If you live in Germany and start a job in Basel, Aargau, Schaffhausen, Zurich or Thurgau, your health insurance is decided in the first three months — and, as a rule, for the whole time you work across the border.
The agreement on the free movement of persons lets cross-border workers living in Germany, France, Italy and Austria apply to be exempted from the Swiss insurance obligation, so that they can stay in their country of residence's health system or take out cover there. This is the right of option: Swiss compulsory health insurance, the KVG (LAMal), on one side, German cover on the other.
Three months, and a written application
The LAMal joint institution is plain about the deadline: the right of option must be exercised within three months of the start of employment. The Federal Office of Public Health adds that exercising the option tacitly is not valid. Simply staying with your German fund therefore decides nothing.
The competent authority is the one in the canton where you work. For Basel-Stadt, the canton points to the LAMal joint institution in Olten and requires the application within three months of the start of the cross-border permit; a fee is charged for processing. You send a completed and signed notification form, current proof of health cover in your country of residence and in Switzerland, and proof of your cross-border employment.
A choice that lasts as long as the cross-border work
The choice is irrevocable and applies for the whole of an uninterrupted period of cross-border work. The LAMal joint institution lists what does not reopen the option: a change in your financial circumstances, a different premium level, a change of employer or canton of work, and moving from training or an internship into an employment relationship.
A new right of option arises when your work in Switzerland ends and you therefore become subject to insurance in your country of residence, for example through unemployment, and you later work in Switzerland again. The interruption must be documented in writing. On marriage or the birth of a child, cross-border workers from Germany who are insured in Switzerland can still apply within three months; those already exempted, however, cannot return to the Swiss system.
The separate option right: what is special about Germany
For cross-border workers from Germany, a special arrangement allows the right of option to be exercised separately for family members. So someone who chooses Switzerland can have their family insured in Germany. Family members may only exercise the right as one unit, though: the cross-border worker on one side, the family members together on the other.
If the spouse or a parent works in the country of residence, the choice disappears for the rest of the family: the spouse and the children must then be insured in Germany, and health insurance for the children in Switzerland is not possible.
Where you can be treated
According to the Federal Office of Public Health, people insured in Switzerland who live abroad can be treated in Switzerland and in their country of residence. For treatment in Germany, the LAMal joint institution acts as the assisting body; you register for it with a German fund using your entitlement document.
Staying in the German system does not leave you free in Switzerland: for treatment planned in advance in Switzerland, your German fund's rules apply, and it is worth clarifying them before deciding — especially if you already see a doctor in Switzerland.
What each system costs
Swiss basic insurance is paid per person. For insured people living abroad, the funds calculate a separate premium for each country, and the premium for the country of residence applies, not the one for the canton of work. Your salary plays no part. For a premium reduction, the canton where you work is responsible, and its conditions apply.
On the German side the arithmetic is the other way round. In German statutory health insurance, a voluntary member's contribution is assessed on the member's overall economic capacity, not per head. The German federal health ministry gives for 2026 a general contribution rate of 14.6 per cent, a reduced rate of 14.0 per cent, an average supplementary rate of 2.9 per cent and a contribution assessment ceiling of 5'812.50 euros a month. What that means for you is calculated by your fund — ask before you decide.
What does not depend on your choice
The right of option only concerns health insurance. For the other social insurance schemes, the law of the state where the work is done applies, whatever your place of residence. So you pay AHV/AVS contributions like every employee in Switzerland, occupational pension contributions from the statutory minimum annual salary, and your employer insures you against accidents. You are only covered against non-occupational accidents if you work at least eight hours a week for the same employer.
If you become fully unemployed, the State Secretariat for Economic Affairs says the country of residence is responsible for unemployment benefits. You then register as unemployed in Germany, not in Switzerland.
And tax?
Tax is not the subject of this guide, but it is part of the decision. As a cross-border worker under the double taxation agreement with Germany, your Swiss employer withholds at most 4.5 per cent of gross income at source; for that you need the German certificate of residence, renewed every year. The Federal Tax Administration provides forms Gre-1, Gre-2 and Gre-3 for it.
Anyone who does not return home often enough loses cross-border status and is taxed differently. How many such days are allowed, and how days worked from home count, follows the agreement and the tax authorities' practice; a protocol amending the agreement came into force on 27 November 2025 and has applied since 1 January 2026. Ask the tax administration of your canton of work about your own case.
Before the end of the third month
Timing decides it. Gather early what matters in your case: how many people need insuring and where your spouse works, where you are treated today, the Swiss premium for a residence in Germany, and the contribution your German fund calculates for you. Then send the application in writing, before the deadline runs out.