Information on health insurance within EU/EFTA States
In which country should I be insured?
The rules relating to social insurance between the EU/EFTA Member States and Switzerland are governed by the agreement on the freedom of movement of persons concluded between Switzerland and these states. These agreements established coordination of the social insurance systems of these different countries, the main aim being to permit determination of the state responsible in each instance and the coordination procedures.
Within the health insurance framework, the agreement stipulates that the appropriate state is generally the country in which a person is working. A Swiss citizen for example established in France and working in France will therefore be governed by the French health insurance regime.
Specific rules exist for different categories of persons:
Frontier workers
Frontier workers and members of their families who are not in active employment must take out insurance in the country in which the frontier worker pursues a gainful activity. However, in some countries frontier workers and the members of their families who are not in active employment may choose the state in which they wish to have insurance. -> Table
Pensioners
Pensioners benefiting from AVS/AI, accident insurance and occupational benefit pensions must in principle be insured in Switzerland if they do not receive a pension from their country of residence.
If the pensioner receives a pension from his country of residence, he must be insured in that country against illness even if the pension which he draws in the country of residence is less than the Swiss pension.
If the pensioner is domiciled in a country from which he does not receive a pension but receives a Swiss pension and a pension from another EU/EFTA state, he must take out insurance in the country in which he has held insurance for the longest period for retirement pension purposes.
Here too there are some exceptions from the general principle depending on the country.
For instance pensioners living in Germany, France, Italy, Austria or Spain and their non-employed family members affiliated to the health insurance system of their country of residence can be exempted from the insurance obligation in Switzerland (insurance right of option, check Link “overview list of health insurances in the EU”).
In Switzerland, the Common Institution under the Fed. Health Insurance Act (Gemeinsame Einrichtung KVG) scheme is responsible for verifying the affiliation of Swiss pensioners to a Swiss health insurance scheme.
Persons drawing unemployment benefit in Switzerland
These persons have health insurance in Switzerland. As in the previous cases, there may be an opportunity to choose the appropriate state depending on the country of residence. -> table.
Persons who are insured in Switzerland will pay premiums calculated as a function of the country in which they reside. Premium reductions are possible on certain conditions. For further details, please consult the Internet sites indicated in the links.
Where should I obtain healthcare?
Important: the fact of holding Swiss insurance does not necessarily give an entitlement to obtain medical treatment in Switzerland! That choice exists only for frontier workers or for persons insured in Switzerland and residing in the following countries: Austria, Belgium, France, Germany, Hungary, Netherlands.
In all other cases, the principle is set down in the agreement on the freedom of movement of persons with the EU/EFTA Member States which stipulates that persons insured in Switzerland are entitled to obtain healthcare in their country of residence as though they were affiliated to the local social insurance.
If these persons wish to receive medical care in Switzerland or in another EU/EFTA Member State (except if, during a stay in such a country, a person requires medical care to be able to continue the planned stay), they must apply for permission from the liaison body of their country of residence which has sole authority to decide. Generally, permission is granted if the medical care in question figures among the benefits stipulated by the legislation of the member state on whose territory the person concerned resides and if such care cannot, given his present state of health and the probable evolution of the illness, be provided within the time limit normally necessary to obtain the treatment concerned in the member state of residence.
