slip by. Saying nothing means LAMal, with an insurer chosen for you and no comparison of premiums at all.
- Counting from the day you signed the contract. The deadline runs from your first day of actual work.
- Believing LAMal cuts off treatment in France. It does not: registering with the CPAM keeps you covered on both sides.
LAMal or CMU for your household?
Heidi's cross-border mode takes your situation and settles it with your own figures.
The questionnaire, the rules that apply to you, the thresholds and the deadlines are free. The figures — net pay, the cascade, the cost of the commute — are in Heidi Plus.
Read next
- Retirement as a cross-border worker: AVS, the second pillar and the second right to choose
- Family allowances for cross-border workers: Switzerland or France?
- What happens to my second pillar when I leave my Swiss job?
- Unemployment as a cross-border worker: where to register, who pays and how much?
- G permit: conditions, going home and changing employer
- Quasi-resident status: who can apply, and by when?
- Who gets my taxes as a cross-border worker: France or Switzerland?
- How much do you take home in Switzerland as a cross-border worker?
- How many days of remote work can I do without losing my cross-border worker status?
- Which deductible should I choose for my Swiss health insurance?
- What does LAMal cover, and what does it not cover?
- B, L or C permit: which one applies to me and how do I get it?
Sources
- The cross-border worker's right to choose: deadline, form and irrevocability
- CMU contribution for cross-border workers: basis, allowance and calculation
- Official form for choosing a health insurance system (Cleiss)
Page written by the Heidi team and updated on 13 November 2026. The CMU allowance follows the annual French social security ceiling and changes every year. Only the CPAM, the Urssaf and the competent cantonal authority decide which scheme you belong to.