If you live in Italy and start working in Ticino, Graubünden or Valais, your health insurance is settled in the first three months, and almost always for as long as your job in Switzerland lasts.
Switzerland has agreements with its neighbours, Italy included, that allow EU citizens living there to stay insured in their country of residence. This is the right of option: you can join Swiss compulsory health insurance, the LAMal, or stay with Italy's national health service, the SSN.
Three months, and a formal application
The Federal Office of Public Health is precise about the deadline: the application for exemption from the Swiss insurance obligation must be made within three months of the start of the employment contract. It also points out that in March 2015 the Federal Supreme Court ruled that an option exercised tacitly is not valid. Simply staying registered with your ASL, the local Italian health authority, is therefore not enough.
In Ticino, the competent authority is the Istituto delle assicurazioni sociali (IAS) in Bellinzona. The official form on healthcare cover is part of the application for a G cross-border permit. According to the IAS, if the option is not exercised in time, the cross-border worker is automatically subject to the Swiss insurance obligation.
A choice that lasts as long as the job
The IAS states that the choice made through the right of option remains in force for the whole period of employment in Switzerland. The LAMal joint institution puts it more bluntly: the choice is irrevocable and applies for the whole of an uninterrupted period of cross-border work. Changing employer or canton, rising premiums or a higher income do not reopen the option. An interruption of work, for example a period of unemployment in the country of residence confirmed in writing, can reopen it.
The birth of a child is the other exception, and it has a catch. A cross-border worker insured under the LAMal may then choose Italy within three months of the birth. But the new choice takes effect on the day of the birth, and the Swiss insurer ends the contract the day before: the IAS warns that any costs of the delivery will not be paid by the Swiss health insurer, and advises clearing this with the ASL first.
Where you can be treated
According to the FOPH, people insured in Switzerland who live abroad can be treated both in Switzerland and in their country of residence. A cross-border worker insured under the LAMal can therefore see a doctor near work as well as near home.
To obtain the exemption, a cross-border worker who stays with the SSN must instead show cover both in the country of residence and during a stay in Switzerland. For treatment planned in advance in Switzerland, the Italian system's rules apply; check them with your ASL before choosing, especially if you already see a doctor in Switzerland.
What each system costs
The LAMal is paid per person. For cross-border workers, the FOPH specifies that the premiums for their country of residence apply, not those of the canton where they work; each insurer sets a separate premium for each country. Your salary plays no part in it. LAMal insureds living in the EU on modest incomes can get a premium reduction, and the canton of work is responsible for it: its conditions apply.
On the Italian side, the 2024 budget law introduced a contribution from cross-border workers to the national health service. The implementing decree, published in Italy's Official Gazette on 18 December 2025, leaves it to the regions to set it each year at between 3 and 6 per cent of the net salary received in Switzerland, with a minimum of 30 and a maximum of 200 euros per month worked. It covers residents who work in Switzerland and use the SSN, the "old cross-border workers" as defined in the 2020 tax agreement, and their dependent family members.
When family comes into it
For dependent family members living in Italy, the IAS distinguishes three cases.
- Only one parent works, in Switzerland: the whole family follows that parent's choice. If they stay with Italy, everyone stays with the SSN; if they choose the LAMal, the whole family must be insured in Switzerland, with the same insurer.
- The other parent works or draws a pension in Italy: the children stay insured in Italy. If the cross-border worker chooses the LAMal, they are the only one insured in Switzerland.
- Both parents work in Switzerland: each exercises their own option. If they choose differently, all the children follow the same system, and that choice for the children cannot be changed later.
In Switzerland, every insured person pays their own premium. A whole family under the LAMal therefore does a different calculation from a single person.
What does not depend on your choice
The right of option only concerns health insurance. According to the Federal Department of Foreign Affairs, cross-border workers are generally insured in the country where they work. You therefore pay into the AHV/AVS like any employee in Switzerland, into the second pillar once your annual salary exceeds the entry threshold, set at 22'680 francs since 2025, and you are insured against accidents through your employer. Cover for non-occupational accidents requires at least eight hours of work a week with the same employer.
If you become fully unemployed, the Federal Social Insurance Office states that cross-border workers generally receive benefits in their country of residence, under the rules that apply there.
And tax?
This guide is not about tax, but it is often the next question. Since 1 January 2024, a new agreement between Italy and Switzerland has governed how cross-border workers are taxed. According to the Ticino tax administration, "old cross-border workers", who were already working in Ticino, Graubünden or Valais between 31 December 2018 and 17 July 2023, remain taxed only in Switzerland until they stop working there. New cross-border workers are taxed in Switzerland, at 80 per cent of the ordinary withholding tax, and then in Italy, which takes the Swiss tax into account. Under the agreement, a cross-border worker is someone who lives in a municipality within 20 kilometres of the border and, in principle, returns there every day.
A protocol that came into force on 9 February 2026, applying from 2024, also allows working from home for up to 25 per cent of working time without losing cross-border status.
Before the end of the third month
Timing is everything. Gather early what makes the difference in your case: how many people need insuring and where they work, where you are treated today, the LAMal premium for a residence in Italy, and what your region plans for the health contribution. Then send the application to the IAS, in writing, before the deadline.