Frequently asked questions of border commuters

Vivao Sympany AG (“Sympany”) offers the euroline insurance product in accordance with the Federal Law on Sickness Insurance (KVG) to border commuters who work in Switzerland but live in an EU/EFTA country.

The following questions and answers pertain to border commuters who live in France or Germany.

If you live in another country or would like more information, please call: +41 58 262 43 04.

See also: www.kvg.org

Who is a border commuter in Switzerland?

Anybody who works in Switzerland, has their domicile in an EU/EFTA country and returns to their home at least once a week is deemed to be a border commuter.  

Border commuters usually need a border commuter permit (G permit). Swiss citizens who work in Switzerland but live in an EU/EFTA country do not need this permit.

Do border commuters have to take out health insurance in Switzerland or at their place of residence?

Border commuters need to take out health insurance at their place of work, i.e. Switzerland (place of work principle). They can, however, apply for exemption from the obligation to take out insurance in Switzerland by providing proof that they are insured in their country of residence (exercise of the right of choice).

Who else living in Germany or France is obliged to take out insurance in Switzerland?

  • All EU citizens who work in Switzerland and their non-gainfully employed family members who are resident in the EU.
    Special cases for Germany: non-gainfully employed family members do not have to be insured together with the employee. The family members have their own joint right of choice and can take out joint insurance in their country of residence.
  • Persons who live in the EU and draw a Swiss pension or unemployment allowance and their non-gainfully employed family members who do not receive a pension in their country of residence.

Non-gainfully employed family members who must be insured in Switzerland have to take out health insurance from the same health insurer as the border commuter. Family members include spouses, minor children and children who are of age but are entitled to support (the law of the country of residence applies).

 

What exactly is the right of choice?

The right of choice is the right to choose the insurance. This means that border commuters from Germany and France can choose if they wish to take out insurance in Switzerland or in their country of residence. If the right of choice is not exercised within three months of taking up employment in Switzerland, the border commuter is obliged to take out insurance in Switzerland. If the right of choice is exercised, the insurance obligation applies to the country of residence.

Can the right of choice be exercised more than once?

The right of choice can only be exercised once and is irrevocable. There are several circumstances (operative events) that can trigger the right of choice:


Operative events that trigger the right of choice for Germany:

  • taking up employment in Switzerland
  • taking up employment in Switzerland again after a period of unemployment
  • taking up residence in Germany (moving from Switzerland to Germany)
  • changes in marital status (marriage, birth of a child, divorce, death of a spouse) --> if the right of choice has been exercised once and insurance was taken out in Germany, the right of choice cannot be exercised a second time if the marital status changes at a later date.
  • status changes from employee to pensioner


Operative events that trigger the right of choice for France:

  • taking up employment in Switzerland
  • taking up employment in Switzerland again after a period of unemployment
  • taking up residence in France (moving from Switzerland to France)
  • status changes from employee to pensioner


The canton in which a border commuter works is responsible for reviewing and possibly granting a new right of choice rather than the insurance company. In BS, BL, AG, AI and GL, the canton is represented by the Common Institution KVG.

 

What deadlines apply for exemption from the insurance obligation?

The application for exemption must be submitted within three months from the occurrence of the operative event.

How is the right of choice exercised?

An application must be submitted to the canton in which the employee works. Pensioners and border commuters who work in the cantons of BS, BL, AG, AI and GL must submit their application to the Common Institution.

Special case for France: The “Choix du système assurance-maladie applicable” form also has to be completed and must be signed by the competent authorities in France and Switzerland.

 

How does the decision by the Federal Tribunal of 10 March 2015 affect border commuters?

According to the decision by the Federal Tribunal of 10 March 2015, border commuters who did not receive formal exemption from their canton have not been legally exempted from the obligation to take out insurance in Switzerland. As border commuters are therefore actually obliged to take out insurance in Switzerland, they can be insured in accordance with the KVG.

If you wish to be insured under the KVG and have not yet been formally exempted from the insurance obligation by the canton, you need a confirmation from the canton in which you work.

Special case for French border commuters:
Border commuters who have not applied for formal exemption can apply to the competent cantonal office or the Common Institution for exemption from the obligation to take out health insurance in Switzerland from 1 October 2016 to 30 September 2017. If no application for exemption is submitted, the border commuter is obliged to take out insurance in Switzerland.

 

Is Sympany comparable to a “statutory” health insurer in Germany?

Yes – Vivao Sympany AG provides social health insurance in Switzerland in the same way as a statutory health insurer in Germany.

What insurance products does Sympany offer to border commuters who can take out insurance in Switzerland in accordance with the Federal Law on Sickness Insurance (KVG)?

Sympany offers the euroline border commuter product. This social insurance product offers the basic insurance cover required by the KVG in accordance with the bilateral agreements on the free movement of persons between Switzerland and the EU/EFTA. euroline allows customers to receive treatment both in Switzerland in accordance with the KVG benefits list and in their country of residence in accordance with the benefits list legally valid in the country of treatment.

What must I do as a border commuter if I wish to take out euroline?

To be accepted for the euroline product, you have to complete a euroline application together with the applicable supplementary form (for the E form). We also need a copy of your border commuter permit (G). Please give us a call. We would be happy to advise you.

Special case for France: The “Choix du système assurance-maladie applicable” form also has to be completed and must be signed by the competent authorities in France and Switzerland.

 

Where can border commuters obtain medical treatment, and which benefits are paid?

Border commuters and their non-gainfully employed family members can obtain medical treatment in their country of residence as well as in Switzerland, and in an emergency also in a third-party country. When seeking treatment in Switzerland, the benefits list and cost contribution regulations of the compulsory basic health insurance pursuant to the KVG apply. When seeking treatment abroad, the statutory compulsory benefits and cost contribution regulations of the country of residence apply.

What must border commuters remember when drawing benefits?

For medical treatment in Switzerland
If you are insured with Sympany, Sympany is responsible for paying benefits in Switzerland. Always carry your Sympany insurance card with you. You need this card if you go to the doctor or a hospital in Switzerland. You also have to show your Sympany insurance card to the Swiss pharmacy if you use a prescription by a Swiss doctor to buy drugs that are only available on prescription.

For medical treatment abroad
You have to choose a statutory health insurer in Germany or the CMU in France. These health insurers are responsible for benefits and benefit statements in your country of residence. Please submit Form E106 to the statutory health insurer in your country of residence without delay. They will send you an insurance card. Please use this insurance card when you go the doctor in your country of residence so that you qualify for medical benefits according to the prescribed minimum benefits list.

For medical treatment outside of your country of resident and Switzerland
Border commuters are also insured for acute sickness or an emergency abroad (outside of their country of residence and Switzerland). Please show your Sympany insurance card when you request medical treatment. The costs are covered worldwide up to a maximum of twice the KVG rates. In EU countries, the benefits list and cost contribution regulations of the relevant country apply.

What must border commuters do when they no longer work in Switzerland?

If you no longer work in Switzerland or become unemployed and receive unemployment benefits from your country of residence, you are no longer subject to the obligation to be insured in Switzerland. In this case you have to terminate your insurance contract with Sympany from the date on which your employment in Switzerland ends. There is no notice period. Please send Sympany a written notice of termination, citing the reason for the termination. Sympany will terminate your current insurance contract as soon as it receives confirmation of future insurance cover from a health insurer in your country of residence.

What applies to border commuters who retire/when pension payments start?

When border commuters retire, they stop working in Switzerland. Their non-gainfully employed family members now also have to be insured in accordance with the rules that apply in their country of residence. It is only possible to continue your insurance in Switzerland under very limited conditions.

Retirement with Swiss pension only
These pensioners are obliged to take out insurance in Switzerland. When pension payments begin they can exercise a new right of choice and request exemption from the Swiss insurance obligation.

Retirement with pension from country of residence and Switzerland
These pensioners are obliged to take out health insurance in their country of residence. It is not possible to take out KVG insurance in Switzerland.

Retirement with pensions from several countries, but no pension from country of residence
Please contact the competent authorities in one of the countries from where you receive a pension for more information.

  • Switzerland: Common Institution ISL
  • Germany: Deutsche Verbindungsstelle Krankenversicherung Ausland (DVKA)
  • France: Centre des liaisons européennes et internationales de sécurité sociale (CLEISS)

Fragen und Antworten für mondial Versicherte

mondial ist ein Produkt von Sympany Versicherungen AG. Grenzgänger mit Wohnsitz in Deutschland und einer bestehenden mondial Versicherung können sich seit dem Bundesgerichtsentscheid vom 10. März 2015 unter bestimmten Voraussetzungen auch im Produkt euroline von Vivao Sympany AG versichern.

Welche mondial Versicherten mit Wohnsitz in Deutschland können sich auch im Produkt euroline versichern?

Gemäss Bundesgerichtsentscheid vom 10. März 2015 ist ein Grenzgänger nur rechtsgültig von der Versicherungspflicht in der Schweiz befreit, wenn die Befreiung vom Kanton formell vorgenommen wird. Wurden Sie bisher nicht formell vom Kanton von der Versicherungspflicht befreit, können Sie sich mit einer entsprechenden Bestätigung des Arbeitskantons nach KVG versichern.

Sind die Sympany Versicherungen AG und die Vivao Sympany AG vergleichbar mit einem gesetzlichen Krankenversicherer in Deutschland?

Bei Sympany Versicherungen AG handelt es sich um eine Privatversicherung. Sie ist insofern nicht vergleichbar mit einem gesetzlichen Krankenversicherer in Deutschland. Vivao Sympany AG hingegen führt wie ein gesetzlicher Krankenversicherer in Deutschland die soziale Krankenversicherung in der Schweiz durch.

What insurance products does Sympany offer to border commuters who can take out insurance in Switzerland in accordance with the Federal Law on Sickness Insurance (KVG)?

Sympany offers the euroline border commuter product. This social insurance product offers the basic insurance cover required by the KVG in accordance with the bilateral agreements on the free movement of persons between Switzerland and the EU/EFTA. euroline allows customers to receive treatment both in Switzerland in accordance with the KVG benefits list and in their country of residence in accordance with the benefits list legally valid in the country of treatment.

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+41 58 262 43 04

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